When Boots-on-the-Ground Meets Policy Hell

This week, Steve sits down with Nathan "Narcan Nate" Smiddy, a fellow traveler from the rooms who went from small-town Tennessee addict to one of the most respected harm reduction advocates on the West Coast. Nate's story cuts deep—from growing up in a cop family in Jellico to chasing that first devastating high, to finding his calling keeping people alive on the streets of San Diego. He doesn't sugarcoat the reality: people use meth to stay awake and safe on dangerous streets, they lose their cars to $600 parking tickets while living in them, and the system is designed to punish rather than heal. But Nate shows up anyway, carrying Narcan, treating wounds, and testing drug supplies because he knows that staying alive is the first step toward getting better.

The Fight Gets Harder Under Trump's New Order

Just as harm reduction efforts were starting to show real results—national overdose deaths finally dropping in 2023—Trump's new executive order threatens to drag us back to the failed "tough love" approach of the 1980s. Nate breaks down how the administration plans to gut funding for evidence-based programs, reward cities for criminalizing homelessness, and push people toward RFK Jr.'s dystopian farm camps instead of proven treatments like MAT. It's the same old story: politicians who've never lived it making moral judgments about medical problems. But as Nate says, this isn't the time to back down—it's time to get louder, show up at city council meetings, and take care of our own communities the way harm reduction activists have been doing since the beginning.

Resources:

https://nextdistro.org/

https://metrodrug.org/

https://www.hellbenderharmreduction.org/

https://www.asapofanderson.org/