"Either way, they will use. And so, probably, would you:" A critical discourse analysis of harm reduction portrayal in United States opinion news media

Background: Opioid overdose deaths are declining in the United States for the first time in over five years. These reductions are partially attributed to increasing availability of harm reduction services, but services remain poorly implemented. The framing of issues in news media shapes public sentiment and uptake of services in policy and practice. The aims of this study were to: (1) content analyze United States opinion news media to describe overall attitudes towards and stigmatizing language about harm reduction; and (2) critically analyze discourses underlying articles with respect to stigma and harm reduction support. Methods: Thirty-nine opinion articles across 17 United States newspapers on harm reduction published between May 2023 and April 2024 were included. Targeted analyzed content included attitudes toward harm reduction and stigmatizing language. Results: Most articles had positive attitudes (32/39; 82.1 %), only 5/39 articles (12.8 %) were negative; two were balanced. Over half (22/39; 56.4 %) included stigmatizing language. Critical discourse analysis revealed pro-harm reduction articles were tied together by several threads: harm reduction strategies are evidence-based, do not increase crime, decrease stigma and systemic oppression, and policy change is needed to improve implementation. Among anti-harm reduction articles, discourses included: discriminatory stereotypes to portray opioid use and harm reduction depicted as enabling substance use, equating opioid use with crime, and dismissing systemic injustices influenced by punitive drug policy. Conclusions: Contemporary United States opinion news media predominantly presents pro-harm reduction discourse, but often use stigmatizing language.