The Biden Administration Is Rejecting “The War On Drugs” And Turning To “Harm Reduction”

“To have the Office of National Drug Control Policy talking about ‘harm reduction’ is important,” said one public health expert. “I remember when you couldn’t say those words there.”

The Biden administration is pushing to reform state drug laws in its latest move aimed at preventing deaths among people who use illegal drugs. The new approach focuses on so-called “harm reduction” measures that promote safe drug use over abstinence and the threat of imprisonment.

On Monday, the Office of National Drug Control Policy announced a $2.5 million grant to draft model laws to support such harm reduction programs, increase drug treatment options, and reform criminal statutes that have harmed people of color in particular. It’s the federal drug policy office’s latest shift away from the “War on Drugs” strategy that was started during the Nixon administration 50 years ago.

“It’s frankly refreshing to see this office talking about helping people, and not about punishing them,” said epidemiologist Traci Green, director of the Opioid Policy Research Collaborative at Brandeis University. “For better or worse, model laws for controlled substances have led to changes in the past. So it is smart, I think, to follow this path to reform laws that unfortunately need modernizing in many states.”

Last year, more than 93,000 people died of drug overdoses in the US, the highest number ever. The increase was driven in part by the social isolation created by the pandemic, as well as by the wider spread of fentanyl, a drug some 25 to 40 times more potent than heroin, into the illicit drug market. The awareness that overdose deaths are only increasing, combined with reports of HIV outbreaks among people who use drugs in West Virginia and Boston, has intensified efforts to move to a harm reduction approach in the federal response to drug use. In direct contrast, however, some cities, such as Charleston, West Virginia, and Atlantic City, New Jersey, have recently shut down needle exchange sites, which are known to decrease the risks of infectious diseases spreading among people who use illicit drugs.

Announcement of the two-year grant follows the Drug Czar’s office’s easing limits on medications that treat addiction to opioids and allowing the use of federal funds to pay for test strips that can detect fentanyl in drugs. In April, ONDCP acting director Regina LaBelle announced that $30 million in federal funding would be included in the pandemic relief package to fund harm reduction programs for the first time, notably needle exchanges. And last month, ONDCP worked with the Drug Enforcement Agency to end a decadelong moratorium on using vans to dispense methadone to people who are physically dependent on opioids, making the treatment accessible to places without nearby clinics and correctional facilities.

“To have the Office of National Drug Control Policy talking about ‘harm reduction’ is important, both as a symbol, and for real,” said public health law expert David Rosenbloom of the Boston University School of Public Health. “I remember when you couldn’t say those words there. And it wasn’t that long ago.”

Some punitive state laws immediately force people physically dependent on drugs who get arrested to immediately lose access to insurance that was paying for their drug treatment. The new program announcing model drug laws should target such approaches, Rosenbloom said.

“That’s exactly the wrong time to have someone stop drug treatment,” he added. “They get out of prison and because they are physically dependent, they immediately use drugs again and overdose.”

Many other current laws treat overdoses as criminal acts rather than health events, only worsening the overdose crisis, said Green. Such laws make it harder for people to get drug treatment and medical care. “There really is a lot to be done to make harm reduction the standard response,” she said.

But making model drug laws is just the first step. It remains to be seen whether states actually end up adopting them. “The real question is whether the momentum will be there to make them into real laws,” Green said.


This story has been updated to clarify that ONDCP worked with the Drug Enforcement Agency to end a moratorium on distributing methadone via vans.

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