This publication, produced by the Big Cities Health Coalition (BCHC) – a forum for the leaders of America’s largest metropolitan health departments, serving 61 million people – presents findings from a 2025 poll of city residents on their views toward overdose prevention strategies. It examines public support for specific harm reduction measures, including naloxone and fentanyl test strip distribution and the availability of overdose prevention centers. The report also analyses messaging that resonates most strongly with the public, such as framing overdose prevention as part of a comprehensive strategy, a bridge to recovery, and a means of saving lives. It provides recommendations for strengthening support among residents and policymakers, highlighting the role of personal stories in increasing understanding and acceptance.