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The U.S. drug crisis has never been worse. Last year, the U.S. passed another grim milestone, with a record 108,000 Americans dying from overdose deaths and many more suffering from addiction. Despite an unprecedented amount of money and attention, the death toll from drug overdoses continues to rise at an alarming rate. Amid the worsening crisis, policymakers have proposed a range of bold new strategies to help reverse the rising tide. Desperate times, as they say, call for desperate measures.
Among these is a set of controversial harm reduction practices designed to stave off some of the worst outcomes of chronic drug use, including overdose deaths. The idea behind harm reduction is that some people are unable or unwilling to abstain from using drugs, and so we should aim to keep them as safe as possible, for example by providing drug test strips to detect the presence of potentially fatal substances like fentanyl, widespread distribution of the overdose-reversing drug naloxone and clean needles to prevent the spread of diseases like hepatitis C and HIV.
Beyond these common-sense steps, some harm reduction advocates have called for more drug consumption sites—that is, facilities purpose-built for users to take drugs under supervision. Support for these facilities, sometimes called "safe consumption sites," has grown in the U.S. and around the world. Earlier this year, two new facilities opened in New York, and for months, city officials in San Francisco have been quietly operating a consumption site in the infamous Tenderloin District. Meanwhile, policymakers in Scotland, which has among the highest rates of drug addiction and has long been known as the "sick man" of Europe, are debating whether to permit consumption sites to address a rise in overdose deaths.
For all their presumed advantages, drug consumption sites also pose several ethical and practical concerns. In the first place, they perpetuate drug addiction—although treatment options are often available, most users visit these facilities to use drugs, not to stop using. And while they may help prevent sudden overdose deaths—the two centers in New York reportedly reversed 280 overdoses since opening—they do little to prevent the slow death of drug addiction.
It's also unclear how many drug users actually use these facilities and how frequently. According to OnPoint NYC, the organization that operates the New York facilities, there have been 1,100 visitors and over 17,000 visits since they opened. This is not an insignificant amount, but likely represents a small proportion of drug users across the city. Indeed, the limited number of drug consumption sites and their locations in the inner city make it impractical for many people to use them. Most people are unlikely to travel great distances—if at all—to use drugs.
Then there's the issue of supply. Users are required to bring their own drugs to these consumption sites, which promotes drug trafficking and other criminal activity. And the drugs themselves are increasingly dangerous, with extremely potent and addictive drugs like fentanyl contaminating the illicit drug supply and driving up the death rate.
The fact is, drug consumption sites are not a panacea, and an inordinate amount of time and money has been spent litigating their utility rather than implementing more effective and cheaper policies. We know, for example, that naloxone is incredibly effective at reversing opioid overdoses, one of the primary purposes of drug consumption sites. Policymakers should promptly remove any barriers to accessing naloxone and make it as widely available as possible. And rather than continuing to invest in drug consumption sites, authorities should instead fund more "street teams" of social workers and medical professionals to assist drug users in the places they are most likely to use—to quite literally "meet them where they are." Many organizations already perform these services; we should support and expand them.
And let's not forget, the U.S. already has a regime to provide medication-assisted treatments for substance use disorders—including FDA-approved drugs such as methadone, buprenorphine and naltrexone—which are clinically proven to suppress and reduce cravings for opioids and block their effects. They are dispensed by medical professionals—so users know what they're getting—and are shown to be effective in improving patient survival, increasing treatment retention, decreasing illicit drug use and other criminal activity and increasing users' ability to gain and maintain employment.
The American drug crisis remains a serious, intractable problem and harm reduction practices are at least part of the solution, along with other drug control policies focused on treatment, supply reduction, and demand reduction and prevention. But as U.S. policymakers consider these different approaches, they must ensure they adopt smart, effective, compassionate policies that don't just save lives, but enhance them. Americans—including the "least of us"—deserve nothing less.
Jim Crotty is an associate vice president at The Cohen Group, a strategic advisory firm in Washington, D.C., and the former deputy chief of staff at the U.S. Drug Enforcement Administration. The views stated in this article are his own.
The views expressed in this article are the writer's own.
