When COVID-19 struck, the United States was already facing a number of public health crises, with national rates of overdose, HIV, and viral hepatitis rising due to increases in substance use linked with a surge in prescription opioids.
The pandemic has converged with these crises, worsening health outcomes for people who use drugs — a crisis that is likely to persist unless we change our approach to drug use.
Take overdose deaths, which increased some 20 percent in the United States between June 2019 and June 2020, to more than 81,000, according to the Centers for Disease Control and Prevention. That's the most fatal overdoses ever recorded in a single year.
And while national figures for new HIV and viral hepatitis cases are not yet available, it's likely they are growing, too, given reported spikes in injection-drug use. (Both diseases can be transmitted via the sharing of injection supplies.) From 2014 to 2018, HIV diagnoses increased 9 percent among Americans who use drugs overall, while some 2.4 million Americans had been diagnosed with hepatitis C as of 2016.
Such grim statistics underscore the need for the U.S. to adopt evidence-based drug policies that can save lives and improve outcomes for people who use drugs. The willingness of the Biden administration to think differently about national drug policy and the changing views of Americans present a critical opportunity to do that.
For decades, policy makers and medical professionals have addressed substance use in two main ways: demand reduction and supply reduction. Both approaches treat substance use as an immoral behavior to be eschewed, instead of as a personal response to social factors or difficult life circumstances.
Neither strategy has significantly reduced substance use or its associated harms. Even though drug arrests jumped 171 percent between 1980 and 2016, the price of most illicit drugs fell, while attempts to dismantle the international drug trade have resulted in extreme violence.
Indeed, America's War on Drugs has tyrannized countless numbers of Black and brown families with racialized policies like mandatory minimum sentencing guidelines. Such policies have resulted in the overcriminalization of minor drug offenses, the mass incarceration of Black and brown people, and fractured communities across the nation.
Meanwhile, Americans are still using drugs.
It is long past time for the U.S. to embrace the principle of harm reduction, which has proven to lower rates of substance use around the world. Harm reduction recognizes the humanity of people who use drugs, acknowledging that people's relationships with substances usually change over time, and aims to minimize the negative consequences of substance use by fostering the inclusion of those who use drugs in an ecosystem of interventions and services.
The most effective harm-reduction interventions are syringe-services programs (SSPs), which were introduced in the 1980s and '90s as a community-based response to injection-drug use amid the HIV/AIDS epidemic.
Today, they provide syringes, overdose-prevention education, syringe-litter cleanup, infectious-disease testing, and — crucially — naloxone, the lifesaving overdose antidote. SSPs also connect their clients to treatment for substance-use disorder, as well as primary care and social services.
Despite this vital work, U.S. laws have long constrained service providers. In 1988, bipartisan opponents of syringe services prohibited providers from receiving federal funds until the government determined they were safe and effective. The ban remains partially in effect, even as reams of research have shown the benefits of syringe services, from reducing emergency medical costs to lowering rates of HIV and hepatitis C. SSPs still cannot use federal funds to purchase syringes, which help prevent infectious disease among people who inject drugs.
Since the COVID-19 pandemic began, I've seen a dramatic spike in people receiving syringe services through my work managing AIDS United's Syringe Access Fund, which disburses about $1 million in philanthropic funds to SSPs annually. And it is happening at a time when public and private funding for harm-reduction services was already inadequate.
Although Congress has allocated billions of dollars to combat the opioid crisis, many of those programs stop short of addressing the complex health, psychosocial, and socioeconomic factors underlying chronic substance use. For instance, half of all State Opioid Response (SOR) grants — a major federal initiative designed to help states expand their opioid addiction treatment services over the course of two years — went unspent, a federal watchdog has found, by the time the program was wound down. At the same time, our Syringe Access Fund grantees are struggling to meet their clients' needs and pay their bills. This not only imperils lives and public health but strains local resources.
It is time Americans recognize that the best way to reduce the staggering number of lives lost to overdose each year is to invest in services that support people while they are using drugs. To do that, we need to reach people who use drugs where they are. Syringe services programs are a cost-effective way to serve communities that many see as hard to reach, but which actually are hardly reached, as well as an opportunity to invest in a more holistic and inclusive public health infrastructure.
Without greater investment in that infrastructure, hundreds of thousands of Americans are likely to slip through the cracks and die from overdose in the years to come. We have the tools to prevent these deaths, so long as we invest in the lives of people who use drugs.
Zachary Ford is a senior program manager at AIDS United, where he oversees the Syringe Access Fund, a grantmaking initiative focused on improving health outcomes for people who use drugs.