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Harm Reduction and Drug
Policy Reform in the U. S.
Laura Thomas, MPH, MPP
Drug Policy Alliance
MIDARP's 8th Annual Drug Addiction Research Symposium
June 14, 2013
June 14, 2013
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Drug Policy Alliance
• The Drug Policy Alliance envisions a just society in which the use
and regulation of drugs are grounded in science, compassion, health
and human rights, in which people are no longer punished for what
they put into their own bodies but only for crimes committed against
others, and in which the fears, prejudices and punitive prohibitions of
today are no more.
• Our mission is to advance those policies and attitudes that best
reduce the harms of both drug use and drug prohibition, and to
promote the sovereignty of individuals over their minds and bodies.
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Drug policy reform victories
• Greater public support for drug policy
reform
• Legislative and ballot victories
• New voices in support
• Increased positive media coverage
• New movement internationally
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And yet…
• And yet we still arrest over 1.5 million people for drugs every
year, almost half for marijuana.
• We still incarcerate a larger proportion of our population than any
other country, with African Americans bearing the heaviest burden of
incarceration and its collateral consequences.
• Two-thirds of people incarcerated for a drug offense in state
prison that are black or Latino, although these groups use and sell
drugs at similar rates as whites.
• Congress refuses to fund sterile syringe access to prevent HIV and
hepatitis C transmission, thanks to a federal ban reinstated by
Congress in 2011
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Accidental drug overdose kills more
people than motor vehicle accidents
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Drug war violence kills thousands
• Number of people
killed in Mexico's
drug war since
2006:
70,000+
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What does the future hold for drug
policy reform in the U. S.?
• We still rely primarily on our criminal justice system to respond to
drug use, rather than seeing drug use as a health issue.
• People who use drugs are heavily stigmatized, marginalized, and
criminalized
• Popular opinion is well ahead of elected officials
• Agreement that we need to try something different
• Health insurance system is about to change dramatically
• Other countries stepping forward with new models: Portugal, New
Zealand, Uruguay, Colombia
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Harm reduction: the seat belt and
bike helmet of drug use
• Harm Reduction refers to policies, programs and
practices that aim primarily to reduce the adverse health,
social and economic consequences of the use of legal
and illegal psychoactive drugs without necessarily
reducing drug consumption. Harm reduction benefits
people who use drugs, their families and the community.
• The harm reduction approach to drugs is based on a
strong commitment to public health and human rights.
• Large evidence base for effectiveness
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Harm reduction interventions
• Sterile syringe access (needle exchange) for HIV and
viral hepatitis prevention
• 911 Good Samaritan laws for overdose prevention
• Naloxone to reverse opiate overdoses
• Opiate substitution therapy (methadone and
bupenorphine)
• Heroin assisted treatment
• Supervised injection services
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Supervised injection facilities
Drug consumption rooms
“legally protected places
where drug users consume pre-obtained drugs
in a safe, non-judgmental environment and
may receive health care, counseling, and
referrals to other health and social services,
including drug treatment.”
(City of Vancouver Four Pillars Drug Strategy)
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Research findings from Insite
• The SIF has resulted in reductions in public disorder related to
injection drug use. It is associated with reductions in public drug use
and publicly discarded syringes.
• Use of the SIF has been associated with increased uptake of
detoxification services and other addiction treatments. Drug users
who use the facility are more likely to enter detox programs,
especially if they have had contact with the on-site substance use
counselor. In Vancouver, use of detox increased by over 30% after
Insite opened.
• The fatal overdose rate decreased by 35 percent in the immediate
vicinity of Insite since it began operating in 2003, while the rest of the
city experienced a much smaller reduction of 9 percent.
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More findings
• The SIF has attracted and retained a high risk population of IDU
who are more likely to be homeless and to frequently inject heroin
and cocaine.
• Use of the SIF has been associated with reductions in HIV and
HCV risk behavior (syringe sharing) and overall injectors used safer
injections practices after attending Insite.
• Many individuals at risk for HIV and HCV infection are receiving safer
injection education at the SIF, and increases in safe microinjecting practices have been observed
• The establishment of the SIF has not not prompted initiation into
injection drug use
• Insite has not led to increases in drug-related crime
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2005 Lancet article
“This study found that IDUs who use Insite to inject drugs are 70%
less likely to share syringes than IDUs who do not use the facility. An
important finding was that IDUs who use Insite were as likely as those
who do not use Insite to share syringes before Insite opened. In other
words, the reductions in syringe sharing observed among Insite
users only occurred after Insite opened, suggesting that Insite
may have been responsible for this important behavioural change.”
Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility
use and syringe sharing in injection drug users. Lancet, 2005;
366(9482): 316-318.
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2010 Addiction article on cost
“Insite’s safe injection facility and syringe exchange
program reduce substantially the incidence of HIV
infection within Vancouver’s IDU community. The
associated savings in averted HIV-related medical
care costs are more than sufficient to offset Insite’s
operating costs.
Pinkerton S. Is Vancouver Canada’s supervised injection facility
cost-saving? Addiction, 105, 1429–1436 S
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So why do we not have supervised
injection services in the U.S.?
• Legal issues
• Political concerns
• Lack of a public health/harm reduction approach
to drug use
• What is the cost of a slow learning curve?
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Portugal model
• Health-based, social inclusion approach
• Decriminalized possession for personal use
• Increased treatment capacity
• Dissuasion Commissions
• Positive results:
– Lower HIV rates
– Fewer overdose deaths
– Reduced drug use
– Reduced crime
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What more can we do to end the
criminalization and stigmatization of
people who use drugs, provide treatment
for those who need it, and reframe our
approach to one based in science,
compassion, health, and human rights?
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Contact information
Laura Thomas, MPH, MPP
Deputy State Director, California
Drug Policy Alliance
131 – 10th Street | San Francisco, CA 94103
Voice: 415.241.9800
[email protected]
www.drugpolicy.org
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