US pivots to ‘harm reduction’ after 107,000 overdose deaths last year

The Biden administration will prioritise “harm reduction” to address drug abuse while reviewing data to assess marijuana legalisation and safe injection sites, in a break from the longstanding US policy, the White House drug tsar has said.

Dr Rahul Gupta, the first medical doctor to hold the post of director of the Office of National Drug Control Policy, said in an interview that federal policy is shifting to address the US overdose crisis as a public health emergency rather than primarily a criminal justice problem.

More than 107,000 Americans died of drug overdoses last year, a rise of almost 50 per cent in two years, according to provisional data published last month by the Centers for Disease Control and Prevention. Gupta said it was clear that decades of anti-drug campaigns had not worked.

“For the first time in history, the federal government is embracing the specific policies of harm reduction,” Gupta told the Financial Times.

Harm reduction policies accept that illegal drug use takes place and aim to minimise its effects to save lives. It has been adopted in some European countries and Australia, but is opposed by some conservative lawmakers in the US, who argue it can encourage drug abuse.

Fentanyl, a powerful painkiller used in hospitals but now a common street drug, accounted for about two-thirds of US overdose deaths.

The Biden administration is funding nationwide distribution of the overdose prevention medication naloxone, fentanyl drug testing strips and sterilised syringes to addicts. But it has not yet lifted a ban on supervised injection sites, which are locations where drug users can self-administer drugs and receive emergency help if they overdose.

Two such sites recently opened in New York, prompting calls from Republican lawmakers for president Joe Biden to direct the Department of Justice to close down the “illegal” facilities. So far federal authorities have taken no action.

Gupta said the administration needed to understand the clinical effectiveness of safe injection sites before deciding whether to recommend lifting the existing federal ban. Policy would be guided by science, data and the overriding desire to save lives, he added.

Biden said he supported decriminalisation of marijuana during his 2020 election campaign, which eliminates penalties for possessing the drug. But he has not indicated if he supports legalising cannabis at the federal level.

The president faces mounting pressure to address the issue given the number of US states pushing ahead with legalisation and a vote by the House of Representatives on April 1 to approve a reform bill that would remove marijuana from the federal list of banned substances.

Gupta said the White House position on marijuana legalisation would also follow science by evaluating the experiences of the 19 US states that have already authorised recreational marijuana use.

“We’re learning from those states. We’re monitoring the data and trying to see where things go. But one thing is very clear, and the president has been clear about that. The policies that we’ve had around marijuana have not been working,” Gupta said.

David Herzberg, a historian at the University of Buffalo who specialises in US drug policy, said legalising safe injection sites and marijuana would represent a dramatic change in US policy. He said it was unclear if such policies would win support within the Biden administration.

“You could end up with a kind of turf war . . . there is going to be a lot of money for drug policy and the question will be who is going to get it? Cops or docs,” Herzberg said.

Gupta said there is a clear need to rethink the criminal justice-led approach of the past. “People should not be incarcerated, arrested, for just their drug use,” he said.