IT’S TIME TO UNITE AROUND A COMMON DRUG-CONTROL STRATEGY
Drug overdose fatalities continue to surge in every corner of the country, destroying families and communities and exacting an economic toll of nearly $1.5 trillion in 2020. Yet even as more and more Americans die—a record 108,000 overdose deaths last year alone—there’s little consensus about the best way forward. Amid an unfolding tragedy, advocates of three different approaches—harm reduction, decriminalization, and treatment—appear to be in opposing camps, rather than working together to address a public health crisis.
Saving lives is a priority
Harm reduction refers to measures that keep drug users safe, including supervised injection sites where drug testing strips, medical personnel, and overdose reversal medications are readily available. Until recently, such programs—technically illegal—have been controversial, with critics claiming they promote drug use. But now harm reduction is gaining ground with support from the Biden administration and city officials who want to quickly curb overdose deaths. New York City—which experiences one drug death every four hours—currently has two supervised sites and data indicates that they are preventing some overdoses and deaths. But very few individuals who are saved subsequently enter treatment, instead returning to the streets and a life of drug use.
The same holds true under a groundbreaking decriminalization program in Oregon. According to the law, passed two years ago, anyone caught possessing a small amount of illicit drugs, including heroin and cocaine, are given a citation and fined $100 (much like with a parking ticket), which can be waived if they merely call an addiction recovery hotline to discuss services. So far, the program—which includes a voluntary treatment component—hasn’t reduced the high rate of addiction in the state, with overdose fatalities increasing by nearly 20 percent last year. Of the 16,000 individuals who’ve received citations, less than 1 percent entered treatment.
A united front
Harm reduction, decriminalization, or treatment alone cannot sufficiently address the escalating addiction and overdose crises. Alternatively, we can combine all three into a comprehensive, nationwide program backed by extensive funding and resources. It should feature harm reduction on the front lines, decriminalization to shift the focus from incarceration to healthcare, and finally, a pathway to safe and effective treatment, which today is only available to a small fraction of those with opioid use disorder.
Focus on treatment
A core principle of this effort would be to create incentives to encourage and motivate users to enter a variety of treatment options, such as outpatient, long-term residential, or medically assisted. The goal is not to coerce or force people to take this step, but rather to build trust and provide them with a bridge to recovery. Drug courts, for instance, which offer a choice between jail and rehab, have been successful in this regard, as has a pilot program to guarantee employment to potential job candidates if they complete treatment and stay clean.
To make progress against this drug scourge, we must embrace a strategy that brings together harm reduction, decriminalization, and treatment—and not simply regard each alone as a panacea.
