Drug Policies Need Shot of Humanity, Common Sense
Overdose deaths are on the rise, with 2019 fatalities in the U.S. reaching a record high. Sadly, 2020 will be worse. Getting hit with COVID-19 before we had a grasp of the way out, challenged every aspect of medical care, diminishing, if not decimating, already scant services for those suffering from addiction.
Even though overdose fatalities have quadrupled in the last decade, we continue to fumble with comprehensive drug policy reform, a failure that leaves so many harms in its wake: mass incarceration, loss of productivity, homelessness, and the spread of infectious diseases such as HIV and hepatitis.
When we get it through our heads that addiction is a medical condition, rather than a crime, we can focus on real solutions, those that are health-related and proven effective: 1) regulation of standards for evidence-based treatment, and 2) harm reduction services that keep people safe when treatment isn’t an option.
Harm reduction includes an array of life-saving services that together shore up the best outcome but, for now, I am focusing on just one: the availability of clean needles. Employed in Europe since the 1970s and the U.S. since the 1980s, syringe programs are the world’s longest-running and most widespread health-centered intervention in reducing the harm for intravenous drug users.
A Cato Institute forum I attended this year, “Needle Exchange Programs: Benefits and Challenges,” featured experts—including Vice Admiral Jerome Adams, the U.S. Surgeon General, and Ricky Bluthenthal, a professor of Preventive Medicine and Associate Dean for Social Justice at the University of Southern California Keck School of Medicine—both of whom shared heaps of scientific data leaving no doubt that syringe service programs save lives, reduce the spread of disease, and build trust that connects people with ongoing health care and improved lives.
Considering the two million people in the U.S. currently struggling with a substance use disorder, and the increase in intravenous drug use, Dr. Adams talked about our current “failure to address the root cause of addiction,” and its resulting “mortality and morbidity, including an explosion in the infectious diseases linked to injection drug use.”
Sharing before-and-after studies conducted in specific jurisdictions where syringe access was substantially increased, Dr. Adams drove home the case for high accessibility, detailing the increased life-saving outcome in squelching the spread of deadly disease and in fostering relationships, something he repeatedly underscored, “People need to know that you care before they care what you know.”
Dr. Bluthenthal’s distinguished career has been dedicated to health care over judgment.
“For people who inject drugs,” he said, “we should not be satisfied with interventions that don’t put health care first. We can’t endure these multiple diseases that are killing people every day while waiting for the rest of us to get over our stigmas related to drug use. We have to put humanity and dignity at the center of our programs.”
“Part of the genius of syringe programs is, in giving people what they need, they will come to you for it, which then provides the opportunity to offer more services.” Emphasizing the need for a continuum of harm reduction initiatives that ideally include overdose prevention sites, Dr. Bluthenthal was clear, “We have a growing population using injectable drugs and we need to mobilize in thinking about their health. Often policy choices are really political choices, and not focused on what works best. But the more generous the harm reduction services, the better the health outcome.”
“We need to put resources in the hands of people who use drugs,” Dr. Bluthenthal said. “They are every bit as capable of improving their life circumstances as any one of us. But what we have had is 40 years of trying to disempower them, remove resources from them, and isolate them; what we’ve ended up with is the deadly health consequences.”
Endorsed by the World Health Organization and the American Medical Association, syringe access programs are well-researched with irrefutable scientific consensus: they are effective and inexpensive; they do not encourage drug use; they do not increase improper syringe disposal or crime.
Urging bold expansion of syringe access throughout the U.S., these experts identified only one challenge: availability. Tragically, syringe programs are legally permitted in only 30-some states and Washington, DC. And, even where they are legal, access is often inadequate.
Maryland is a case in point. Long ahead of the curve, Baltimore established one of the nation’s earliest syringe access programs in response to soaring HIV rates, which subsequently declined at a faster pace than other Maryland jurisdictions, prompting the Maryland General Assembly to pass legislation in 2016 authorizing statewide syringe programs. Yet access throughout much of the state lags, ranging from woefully poor to non-existent.
We’ve known of the benefits of these health-centered programs for over twenty years, yet the implementation gap is colossal. Ignoring the research, policies that are politically—not scientifically—motivated continue to deny sufficient syringe access, reinforcing the barriers to life-saving interventions, and keeping the U.S. the world leader in overdose deaths.
“Recovery from addiction is possible. But the most effective programs are underutilized due to stigma—the biggest killer we have to fight,” Dr. Adams lamented. To tackle this increasingly deadly crisis, we must figure out a way to shed the stigma and prioritize health-based solutions—a practice too often sidelined, but one that has proven effective regardless of whether the benefit is measured in humanitarian or economic terms.
We can do better.