Naloxone is one of the harm reduction methods that’s gained more widespread acceptance in the United States. The medication reverses deadly overdoses caused by opioids such as fentanyl and heroin.

Every time Shani Damron, 34, buys methamphetamines or heroin on the streets of Huntington, W.Va., she knows the risk is extreme.

“That fentanyl is no joke,” Damron said, referring to the deadly synthetic opioid that now contaminates much of the illegal drug supply in the United States. “Every time we stick a needle in our arm, we’re taking a 50-50 chance. We could die.”

There’s also a high risk of disease from contaminated needles shared by drug users. Damron’s community has seen a major HIV/AIDS outbreak.

“I don’t know if I have any friends that’s not positive for HIV,” she said. “Every one of us are. I am, too.”

Harm reduction advocates say these outcomes for Americans struggling with addiction are avoidable.

Louise Vincent runs a program in Greensboro, N.C., where people can get clean needles and test street drugs for contamination. These services help keep people safer, she said, but they’re banned in much of the country.

“You know I guess we have to decide, as a community and as a society, is it OK to just let people who use drugs die? Is that really something we’re comfortable with?” Vincent asked.