Hip hop, like other music genres, is no stranger to drug overdose. The list of dead rappers grows ever-longer: DMX, Juice WRLD, Lil Peep, and many, many more. But what sets the genre apart is the extent to which it talks openly about drug use and its impacts.
“I’m a bit surprised that I’m even still alive,” rapped Mac Miller in 2014, “mixing uppers and downers, practically suicide.” It proved a premonition when the ultra-successful rapper died in 2018 after taking counterfeit pills that contained fentanyl.
As the moral panic of the War on Drugs peaked in the 1990s, most Americans swallowed the rhetoric and enthusiastically supported punitive policies. Hip hop stood in stark defiance. Its open discussion of drugs, among other taboos, riled mainstream (read: white) America.
That makes hip hop and harm reduction natural bedfellows. Because it is much easier to discuss safer use in forums where use itself is already out in the open. Critics have long accused the genre of “glamorizing” drug use. But while hip hop lyrics encompass the allure and pleasures of drugs, they also include desperate insights into racist criminalization, addiction, hopelessness and suicidal ideation.
A tenet of harm reduction is not judging substance use, but trying to reduce the harms associated with it. Hip hop has a decades-long tradition of not judging, but also of experiencing the related harms.
Hip hop duo Atmosphere co-headlined a tour with Cypress Hill—and brought harm reduction along with them.
Despite this, rap concerts have often lacked the kind of harm reduction services one might typically find at raves and days-long music festivals. That’s all changing.
This August, hip hop duo Atmosphere co-headlined a tour with Cypress Hill—and brought harm reduction along with them. The tour spanned the American West, playing 17 shows across 11 states. At 14 of the shows, local harm reductionists staffed a booth to pass out naloxone and fentanyl test strips, and share overdose prevention information.
The program, Beats Overdose Prevention, was designed and implemented by a long-time fan turned harm-reduction-on-tour-coordinator (it’s me, I’m the fan), and supported by the Levenson Foundation and Health in Justice Action Lab. It was first championed by Slug, Atmosphere’s rapper. It was then endorsed by Cypress Hill, who—with the help of trademark songs like “Hits From the Bong”—have been advocating for cannabis destigmatization and reform for nearly 30 years. Beats Overdose Prevention hopes to encourage a broader trend in hip hop and music to include harm reduction messages in lyrics, videos, and at events.
Slug is leading the way. During his set each night, just before playing the cult classic “God’s Bathroom Floor,” he delivered a speech to the audience. In typically lyrical fashion, he subtly and poetically shared harm reduction messages—about looking out for one another, and about the unending tendency for humans to numb their pain. Tens of thousands of people have now heard this live.
Slug with the author in Rad Health Resources shirts at the August 7 show in Houston, Texas
Slug first entered the harm reduction scene in May, with an Instagram post. In the first photo, he is seen wearing a Rad Health Resources T-shirt emblazoned with “Dead People Can’t Recover.” Next, he can be seen holding Narcan, IM naloxone and fentanyl test strips.
The post was met with tens of thousands of likes and a slew of heart-wrenching comments, about everything from loved ones lost to overdose to lives saved by harm reduction. The message resonated with an audience well outside of the bubble that the movement typically inhabits.
This increasing resonance could reflect increasing empathy. Last year was the worst in history for drug overdose in the United States, with over 93,000 people dying. As the magnitude of our overdose crisis swells, so does the number of people directly impacted by loss. What was once dismissively referred to as a plight of “addicts” is now impacting most Americans on a personal level. Tactics of othering and dehumanization flounder when tragedy strikes close to home. The nation is being forced to reconsider its preconceptions.
Overdoses have disproportionately skyrocketed among Black Americans—who also faced many drug-related deaths, and grossly disproportionate criminalization, long before the overdose crisis began dominating headlines.
Illicit fentanyl is ubiquitous in today’s drug supply, a convergence of prohibition and unregulated market forces. Counterfeit pharmaceuticals have stepped in to meet demand after prescribing was rapidly and unscientifically reduced. While heroin itself presents a risk for overdose, above all when combined with substances like alcohol or benzos—and many a musician has succumbed—the risk is exacerbated with fentanyl.
Mac Miller, Prince and Lil Peep all died from what were likely counterfeit pharmaceuticals that contained the highly potent synthetic opioid; fentanyl test strips could have given them lifesaving knowledge of what they were about to take.
In light of this threat, it’s notable how many references to “percs” and “xans” are found in trap music. Trap—in this context I’m referring to the present-day iteration of the hip hop subgenre that favors repetitive vocals and synthesized rhythmic beats—is particularly apt to discuss “pill popping.”
Trap artist Lil Xan, whose stage name literally refers to Xanax, is these days an advocate for benzodiazepine addiction recovery and awareness. While he and other artists advocate for recovery, as Slug’s T-shirt reads, dead people can’t recover. And most drug use does not involve addiction. So there’s a vital role for harm reduction, for artists and fans alike, in keeping people alive during what many are describing as a slaughter—engendered by punitive policies and the prejudices that caused them.
“Many tragedies are avoidable. No one is expendable.”
Along with key resources like fentanyl test strips and naloxone, hip hop’s cultural acceptance of pill usage may itself be protective. While “never use alone” may seem patronizingly out of reach to highly stigmatized injection drug users, consumers of pharmaceuticals (including counterfeit ones) may feel more comfortable abiding by that harm reduction mantra.
The movement that was born as a response to HIV in the 1980s has, understandably, remained significantly focused on injection drug use. Harm reduction organizations are often syringe service programs. While those who inject remain at an elevated risk of overdose and other harms, people who prefer other routes of administration are dying, too. People who do not inject may be less likely to seek out traditional services; some have never even heard of harm reduction.
Polysubstance use, which is commonly mentioned in trap lyrics, is a major driving factor of overdose. Less common—dare I say, absent—are lyrical mentions of safer use strategies. Such references would have the potential to reach millions.
Hip hop, just like harm reduction itself, has a legacy of defiance. The openness with which it discusses drug use is rare in American culture, and the perfect jumping-off point for messaging that could save countless lives. If hip hop can be at the forefront of destigmatizing drug use, it can be at the forefront of safer use and harm reduction, too.
“Harm reduction matters to me because I don’t believe we can afford to lose hungry bright young minds. Many tragedies are avoidable,” Slug stated. “No one is expendable.”
Top photograph of Cypress Hill performing in Montana on August 25: Neubauer Media
Beats Overdose Prevention logo designed by Allison McBride.