This project is about harm reduction, a practice invented to help people who use drugs (PWUDs) use them more safely, as well as live healthier, happier lives. Things PWUDs need are identified effectively because they are directly involved in decision-making. The practice is a critical community-based service that humanizes people. To conduct my research, I volunteered at 4 different harm reduction programs (HRPs) in the United States, spoke with an advocate from the National Harm Reduction Coalition, a nationwide advocacy organization for people who use drugs and conducted online and archival research. This thesis project demonstrates that HRPs face several struggles, including the erasure of their sacrifices and history, lack of institutional recognition, difficulty in accessing funding resources, and issues with the recognition of their effectiveness. The project is critical because HRPs – especially those serving people using intravenous drugs and providing drug paraphernalia – undertake an important service that saves lives. My ethnography demonstrates how these struggles are closely interconnected, and thus, to combat them, I suggest broadening the measures of success to not just include scientific efficacy but also community-based effectiveness. This shift will better capture the on-the-ground care people give to those who may be considered undeserving under scientific and legal regimes. This recognition highlights the important work HRPs do for their communities, which may in turn increase institutional recognition, funding security, and the ability for their history to be recorded.