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Controversial harm reduction strategies appear to slow drug deaths


Record numbers of people are dying from drug overdoses in this country. And some public health experts say it's time to radically rethink how we help people living with drug addiction. There's a growing focus on something called harm reduction, where the goal is keeping people alive even while they are still using drugs to get high. A lot of the most cutting-edge and controversial programs like this are being tested in Canada. NPR addiction correspondent Brian Mann has been looking into this and joins me now. Good morning, Brian.

BRIAN MANN, BYLINE: Good morning, Rachel.

MARTIN: So you spent time researching these programs happening in Canada. What did you find?

MANN: Yeah, it's interesting. Canada has really emerged as the laboratory for harm reduction ideas, some of them pretty radical by U.S. standards, addiction care experts here in the U.S. watching this closely. A growing number of Canadian doctors, for example, are actually prescribing powerful opioids and stimulants that people can use to shoot up to get high. This is an approach called safer supply that aims to keep people from using street drugs that are now laced with powerful and often deadly chemicals. The doctors writing these prescriptions say their patients are experiencing fewer overdoses.

MARTIN: So I want to get back to what - the consequences of that. But for a second, let's talk about how we treat people with addiction here in the U.S. I mean, drug deaths keep rising, as we noted. Why isn't our current strategy keeping more people alive?

MANN: Yeah. Addiction care has gotten better in the U.S. - better therapies, better medications. But getting that kind of quality treatment is still super hard in most of the country. It's also really expensive. And what we've seen with research is that there are tens of millions of people in the U.S. who use drugs every year, and many of them just aren't ready or able to quit. And, again, because those street drugs now are so toxic, a devastating number of people are dying. I spoke about this with Dr. Rahul Gupta, who heads the White House Office of National Drug Control Policy.

RAHUL GUPTA: We have an American perishing every five minutes around the clock, and that's unacceptable. There's a lot of progress that is being made, but we know that there's so much more we need to do, making sure that we can save lives first with harm reduction approaches such as naloxone.

MANN: And you heard him there, Rachel, mention harm reduction and naloxone. And the U.S. has been slowly adopting some of these strategies, distributing this drug naloxone that helps reverse opioid overdoses; some communities providing clean needles to help limit the spread of diseases like HIV and hepatitis. All of this used to be really controversial. And even today, some forms of harm reduction are still illegal in parts of the U.S. But we are seeing kind of a slow-motion shift.

MARTIN: So explain more about what Canadians are doing on harm reduction that the U.S. is not doing.

MANN: Yeah. Over the last three years, government-approved clinics have opened all across Canada where people can come in and use street drugs under medical supervision. So if they overdose, they can get immediate help from a nurse or a provider of care. And, again, as we mentioned before, a lot more Canadian doctors with government permission are prescribing medications people can use to get high. I spoke to a guy named Jamie Myers who picks up his opioids from a pharmacist every week in Ottawa.

JAMIE MYERS: Well, I'm working on getting off fentanyl through the safe supply program, hopefully getting back to being a member of society, you know, having a regular job and being a normal person, regular person.

MANN: And Myers told me he thinks this program is saving his life. The Canadian government, too, has concluded that these approaches are effective, that they are helping reduce fatal overdoses.

MARTIN: Although I can imagine some people raising ethical concerns over this, right? I mean, it means doctors and pharmacists are helping people keep using drugs, turning medical workers into, like, drug dealers.

MANN: Yeah. That is a phrase that gets used. You know, it's explosive for politician and still very controversial ethically among people in the medical community. Some critics say harm reduction enables or encourages drug use. One problem with these cutting-edge programs is that they're still so new, Rachel, that there's not a lot of great research showing whether the benefits outweigh the risks. And there are skeptics like Keith Humphreys, who's an addiction researcher at Stanford University.

KEITH HUMPHREYS: When you start distributing opioids in the community, including to people to stop overdose, they will, in some cases, sell them and initiate new people onto drugs. And those people will overdose. If you just say, we're just going to supply these drugs, like, what is the end game?

MANN: So Humphreys thinks it's better and ultimately safer to keep focusing health care dollars on more traditional treatments aimed at ending addiction, not these programs that help people use drugs more safely.

MARTIN: I mean, you've talked to doctors and social workers who actually offer this kind of harm reduction. What do they say about those concerns?

MANN: Yeah, you know, they acknowledge harm reduction can be messy. Working with people tangled up deep in addiction, it's messy. And it means working in an ethical gray zone. But they also point out the opioid epidemic has evolved into something far more dangerous. They say no one ever recovers - has no chance to recover from drug addiction if they're dead. I spoke about this with Chad Bouthillier, who himself used to be addicted to cocaine and fentanyl. Now he works with patients in one of those supervised drug injection sites in Ottawa.

CHAD BOUTHILLIER: The clients are choosing what success means to them at that moment. If it's coming to get clean gear - success. If it's coming to use while being supervised - success. And they can build on those successes.

MANN: So Bouthillier points out that no one has ever died in Canada's supervised drug consumption sites. And, Rachel, he thinks that alone is a huge win that could be replicated all over Canada and all over the United States.

MARTIN: Well, speaking of which, Brian, I'm pretty sure I've read about something like this happening in California, right?

MANN: Yeah, that's right. This summer, California's Legislature actually approved a big pilot program for a new network of supervised drug use clinics that would look kind of like the place I visited there in Ottawa. At the last minute, the state's Democratic governor, Gavin Newsom, vetoed that measure. It was a huge setback for harm reduction advocates in the U.S. But the thing that's happening now is as these drug deaths keep rising, there is pressure to try something new.

So we saw two supervised drug consumption clinics open last year in New York City with support from local officials. It's the only program of its type in the U.S. And it's significant that the Justice Department and the Drug Enforcement Administration have so far left that program alone. They're not moving to shut it down. Right now, the Justice Department is also negotiating with a program that wants to open a similar clinic in Philadelphia. If that happens, it could send a very different signal to cities and states that this kind of harm reduction might be worth trying.

MARTIN: NPR addiction correspondent Brian Mann, thank you.

MANN: Thank you. Transcript provided by NPR, Copyright NPR.

Rachel Martin is a host of Morning Edition, as well as NPR's morning news podcast Up First.
Brian Mann is NPR's first national addiction correspondent. He also covers breaking news in the U.S. and around the world.