Biden Admin Signals Shift To Harm Reduction

Secretary Of Health And Human Services “Trying To Give Users A Lifeline”

Xavier Becerra, the Secretary of Health and Human Services (HHS), has indicated that the war on drugs may be in the midst of a shift (and so too the Biden administration’s drug policy); late last month, Becerra told NPR that as far as harm reduction strategies concerned with mitigating damage from drug abuse go, “We are willing to go places where our opinions and our tendencies have not allowed us to go [before].”

Becerra’s willingness may be the result of desperate times calling for desperate measures; according to the Centers for Disease Control and Prevention (CDC), there were 96,779 overdose deaths during the 12-month period ending in March of 2021. Addiction, often a disease of despair, was provided an opportunity to flourish during the pandemic given the multitude of layoffs and abundance of time spent at home; reporting on the subject, the Associated Press shared that, “pandemic restrictions isolated those with drug addictions and made treatment harder to get.” Furthermore, the proliferation of Synthetic Opioids — along with the legacy of deceptive marketing practices by drug companies, which often masked the addictive and dangerous nature of Opioids — has put the country in a position where new approaches may be well-warranted.

The aforementioned harm reduction strategies include, according to NPR, “clean needle exchange programs designed to slow the spread of diseases such as HIV/AIDS and hepatitis among drug users” as well as “fentanyl test strips to help active drug users identify contaminated street drugs.” In Becerra’s own words, “We are literally trying to give users a lifeline.”

Perhaps most controversially, in his remarks Becerra seemed to open the door to so-called “safe consumption sites.” These are locations where illicit drugs can be taken in a way that is regulated and supervised. Safe consumption sites have been operating in Europe for roughly 30 years; they are largely verboten in the US, despite evidence that they can effectively reach marginalized populations and facilitate health and recovery.

Earlier this year, Rhode Island became the first state to pass legislation to allow safe consumption sites. According to Vice News, at the kind of sites now legal in Rhode Island, “people can use drugs, with oversight from medical professionals trained to administer medicines like naloxone…users can also meet with case workers to connect them with services like housing and job training.” The description of the site sounds in line with Biden administration drug policy aims as stated by the American Rescue Plan Act passed earlier this year, which earmarked millions to “support community based overdose prevention programs, syringe service programs, and other harm reduction services.”

Pushback To Biden Admin Policies And Recommendations

Though Becerra seemed to signal a willingness to give safe consumption sites a shot in more places than Rhode Island, telling NPR that “We’re not going to say ‘but you can’t do these other type of supervised consumption programs that you think work or that evidence shows work,’” HHS immediately distanced itself from the sentiment; an agency spokesperson said in a later statement that, “HHS does not have a position on supervised consumption sites,” elaborating that, “The issue is a matter of ongoing litigation. The Secretary was simply stressing that HHS supports various forms of harm reduction for people who use drugs.”

The Biden administration has faced friction in the face of its drug policies from without as well as from within; a coalition of groups including Human Rights Watch, the American Civil Liberties Union, and the National Council on Alcoholism and Drug Dependence recently addressed a joint letter to President Biden, congressional leadership, and administration officials including Becerra.

The letter accuses the Biden administration and its drug policies of “[leaning] on law enforcement, not evidence-based public health solutions, to solve the overdose epidemic,” going on to say that “it is time to center a public health approach rooted in expanding access to harm reduction and treatment instead of the same ineffective approach of arrest and incarceration.”

Making direct reference to the Biden administration’s recent drug policy recommendations to Congress, which called for “fentanyl-related substances” to be forever designated Schedule I under the Controlled Substances Act, the advocacy and watchdog groups declared that “there is simply no evidence that classwide scheduling or increased enforcement works to reduce illicit drug supply or rates of overdose and addiction.”

Stigma Persists As Supreme Court Defers

Data concerning how well scheduling a substance works to stop abuse of that substance is mixed. Scheduling a substance certainly might help contribute to the already-present stigma that surrounds addiction — potentially portraying drug users as dangerous or immoral people. President Biden has previously pushed back against the characterization of drug users in this manner, and has called for policies that prioritize rehabilitation over punishment.

Most Americans believe that the taboo around drug use and addiction is alive and well. According to a survey conducted earlier this year by Fors Marsh Group, more than two-thirds of Americans think that people who receive treatment for substance use disorders are generally regarded poorly as a result.

Furthermore, 7 in 10 Americans in recovery indicated they didn’t believe they would be hired if they talked about struggling with addiction or substance abuse in a job interview; 93% of respondents, meanwhile, “said it’s important for employers to support substance use recovery programs for their employees.”

The American public seems to want recovery-related resources made available to individuals affected by addiction. The Biden administration’s drug policies may have the same goal; only time will tell if they will end up being a closer match to Becerra’s harm-reduction rhetoric or to the punitive, law-and-order image painted by advocacy and watchdog groups.

For now, it doesn’t appear that recovery-related resources — at least in the form of safe consumption sites — will get any help from the Supreme Court. The Supreme Court of the United States chose not to complete a case review that might have allowed a supervised injection site which could work to prevent overdoses to operate. Therefore, the ruling of a lower court will stand; the nonprofit’s operators will continue to look for a way around the so-called “crack house statute” that has been used to shutter and prevent safe consumption sites for decades — a statute that, ironically, in its enforcement against these sites may itself be leading to more activity inside of actual crack houses.