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In Win for Overdose Prevention, Rhode Island Approves Harm Reduction Centers

Biden is under pressure to prohibit law enforcement from targeting safe consumption sites that reduce drug overdose.

A visitor to a mock safe injection site at Harvard School of Public Health checks out the items on the demonstration table near the medical school in Boston, Massachusetts, on April 30, 2018.

Rhode Island Gov. Dan McKee signed legislation with little fanfare on Wednesday authorizing a two-year pilot program for establishing safe drug consumption sites designed to reduce the harms of drug use and prevent overdose deaths, making the state the first to legalize spaces where people can test and use illicit substances under medical supervision.

The victory for harm reduction and overdose prevention advocates puts mounting pressure on President Joe Biden to assure state and local leaders that his administration will prohibit law enforcement from targeting harm reduction facilities that experts and advocates say are crucial for combating the overdose crisis.

Under President Trump, the Justice Department declared safe consumption sites illegal. Citing an archaic piece of federal law known as the “crack house” statute, which Biden co-sponsored in the mid-1980s, federal prosecutors blocked a proposed safe consumption site called Safehouse from operating in Philadelphia despite broad public support for the facility. Advocates and mayors of major cities are now asking the Biden administration to reverse the Justice Department’s position.

Safe drug consumption sites operate in countries across the world and are known by many names, including supervised injection sites, supervised consumption services and overdose prevention programs. In Rhode Island, they are dubbed “harm reduction centers,” because the services would offer safety supplies and resources for drug users, including staff trained to use naloxone, the opioid overdose reversal drug credited with saving countless lives. Drugs are tested at such facilities, giving users advance warning of bad batches that can cause an outbreak of overdoses. Safe consumption sites in Canada and other countries also provide pathways to addiction treatment for those who want it.

“There are mountains of evidence, from years and years of experience in other countries, to show that these centers save lives, increase the likelihood of a person entering treatment, and provide people access to other vitally important health resources,” said Lindsay LaSalle, Managing Director of Policy for the Drug Policy Alliance, in a statement.

The Trump administration’s crackdown on Safehouse in Philadelphia left city and state leaders across the U.S. uncertain whether the Justice Department would prosecute supervised drug consumption under Biden. Rates of fatal drug overdose reached terrifying new heights as the COVID pandemic raged in 2020, but it appears the Biden-Harris administration has yet to take a position on safe consumption sites. The White House Office of National Drug Control Policy (ONDCP) did not respond to inquiries from Truthout by the time this article was published.

“With at least 92,000 of our friends and family members lost to overdose in 2020 alone, we simply cannot wait any longer,” LaSalle said.

In April, the mayors of six major cities, including New York City, Pittsburgh and San Francisco, sent a letter to Attorney General Merrick Garland requesting the Justice Department reverse its Trump-era position and institute a policy deprioritizing enforcement of federal drug control law against supervised consumption and overdose prevention programs. During Senate confirmation hearings, Garland said he could not comment on safe consumption sites because the Justice Department’s lawsuit against Safehouse was still pending.

As Rhode Island moves forward with its pilot program for harm reduction centers, where people would use illicit drugs they obtained on their own in a safe and supportive environment, the Justice Department will be under pressure to issue guidance to cities and states pushing for similar programs that may violate federal law under the precedent set by the Trump administration.

At least one “underground” supervised consumption site in the U.S. is already operating in the shadow of the law and is credited with preventing dozens of potential overdose deaths. A 2020 study found no overdose deaths at the site over a five-year period. At least 33 overdoses were reversed without calling for an ambulance, suggesting the supervised consumption model can indeed saves lives and public resources in the U.S.

“[The] victory in Rhode Island gives us hope that there are policymakers that are willing to actually lead and do what needs to be done to save lives in the face of one of the worst public health crises of our time,” LaSalle said.

Biden pledged to tackle the overdose crisis, but critics say his administration has been slow to make broad changes in federal policy that are badly needed to curb the rising number of deaths. The Biden-Harris administration has said that expanding access to “evidence-based” drug treatment and harm reduction services is a priority, but it has also angered public health and civil rights groups by continuing to wage the war on drugs through law enforcement and incarceration. Advocates say responding to a public health crisis with drug police and harsh mandatory minimum sentencing that fills federal prisons only marginalizes people at risk of overdose and makes the illicit drug supply more dangerous.

At the same time, Biden is the first president to prioritize harm reduction, a broad range of strategies and services that help people who use drugs stay alive and take control of their own health. For decades, reactionary politicians accused harm reduction efforts of enabling illegal drug use, even as programs such as syringe exchanges proved indispensable for saving lives and preventing the spread of diseases such as HIV. A list of policy priorities released by the ONDCP earlier this year declares support for research on “emerging” harm reduction strategies “in the real world” but does not mention supervised consumption by name.

Decades of criminalizing drug use failed to prevent the overdose crisis we see today, and now policymakers across the political spectrum are embracing harm reduction. The pandemic relief package championed by Biden and passed earlier this year dedicates $30 million to harm reduction “interventions” such as syringe exchange programs, where injection drug users can swap used syringes for clean ones and access other resources. Whether any of that money will eventually reach safe consumption sites may depend on how the Biden-Harris administration reacts to the news out of Rhode Island.