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Abstract
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... I love guns.
But in addition to being a gun owner, hunter, and native North Dakotan, I'm a physician who practices in the heart of Baltimore and has studied public health policy. I know how central gun ownership is to wide swaths of America, and I know the devastating impact of our lack of gun regulation. These realities need not be at odds. By partnering with gun owners and embracing the public health principle of harm reduction, we can craft a safer Second Amendment.
Harm reduction, a strategy of making gun use safer within the bounds set by our culture and courts, starts by recognizing that gun ownership across America is here to stay. An estimated 30% of Americans own a gun, and most grew up around them (1). Since our nation's inception, gun ownership has been cherished, and in District of Columbia v. Heller and more recently in NYSRPA v. Bruen, the Supreme Court affirmed it as a constitutional right (2, 3).
However, both Bruen and Heller maintain that gun rights can be regulated (2, 3), and the history of public health tells us that regulation allows for harm reduction. Without banning cars, we reduced motor vehicle deaths per vehicle mile by 90%, simply by making the cars, roads, drivers, and conditions safer (4). Hundreds of Americans are saved from an opioid overdose daily thanks to the reversal agent naloxone. Condoms and clean needles have spared millions from HIV, viral hepatitis, syphilis, and other infections. Countless heart attacks have been prevented by utilizing cholesterol-lowering statin medications, regardless of a patient's willingness to change their lifestyle.
Harm reduction can work against gun violence, too. In fact, it already has. In response to Prohibition-era gang violence, machine guns and sawed-off shotguns were strictly regulated. They remain so today. More recently, we've expanded background checks, though not universally. We temporarily limited magazine capacities and banned assault weapons, but unfortunately we let those laws lapse--and, partly as a result, we are seeing an unconscionable increase in mass shootings (5).
At the state level, there are even more impressive examples of harm-reducing regulations. Since the 1990s, California has passed a series of sensible gun laws--under both Republican and Democratic governors--that have transformed the state from one of the worst to one of the best in terms of gun safety (6). Almost all of California's efforts have been upheld in court...
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