Researchers and doctors say they know how to curb harm caused by addiction and the spread of dangerous drugs. But lawmakers are reluctant to allow needle exchanges and access to safer narcotics.
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This week, the U.S. marks the 50th anniversary of the war on drugs. And this comes as overdose deaths have hit a record. Public health officials say there are proven harm reduction strategies to help people with addiction stay alive. But those programs face a growing backlash. NPR addiction correspondent Brian Mann reports.
BRIAN MANN, BYLINE: Shani Damron has struggled with addiction since she was a teenager - alcohol first, now heroin and methamphetamines. She says using drugs is more deadly than ever. That's because much of the supply of street drugs is contaminated with the potent synthetic opioid fentanyl.
SHANI DAMRON: I mean, that fentanyl's no joke. And it's just a split second, you know? And every time we stick a needle in our arm, we're taking a 50/50 chance, you know, we could die.
MANN: Damron says there's also high risk of disease from contaminated needles shared by drug users. Her community, Cabell County, W. Va., has seen a major HIV/AIDS outbreak.
DAMRON: Like, I don't know if I have any friends that's not positive for HIV. I mean, every one of us are. I am, too.
MANN: Harm reduction advocates say these outcomes are avoidable. Louise Vincent runs a program in Greensboro, N.C., where people can get clean needles and test their street drugs for contamination. Vincent says this works. It keeps people safer. But services like hers are banned in much of the country.
LOUISE VINCENT: You know, I guess we have to decide as a community and as a society, is it OK to just let people that use drugs die? Is that really what we're comfortable with?
MANN: Under the drug war model in place since the 1970s, Americans who use illegal drugs are often treated as criminals. Many of the nation's top drug addiction researchers say evidence is now clear that approach didn't work. One alternative would be to treat people with addiction like patients with a chronic disease. That could mean offering drug users a safe supply of their drug of choice, along with supervised consumption sites where they can be protected from overdoses, meanwhile, guiding them toward treatment and health care. That approach is being tried in parts of Australia, Canada and Portugal. But in much of the U.S., addiction policy is moving in the opposite direction. Again, Louise Vincent in North Carolina.
VINCENT: I would be naive to say that this is well accepted. We just defeated a bill that was trying to - that would have shut down those programs.
MANN: In recent months, officials in parts of the U.S. devastated by addiction have rolled back harm reduction programs. Local leaders in Scott County, Ind., voted to shut down a needle exchange that helped slow a major HIV outbreak among drug users. Lawmakers in West Virginia, where the opioid epidemic is still widespread, approved a similar measure. Dr. Michael Kilkenny, who heads the public health department in Cabell County, W. Va., says the new law will dissuade towns from offering clean needles even when there's clear medical need.
MICHAEL KILKENNY: New setups are going to be remarkably restricted. Communities that were on the fence, they've been knocked off the fence in the wrong direction.
MANN: Some forms of harm reduction are more accepted now. Many communities distribute naloxone among people who use drugs. It's a medication that can reverse overdoses caused by fentanyl and other opioids. But public health experts tell NPR much of the harm reduction happening in the U.S. occurs underground, with services provided illegally by churches, nonprofits and activist groups. Keith Humphreys, an addiction researcher at Stanford University, says it also appears many doctors are quietly keeping their patients safe by prescribing opioids to people addicted to pain pills.
KEITH HUMPHREYS: There are plenty of physicians who make the decision that, well, I wish this person weren't taking such very high doses, but I know that if I pull them away, they might go out and start using heroin. It's not perfect, but it's better than the alternative. And that kind of thinking is really central to the concept of harm reduction.
MANN: There's also pressure on doctors to prescribe more buprenorphine. It's a medication that can reduce opioid cravings, preventing relapses and overdoses. But harm reduction advocates say most Americans don't have access to that kind of treatment or safe drug supply. That's especially true for people who are poor and homeless, like Shani Damron, who says she has no choice but to go to the streets for her heroin.
DAMRON: I take my chance with my 50/50 shot of whether it's going to kill me or not (laughter).
MANN: The U.S. saw more than 90,000 fatal overdoses last year, a 30% increase. If current trends continue, drugs will soon kill more Americans every day than COVID-19. Brian Mann, NPR News.
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