My thesis is an ethnography of the harm reduction staff of the syringe exchange program (SEP) of Prevention Point Philadelphia (PPP) during a period of six months between 2011 and 2012. Using interviews, participant observation, and secondary research, the thesis examines how the political dimensions of a now institutionally recognized, albeit controversial public health strategy have adapted to new structural constraints by contextualizing the movement’s trajectory through the perspective of individuals involved in the organization. Profiling the current staff of the SEP facilitates an exploration of the radical political heritage of harm reduction internationally, nationally, and in Philadelphia. The incorporation of harm reduction into a neoliberal public health framework resulted in an uneasy and ongoing transition characterized by a tension between principles and practices that site workers embody. I draw on Foucault’s concept of biopower as a means of critiquing the disciplinary effects of institutionalized harm reduction practices, while using Mbembe’s concept of necropolitics to theorize the precarious state of PPP. I suggest that a return to the radical politics of its genesis provides an avenue of resistance to the more repressive consequences of a biopolitical and necropolitical public health system.