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Biden’s Drug Czar Is Leading the Charge for a ‘Harm Reduction’ Approach

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MANCHESTER, N.H. — During a recent interview here, Dr. Rahul Gupta, President Biden’s drug czar, seemed to be on the verge of supporting a radical shift in U.S. drug control policy.

Asked for his views on supervised consumption sites, where users bring their very own drugs to take under the supervision of trained employees in case they overdose — an idea accepted in Canada and Europe but still technically illegal in america under federal law — Dr. Gupta’s eyes lit up. Then he paused, catching himself, and said he couldn’t weigh in yet.

The Justice Department is predicted to soon determine whether one planned site that it blocked three years ago can operate, giving more insight into the Biden administration’s views on the concept. Many public health experts consider it could help stem a record variety of overdose deaths largely brought on by synthetic fentanyl.

“All of us are enthusiastically waiting” for the department to weigh in, Dr. Gupta said.

Support for supervised consumption from the Biden administration could be a serious turning point in how the federal government addresses an epidemic of addiction and overdoses that has endured for many years and now claims greater than 100,000 lives a 12 months. As an alternative of discouraging drug use, such sites aim to maintain users from dying, with trained personnel providing syringes and other sterile equipment for using drugs and dealing to reverse overdoses on the spot.

Dr. Gupta is already overseeing what experts describe as probably the most progressive federal drug strategy since his office’s inception.

The strategy largely rests on the concept of harm reduction, focused not on helping drug users achieve abstinence but on lowering their risk of dying or acquiring infectious diseases. A central piece is providing sterile needles to make use of in injecting drugs, tools to examine drugs for fentanyl and other lethal substances, and naloxone, a medicine that may revive individuals who have overdosed. Mr. Biden is the primary president to support the approach.

“It’s late by, I don’t know, a number of many years,” Alex Kral, an epidemiologist and drug policy expert at RTI International, a nonprofit research organization, said of the White House support for the approach.

Dr. Gupta’s comments in Latest Hampshire got here days after the Centers for Disease Control and Prevention announced that overdoses rose again to record-breaking levels in 2021, nearing 108,000, a year-to-year increase of nearly 15 percent. The recent surge has hit Black and Native American communities particularly hard.

The administration has said it goals to cut back overdose deaths by 13 percent by 2025. Without more harm reduction interventions, Dr. Gupta said, 165,000 people could fatally overdose every year by 2025.

Dr. Gupta, within the eyes of some addiction experts, is an unlikely flag-bearer for the strategy. Just 4 years ago, he was blamed for the demise of harm reduction programs in Charleston, W.Va., after he signed off on a report criticizing one heavily used site, resulting in its decertification.

He now says the closure of the Charleston program was a big mistake; in an interview, he emphasized that he had supported greater than a dozen harm reduction programs in West Virginia when he was overseeing public health there.

Dr. Gupta describes fentanyl — not the pharmaceutical kind, but an artificial version produced in illicit laboratories, often in Mexico — as a “Pandora’s box” within the nation’s drug supply. Since it is robust and sold in various formulations, small differences in quantity can mean the difference between a drug user’s usual dose and one which is deadly. It is usually combined with stimulants like methamphetamine and cocaine, or pressed into counterfeit prescription pills offered not only to chronic drug users but to experimenting teenagers.

A recent study of illicit pills seized by the drug enforcement authorities found that a considerable share of pills marketed as OxyContin, Xanax or the eye deficit hyperactivity disorder drug Adderall now contain fentanyl. Xylazine, an animal tranquilizer that may have harsh effects on humans, has also recently played a task in a greater share of overdose deaths.

Naloxone, a medicine invented within the Nineteen Sixties that may quickly reverse opioid overdoses, took a few years to come back into mainstream use in america, with federal agencies reluctant to review and fund its use until the last decade, experts said. The F.D.A. approved the primary generic naloxone nasal spray only in 2019. Syringe exchanges, now available in roughly 40 states, were also slow to achieve broad acceptance.

Naloxone is now fundamental to the nation’s efforts to curb overdose deaths. Observing a naloxone training session at an architecture firm in Latest Hampshire that keeps the medication on site, Dr. Gupta observed that he had grown accustomed to the dummies used for such demonstrations.

The goals laid out by the drug control office show how much it has evolved since 1988, when it was created to strive for a “drug-free” America. Its early leaders had backgrounds in law enforcement, resulting in more attention to drug trafficking than addiction.

More moderen drug czars have shied away from law-and-order atmospherics and emphasized addiction; one in all Barack Obama’s picks for the job, Michael Botticelli, was himself a former drug user.

Dr. Gupta is the primary medical doctor to occupy the role, after serving because the health commissioner in a state — West Virginia — that has consistently had one in all the very best rates of overdose deaths in recent many years.

Dr. Dan Ciccarone, a professor of family and community medicine on the University of California, San Francisco, said that Dr. Gupta’s arrival on the White House was the culmination of the shift from the moralistic debate around drugs, blaming suppliers and users, to an approach treating the problem as a health crisis, with acceptance of drug use.

“It became a clinical problem that needs to be handed over to the doctors,” he said. “That is the anti-shame approach: ‘We love you; we’re concerned about you; let’s assist you be ready.’”

Dr. Gupta continues to be trailed by accusations that by condemning the Charleston needle exchange with the audit that he and his colleagues there issued in 2018, he had undermined the progress West Virginia had made in implementing harm reduction programs. A big H.I.V. outbreak amongst individuals who inject drugs — and a scathing C.D.C. report — followed.

State legislators piggybacked on the report last 12 months and passed a bill that severely restricted how syringe exchange programs could operate, calling for identification and the return of used needles — each deterrents to the drug users the programs are intended to assist, experts said. It also threatened penalties for sites that didn’t comply with the brand new regulations.

“There have been plenty of counties set to open programs that then didn’t,” said Joe Solomon, the founding father of Solutions Oriented Addiction Response, or SOAR, which ran a syringe exchange program in Charleston. “They couldn’t afford that opposition of their communities.”

Mr. Solomon said that Dr. Gupta was now benefiting from a more comfortable political environment by which to advertise harm reduction, with “a resurgence of research and momentum” behind it.

Dr. Ciccarone, who pushed Dr. Gupta to more vocally support harm reduction after the Charleston syringe exchange was shut down, called him “reformed.”

“He sees the great thing about harm reduction, the need of harm reduction,” he said. “Because crisis times are calling for desperate measures, we’d like to place all of the tools out.”

Earlier in his profession, Dr. Gupta practiced medicine in Alabama and at a security net hospital in Nashville, experiences he said had illuminated the social and economic causes of addiction, especially among the many poor.

Even now, Dr. Gupta said, many states and cities are only just starting to have conversations in regards to the advantages of harm reduction. Naloxone may be expensive and hard to seek out in some parts of the country, he said; in a recent evaluation of overdose deaths in 2019 and 2020, the Centers for Disease Control and Prevention found that naloxone had been administered in just about 20 percent of the cases. He’s now talking to Food and Drug Administration regulators about allowing naloxone to be sold over-the-counter, which could improve access and affordability.

He has talked up harm reduction this 12 months in Salt Lake City and in Kentucky, where local health departments across the state have taken up syringe exchange programs.

There are actually greater than 80 such programs statewide, said Van Ingram, the director of Kentucky’s drug control policy office, pointing to it an example of bipartisanship in harm reduction policymaking. Local health officials, he added, “needed to take the uncomfortable positions with the identical people they stand in keeping with at Kroger.”

During a visit to Maine’s state prison this month, Dr. Gupta praised a medicine treatment program for opioid addiction, one other facet of harm reduction efforts that addiction experts say is critical to stemming overdoses among the many incarcerated and after release.

As fentanyl continues to pummel communities, Dr. Gupta says that the Biden administration has adopted a consider-everything attitude. It has moved to loosen restrictions on prescribing buprenorphine, an anti-craving drug. Fentanyl test strips, which might now be purchased with federal grants, are one tool that needs to be more widely adopted, Dr. Gupta said, citing cocaine users for instance of who might profit.

“They don’t know there’s a latest contaminant on this,” he said. “After which they’ll die. Is that fair? Is that right?”

A Justice Department decision on supervised consumption — tied to the Philadelphia case — could allow sites to operate without fear of interruption by federal authorities. The resolution could also give the White House a gap to publicly endorse the choice.

“The Department is evaluating supervised consumption sites, including discussions with state and native regulators about appropriate guardrails for such sites, as a part of an overall approach to harm reduction and public safety,” a Justice Department spokeswoman said in an announcement.

Dr. Gupta cautioned in interviews that research on supervised consumption sites in america was practically nonexistent, as the primary authorized sites opened just last November. A 2021 review of twenty-two studies from other countries found that such sites “may reduce the chance of overdose morbidity and mortality and improve access to care while not increasing crime or public nuisance to the encircling community.”

Many Republican governors and state legislatures lately grew more receptive to needle exchanges and naloxone as overdose deaths reached once-unthinkable levels. The Trump administration also supported them, in addition to medication-assisted treatment, by which users receive less potent opioids under medical supervision to ward off withdrawal symptoms and stanch cravings.

Yet some lawmakers still express discomfort with harm reduction tools, not least fentanyl strips, that are gaining acceptance even in some conservative states but remain illegal in others. A recent uproar about so-called “crack pipes” in a harm reduction grant program showed how the thought still faces deep pockets of resistance and may be weaponized politically. Supervised consumption sites remain a selected lightning rod.

At a recent hearing examining the National Drug Control Strategy, which Mr. Gupta’s office oversees, Senator Charles Grassley, Republican of Iowa, said, “I’m nervous that making drugs more accessible is what this administration calls drug control.”

Mr. Grassley wryly noted that in comparison with relatively few mentions of counterfeit pills, the phrase “harm reduction” appeared 198 times in the brand new strategy.

Advocates of harm reduction say that Dr. Gupta still must push for more federal grants for such programs and that lawmakers should remove a restriction on using federal money to buy syringes for needle exchanges.

The primary federal grants for harm reduction groups, a $30 million program funded by the American Rescue Plan, were a far cry from what is required to maintain organizations afloat, experts said. Not receiving a grant “means all of us dedicate quite a lot of time that may very well be spent on far more impactful work fund-raising for the long list of supplies we are able to’t use state or federal funds for,” said Lauren McGinley, the manager director of the Latest Hampshire Harm Reduction Coalition.

Jessica Parnell, who oversees a syringe exchange program in Nashua, said her group relies on charity gaming funds to afford the variety of syringes she needs to fulfill demand. Her group expanded the variety of days on which it serves people each week and began offering glassware in safer smoking kits.

“It’s taken off,” she said. “We’re reaching populations we haven’t before and offering an alternative choice to injection, which is safer.”

Kellene Mulcahy operates a harm reduction program out of the trunk of her automobile in Manchester, with an expanded arsenal she offers to members of the community: sterile water and clean cookers to dissolve illicit drugs, tourniquets and syringes to inject them, condoms, Band-Aids and fentanyl test strips, amongst other items, she said. The more local and versatile the operation, she said, the higher the chances of individuals returning to it.

“They wish to be human beings,” she said, “no matter the selections they’re making.”

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