“Harm reduction” interventions for substance use – measures like needle exchange programs and methadone distribution that aim to reduce the adverse effects of substance use, rather than punish or prevent it – have been repeatedly shown to lower the risk of overdoses, mortality, and drug-related crime. But in many communities in rural America, there is a stigma attached to these approaches. Consequently, policymakers and health professionals in some communities have hesitated to implement or recommend harm reduction measures, fearing backlash.
But does support for comprehensive drug policies, including harm reduction, actually erode the public’s trust in local government?
A team of psychologists at the University of Pennsylvania’s Annenberg Public Policy Center (APPC) and the Social Action Lab aimed to answer this question empirically, by examining the relationship between harm reduction policies and citizens’ belief that their government is competent and has their best interests at heart. In a recently published paper, postdoctoral research associate Xi Liu of the Social Action Lab, research associate professor Man-Pui Sally Chan of the Annenberg School, and Penn PIK Professor Dolores Albarracín, director of APPC’s Communication Science Division and director of the Social Action Lab, report that trust in local government is positively associated with perceptions of governmental support for comprehensive drug policies. The paper is part of the Grid for the Reduction of Vulnerability project, which is funded by the National Institute on Drug Abuse.
“Comprehensive drug policies increase trust in local government: An analysis of authorities’ and residents’ perspectives in rural US Appalachian and Midwestern counties” begins by flipping a common premise on its head: instead of concerning itself with how trust in government influences policy support, it asks how policy choices might influence trust in government. The researchers surveyed authorities and residents in Appalachian and Midwestern counties of states vulnerable to the spread of HIV and hepatitis C, comparing leaders’ estimation of community trust in local government and residents’ actual trust in local government, and also analyzing trust as a function of perceived governmental support for comprehensive substance use policies – those that include harm reduction. They also conducted an experiment to test the effects of perceived government support for comprehensive drug policies on trust, and possible causes of those effects.
Data from the field surveys showed a clear positive association between the perception of governmental support for comprehensive drug policies and trust in the local government, both as assessed by the community authorities and as self-reported by the community residents.
In the experiment, participants were randomly assigned a role of either mayor or resident of a rural Appalachian town and given information about whether residents considered the local government to be supportive of harm reduction and substance use reduction policies. Then, they were asked to estimate the level of trust that community residents have in their local government. Once again, the researchers found evidence that support for comprehensive drug policies increases trust in local government, both among participants assigned to play authorities and those assigned to play residents, and regardless of political ideology. They also found evidence that this was because comprehensive drug policies enhanced perceptions of governmental effort, and engendered optimism about future improvement of drug-related issues.
“Our findings highlight the nuanced perceptions of comprehensive drug policy within Appalachian and Midwestern communities,” said Liu, the lead author. “Despite concerns that harm reduction policies might inadvertently promote drug use, residents trust local authorities more when the authorities promote these policies. These insights should alleviate the common fears of policymakers that prevent these life-saving policies from being implemented in their local communities.”
“Comprehensive drug policies increase trust in local government: an analysis of authorities’ and residents’ perspectives in rural US Appalachian and Midwestern counties” by Xi Liu, Sally Man-pui Chan, and Dolores Albarracín was published in the Harm Reduction Journal on March 17, 2025. DOI: https://doi.org/10.1186/s12954-024-01148-x.
