“Crack pipes.”
Those were the two words Sen. Roger Marshall, R-Kansas, had for the American public in a February 2022 press conference. His comments came as part of a broader diatribe scorning the Biden administration for its alleged provision of “crack pipes” for individuals struggling with substance-use disorders.
Marshall’s comments echoed those of many of his Republican Senate colleagues, including Sen. Ted Cruz, R-Texas, Sen. Marsha Blackburn R-Tenn., and Sen. Marco Rubio, R-Fla. — all of whom have derided the Biden administration for allegedly funding “crack pipes for addicts” and effectively encouraging drug use and threatening public safety.
These comments, however, do not square with the reality of Biden administration drug policy: according to Department of Health and Human Services Secretary Xavier Becerra, “no federal funding will be used directly or through subsequent reimbursement of grantees to put pipes in safe smoking kits,” referring to a federal grant providing funding for the purchase of “safe smoking kits/supplies.”
Against this backdrop, Marshall and his colleagues’ comments represent no more than a gross distortion of a relatively benign health policy, designed to frame the Biden administration as far out of step with the American political orthodoxy. But setting aside the politics, these Senators’ comments also reflect a deeper quarrel not merely with so-called Biden crack pipes but rather with the tenets of “harm reduction.”
This set of principles holds that, so long as drug use is prevalent, policymakers should make drug use safer, while still vigorously attempting to eliminate substance-use disorders. At their core, the principles of harm reduction seem like a no-brainer. But the policy proposals that flow from such a theory are, at least facially, counterintuitive.
Supervised injection sites — those public locations in which individuals can use drugs with supervision and often with sterile needles — is one such harm-reducing intervention, against which the GOP has so thoroughly inveighed. As much as these senators might like us to, we should not immediately balk at the perhaps peculiar drug policies that emerge from the principles of harm reduction. The gut urge to reject all safe drug use initiatives may be tempting, but we ought to take a second, more measured look.
Indeed, to the extent that the Biden Administration’s HHS funds state and local efforts to provide safe drug use materials, it might be a boon to our nation’s wellbeing.
Criticism of safe drug use initiatives like supervised injection sites often hinges on the racy headline that the government is encouraging drug use. Framed in this light, such initiatives naturally incur skepticism. But what the electorate and party elites miss — either intentionally or otherwise — is the “safe” part of these safe drug use initiatives.
To be sure, drug use, itself, can be dangerous, leading to tens of thousands of overdose deaths per year across the nation. Under the U.S.’s current drug use paradigm — in which those with substance-use disorders must clandestinely suffer with addiction for fear of public backlash, or worse, incarceration — this is to be expected.
What proposals such as supervised injection sites and the provision of drug use paraphernalia do is reduce these harms, not punishing them out of existence or sweeping them under the rug. Epidemiological evidence affirms this point. Canadian researchers, for instance, have furnished evidence suggesting that the introduction of supervised injection sites in Vancouver precipitously decreased the rate of overdose deaths: in this study, overdose deaths within a 500-meter radius of such a site decreased by 35%, while the broader city’s rate dropped only about 10%.
The benefits of supervised injection sites do not end with drug-related overdose death: they confer multiple positive externalities, according to researchers. In Australia, for instance, one study found a 68% reduction in ambulance calls related to overdoses, not only confirming these sites’ ability to reduce overdoses but also suggesting that these sites can free up valuable, yet limited, health infrastructure. Another Canadian study suggests these sites can also reduce the illnesses of infectious disease: researchers estimate that anywhere between four to eight HIV-related deaths were prevented in Vancouver per year after the introduction of its “Insite” supervised injection facility. Researchers also have noted that such sites can put people who struggle with addictions on the pathway to recovery, citing “significant improvements in access to addiction treatment programs.”
Supervised injection sites, of course, cannot stand in for all harm reduction policies, but the benefits they engender reveal an underlying tension: if these senators are so concerned about public safety and the risks associated with drug overdoses, why won’t they at least consider proposals to implement safe drug use initiatives rooted in harm reduction?
Political optics are part of the answer. Drug use incurs profound stigma, which is unsurprising given the extent to which we have been inured to the trauma and danger of drug use in the media. Aggressive drug criminalization — a favorite policy of many of the Biden administration’s critics — is the stigmatization of drug use made manifest. Its impact on individual physical and mental health notwithstanding, incarceration all but assures users that their struggle with addiction disqualifies them from enjoying the full rights of other Americans — not to mention that it might actually increase the incidence of gun violence and homicide.
The danger of drugs should, of course, never be understated, but stigmatizing drug users only creates a further rift between users and non-users. By deeming users unfit for public life, stigma condemns those suffering from addiction to suffer in silence and isolation.
Safe drug use and harm reduction policies reverse this paradigm: By drawing drug users out from the shadowy margins of our society, such initiatives not only seek to improve health outcomes but also possess an expressive quality — one that demonstrates to those who use drugs the promise of “life” enshrined in the founding principles of our nation.
To understand and solve the drug addiction epidemic in the United States, we must identify drug use as a fundamentally human problem. Harm reduction initiatives accept the fact that we cannot will the American drug crisis away overnight by merely “cracking down” on law violators. Such proposals recognize that the wellbeing of those suffering in isolation, who may be deemed lost causes, still matters.
To be sure, we have a much longer way to go. No one safe drug use initiative will solve the drug crisis in the U.S. overnight, and some critics will irrationally point to the lack of immediate success as evidence against the principles of harm reduction. But these bad faith arguments do not change the reality: Relegating the drug addiction to the clandestine corners of society is not the answer to the nation’s drug problem.
Image by Markus Spiske is licensed under the Unsplash License.
