The History of Injecting, Part Four: The Damage Done
Since 2001, almost as many Americans have died of drug overdose as have died in every war the United States has ever fought, combined.
That’s over a million lives, almost equaling the 1.3 million American soldiers lost from the Revolutionary War to Afghanistan and Iraq.
Not all those overdose deaths came from injecting. Pills, powders, patches, there are a thousand ways for drug use to go wrong, especially when drug companies deliberately mislead the public and bribe doctors to hand out prescriptions for drugs they know are dangerous.
In the 1990s, Purdue Pharma promised a revolution in pain relief and sold the nation a lie. OxyContin was marketed as modern, safe, and a cure for pain without risk. Doctors were trained to prescribe it freely, addiction risks were buried, and sales bonuses flowed. Hundreds of thousands followed their doctors’ advice straight into addiction. Desperation led to familiar territory: pills were crushed, snorted, injected. Families fell apart, towns collapsed, and rural America drowned in a flood of prescription dope.
The Sackler family, owners of Purdue, laundered their reputation through philanthropy. They funded art galleries, museums, and university wings, The Metropolitan Museum of Art, The Smithsonian, The British Museum, The Louvre, were among many that received money from the Sackler’s and have since removed the family’s name from their buildings.
Serpentine Gallery, formerly Serpentine Sackler Gallery. Courtesy of Wikimedia Commons/Geographer
By the time outrage caught up, the damage was done - half a million dead, millions addicted, and an empire built on pain. Within a decade, the nation that had once declared a war on drugs had built an economy on them. To fend off the horror of withdrawal, people reached for whatever they could get; heroin, fentanyl, and many who had never injected, turned to the syringe as their tolerance grew. The overdoses soared.
In Australia, harm reduction had proven that compassion works. Needle and syringe programs, once dismissed as radical, curbed the spread of HIV, and saved thousands of lives. Between 2000 and 2009, every dollar the Australian government spent on harm reduction returned around four dollars in healthcare savings and prevented an estimated 25,000 HIV infections and 21,000 hepatitis C cases. Today, that return is thought to be closer to $5.50 for every dollar spent, along with countless lives saved and futures restored. Over the past 25 years, Australians have grown steadily more supportive of needle and syringe programs. Once controversial, they’re now recognised as a practical health measure, proof that compassion pays. Where America turned pain into profit, Australia turned empathy into policy.
And then, a new threat from an old source appeared. After the US had spent twenty years and billions of dollars trying to wipe out Afghanistan’s opium trade, the Taliban did what they could not - they banned poppy cultivation. Farmers who planted poppies faced their crops being torched and their families punished under Sharia law. The West celebrated, but in truth, it made the drug trade deadlier.
Before the ban, Afghanistan grew 80% of the world’s opium. Within a year, cultivation collapsed by 95%, from 233,000 hectares to just over 10,000. Afghan chemists didn’t stop when the poppies burned. Ephedra grows wild in the mountains, and from it they made meth. Labs don’t need land, just secrecy.
Poppy crop being destroyed in Afghanistan
Then came the nitazines, synthetic opioids stronger than fentanyl, often invisible to test strips and lethal in a single dose. No crops, no harvests, just chemistry feeding demand. Now nitazines are showing up in heroin, cocaine, MDMA, GHB, fake pills. And the syringe endures.
In 2023–24, Australia’s Needle and Syringe Programs gave out 54.6 million syringes through 4,442 sites, an average of about 749 per injector per year. The most recent U.S. estimate, from 2018, counted 3.7 million people who inject. If they injected at the same rate, and every syringe was clean and single use, they would need 2.77 billion syringes each year. The numbers sound impossible, but they don’t lie.
Australia now has two Medically Supervised Injecting Rooms (MSIRs); one in Sydney and one in Melbourne. In Europe there are dozens of drug consumption rooms. The Netherlands has 31 in 25 cities. Germany has twenty-five. They’re in Switzerland, Denmark, Norway, France, Belgium, Portugal, and Spain. There are over thirty drug consumption rooms in Canada, and New York City has two.
The Medically Supervised Injection Centre in Sydney
Across the US, drug laws remain inconsistent and access to harm reduction services sporadic. Federal law still criminalises most drug possession, while state and local policies vary widely, creating deep inconsistencies. Some states have decriminalised certain drugs; others impose harsh sentences for simple possession. Black and Latino drug users continue to face harsher penalties than white users for the same offences.
The patchwork of state approaches, from public health models to carceral punishment, has produced a fractured national response. The absence of a unified drug policy fuels the crisis, creating confusion, wasting resources, and undermining proven public health strategies. Law enforcement and health responses operate in isolation, slowing any chance of real progress.
And yet, something is shifting. Where the government fails, communities look after each other. The fentanyl crisis in the US is changing how people use drugs. Fentanyl’s strength and unpredictability make every shot a gamble, and more people are turning to smoking instead of injecting. Pipes and foil, not syringes, are becoming the tools of survival.
It isn’t a revolution, and it isn’t clean. It’s harm reduction by necessity, born in the same streets the system abandoned. For some, it’s the difference between life and death. For others, it’s just the next adaptation in a war that was never theirs to win.
The syringe began as a tool of mercy. Then it became a symbol in a war that never ended. Medical, moral, and financial empires rose around it. The drugs changed, the chemistry evolved, but the syringe was always there.
And yet, even now, in alleyways and MSIRs, in living rooms and kitchens, the syringe endures. Not as a symbol of failure, but as a measure of how far compassion still has to go.