What is Harm Reduction?
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines harm reduction as “an evidence-based approach that is critical to engaging with people who use drugs and equipping them with life-saving tools and information to create positive change in their lives and potentially save their lives”.
Harm reduction is grounded in compassion, dignity, and evidence and saves lives by meeting people where they are, offering tools such as:
- Free Narcan (naloxone kits)
- Fentanyl test strips
- Syringe programs
- Harm reduction vending machines
While national overdose deaths among people ages 10–34 dropped by over 37% from 2023 to 2024, the work is far from over.
Top 15 U.S. States for Harm Reduction Access
California ranks #1 for the state with the best harm reduction resources
With 67 syringe service programs, widespread naloxone availability, and more than $65 million in funding, California continues to lead the country in harm reduction. State-supported vending machines and mail-order naloxone initiatives expand access even further, particularly in rural and low-income areas.
Kentucky is the #2 state for harm reduction access
Kentucky stands out for its high naloxone distribution rate (1.3 per 100 people) and robust network of 38 syringe service programs. Harm reduction vending machines are available across multiple counties, and the state has made targeted investments to address overdose rates in both urban and Appalachian communities.
Michigan is the #3 state for harm reduction access
Michigan has prioritized harm reduction through both policy and investment, distributing naloxone at one of the highest per capita rates in the country. With 30 syringe service programs and over $14 million allocated, the state continues to expand access to essential services, often in partnership with local health departments and recovery organizations.
Missouri’s Harm Reduction Efforts
While Missouri didn’t make the list this year, there are steps being taken to close this gap.
Recently, St. Louis County launched a campaign called “I Carry for My Community,” installing 44 free naloxone vending machines across the county in areas with high overdose rates. These machines are stocked with Narcan nasal spray and available to anyone, no questions asked. Click here to see where the initial vending machines are located.
Statewide, Missouri has made progress by legalizing fentanyl test strips in 2023, expanding mail-order naloxone programs, and supporting community-led outreach.
Click here to see where you can get free Narcan in Missouri
Key efforts include:
- 44 naloxone vending machines launched in St. Louis County (2025)
- Legalization of fentanyl test strips statewide (2023)
- Free naloxone access via mail, vending, and clinics
- Peer-led overdose outreach and education
- Ongoing efforts to legalize syringe exchange programs
These efforts show that harm reduction is gaining momentum in Missouri, even if there’s still progress to be made. We hope to see Missouri on the list in 2026.
In the meantime, local resources like Sana Lake are here to help. If you or someone you love is struggling with substance use, we offer compassionate, evidence-based care right here in Missouri. Explore our levels of care, or reach out today.
Methodology
We ranked the U.S. states with the most accessible harm reduction resources by analyzing the number of harm reduction vending machines, statewide naloxone access (whether or not it’s available without a prescription), number of syringe service programs, amount of harm reduction funding each state receives, and search interest for terms such as ‘free harm reduction kit by mail’ and ‘harm reduction resources near me’ in each state.
References
Harm reduction. SAMHSA. (n.d.). https://www.samhsa.gov/substance-use/harm-reduction
Howard, J. (2024, May 9). How Vending Machines help states battle the opioid crisis: “you don’t know when you’re going to need these products.” CNN. https://www.cnn.com/2024/02/22/health/oklahoma-narcan-vending-machines
Mann, B. (2025, June 10). Drug deaths plummet among young Americans as Fentanyl Carnage eases. NPR. https://www.npr.org/2025/06/10/nx-s1-5414476/fentanyl-gen-z-drug-overdose-deaths
St. Louis Public Radio | By Olivia Mizelle. (2025, July 21). St. Louis County debuts naloxone vending machines. STLPR. https://www.stlpr.org/health-science-environment/2025-07-16/st-louis-county-debuts-naloxone-narcan-vending-machines
Where to get Naloxone. NoMoDeaths. (n.d.). https://www.nomodeaths.com/where-to-get-naloxone
