harm reduction

Will Congress Finally X-Out the “X” Waiver?

Members of Congress are growing more appreciative of the benefits of Medication Assisted Treatment in addressing the overdose crisis. Two bills presently under consideration—one in the Senate and one in the House—are the latest evidence of that awareness. 

The Coming “Stimulant Crisis?”

Earlier this month the Centers for Disease Control and Prevention, in the Morbidity and Mortality Weekly Report (MMWR), reported that from 2015-2016 deaths from cocaine and psychostimulants (such as methamphetamine, Ritalin, dextroamphetamine) increased 52.4 percent and 33.3 percent respectively. In 2017, the CDC reported a total overdose rate of 70,237, and cocaine was involved in 19.8 percent of those deaths while other psychostimulants were involved in 14.7 percent. Opioids, primarily synthetic (fentanyl and fentanyl analogs), were found in 72.7 percent of the cocaine deaths and 50.4 percent of the other psychostimulant deaths. The report mentioned that provisional 2018 data indicate deaths involving cocaine and other psychostimulants are continuing to increase.

As I have written here and here, deaths related to cocaine, methamphetamine, and other psychostimulants have been on the rise for several years now, despite legislation in 2005 that was supposed to address the problem, and recently fentanyl has replaced heroin as the drug with which they are combined to make a “speedball”—a mixture aimed at reducing the negative “come-down” effects after the rush from the stimulant.

The most important sentence in the CDC report was this: “Increases in stimulant-involved deaths are part of a growing polysubstance landscape.” This should be viewed in the context of a recent study from the University of Pittsburgh that concluded:

The U.S. drug overdose epidemic has been inexorably tracking along an exponential growth curve since at least 1979. Although there have been transient periods of minor acceleration or deceleration, the overall drug overdose mortality rate has regularly returned to the exponential growth curve. This historical pattern of predictable growth for at least 38 years suggests that the current opioid epidemic may be a more recent manifestation of an ongoing longer-term process. This process may continue along this path for several more years into the future…Indeed, it is possible that a future overdose epidemic may be driven by a new or obscure drug that is not among the leading causes of drug overdose death today. Understanding the forces that are holding multiple sub epidemics together onto a smooth exponential trajectory may be important in revealing, and effectively dealing with, the root causes of the epidemic.

Libertarians and Harm Reduction

Last week we held a day-long conference at the Cato Institute devoted to exploring the strategy known as “harm reduction” to address the rising rate of drug overdose deaths and the spread of infectious diseases, such as hepatitis and HIV.  

In my remarks at the beginning and at the conclusion of the conference, I pointed out that the harms afflicting the drug-using community and their intimate contacts are the direct result of drug prohibition. Cato’s Jeffrey Miron emphasized that point in a key presentation and discussed the success Portugal has had in reducing overdose deaths, HIV, hepatitis, and the heroin addiction rate after it decriminalized all drugs in 2001.

While I stated that the ultimate act of harm reduction would be to end the War on Drugs, I argued that, as a start, the goal of drug policy must shift from one that is focused on prohibiting and punishing the consumption of certain unapproved substances to one that is focused on reducing the disease transmission and deaths that come from drug prohibition. Rather than continue to pour huge amounts of resources into putting people in cages for buying, selling, or placing certain unapproved substances into their bodies, those resources would be put to better use reducing the harms our current policies inflict on people. Harm reduction is realistic. It recognizes there will never be a drug-free society and therefore seeks to make nonmedical use of licit and illicit drugs in the black market less dangerous.

Harm reduction strategies include:

  • Needle-exchange programs and safe (aka supervised) injection facilities 
  • Medication Assisted Treatment with drugs like methadone, buprenorphine, and sometimes hydromorphone (dilaudid) and heroin—so those with addiction or dependency can avoid the horrors of withdrawal (and the use of dirty needles) while stabilizing their lives, then gradually taper off the drug on which they are dependent.
  • Making the overdose antidote naloxone as well as fentanyl test strips more readily available. 
  • Decriminalizing cannabis, which has demonstrated potential in the treatment of pain as well as in the management of withdrawal and possibly even as Medication Assisted Treatment.
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