Harm reduction is a public health approach that emphasizes reducing the negative effects of drug use rather than eliminating it. It has been practiced for decades; however, the COVID-19 pandemic poses new challenges for people who use drugs (PWUD) and harm reduction providers. In the United States, public health recommendations to curb the pandemic are complicating harm reduction efforts. Harm reduction programs are rethinking how they engage with PWUD to comply with these recommendations while also providing essential services. In this article, we draw on academic literature, news articles, and information distributed by harm reduction programs to discuss issues currently faced by PWUD and harm reduction providers across the country. This discussion focuses on policy changes and programming adaptations related to three harm reduction interventions—syringe services programs, overdose prevention, and medications for opioid use disorder—that have emerged or gained traction during the pandemic. We argue that anthropologists should play a key role in addressing the obstacles and opportunities for harm reduction in the United States during and post-pandemic. Ethnographic research can generate important knowledge of how pandemic-related service and policy changes are localized by providers and experienced by PWUD and uncover how race, class, and gender may shape access to and experiences with modified harm reduction services. Applied anthropologists also have an important role in collaborating with harm reduction programs to ensure that the voices of marginalized individuals are not ignored as policy and programming changes take place during and after the pandemic.

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