Algorithmic Doors to Community and the Trap of Visibility: TikTok for Harm Reduction Activism in the U.S. Overdose Crisis

Opioid-related overdose death continues to be a public health crisis in the United States, reaching a new peak in 2021 with more than 100,000 people dying of drug overdose; 75% of these deaths involved an opioid. Naloxone, often known by the brand name Narcan®, can be easily administered to prevent opioid overdose death. While naloxone is a central harm reduction tool, it has generated controversy as discussions of its use have been framed by longstanding stigmas associated with drug use. Critics have framed it as a “moral hazard” that encourages drug use, stigmatizing its distribution and uptake. Harm reductionists have responded by countering misinformation about drug use and harm reduction and humanizing people who use drugs. Social media platforms have become key sites for these debates. These are digital social spaces in which individuals may fuel stigma and/or build community with others by enacting identities, exchanging knowledge, and bonding over shared experiences. TikTok, a video-based platform, has become an active space for community-building around harm reduction. This article examines the experiences of people who post about naloxone on TikTok. We draw on thematic analyses of semistructured, open-ended interviews with 13 TikTok users who tagged posts with #naloxonesaveslives or #narcansaveslives hashtags from June 2020 to April 2023. Specifically, we explore how these individuals understand and leverage TikTok's association, creative, and interactive affordances as “doors” to build harm reduction community and to educate others about drug use and harm reduction. We also explore how they navigate the “traps” of visibility on TikTok that pose challenges to using the platform for harm reduction activism: stigma, burnout, mental distress, and digital silencing. Finally, we consider the implications of our findings for future research and practice related to digital harm reduction activism.