Crack pipes are the least interesting part of Biden’s new drug policy

I saw an example of this kind of policy firsthand when I visited one of the first legal drug consumption sites in the US, at a former needle exchange in east Harlem. I watched a man inject heroin, mixed with fentanyl, in a private booth right in front of me

Medication to treat overdoses are arranged on a cart inside a a supervised drug-injection site in Harlem, New York. (Richard Hall / The Independent )

Every so often, someone in a position of authority will summon the courage to implement a drug policy that is based on evidence, rather than fear. Invariably, that effort is met with moral panic and cries of societal decay.

And so it was this week, when two such policies aimed at reducing harm to drug users prompted a wave of outrage from conservative media.

The first was an announcement by the Department of Justice that it was evaluating the use of supervised drug consumption sites — that is, in simple terms, sites supervised by trained staff where drug users can consume illegal drugs without fear of arrest. The second was a few words in a report from the Department of Health and Human Services (HHS) that said funding was available for programmes that included “safe smoking kits/supplies.”

Both policies, apparently discovered on the same day in the same corner of the internet, made headlines on Tuesday across conservative media, including segments from Fox News talking heads Tucker Carlson and Sean Hannity.

“Joe Biden’s latest idea is to pay Black people to smoke more crack,” was how Carlson described it.

"You bring the drugs, Uncle Sam has the needle,” read another Fox News chyron.

The smoking kits in question have been available for years to drug users outside of government-funded programmes. They can include glass stems, rubber mouthpieces, brass screens, lip balm and disinfectant wipes. Their use is aimed at encouraging safer drug use by avoiding the need for sharing, which can prevent the spread of diseases like HIV and Hepatitis C. Using brass screens lowers the risk of lung issues by reducing the amount of debris that is inhaled.

In any case, the White House later denied that “crack pipes” were part of any HHS funding proposal. HHS secretary Xavier Becerra released a statement declaring that “no federal funding will be used directly or through subsequent reimbursement of grantees to put pipes in safe smoking kits.”

The supervised injection sites, also called “overdose prevention centres,” are the result of years of lobbying by drug campaigners and success stories from Canada and Europe. The first of its kind opened in New York in November, and despite technically operating in violation of federal law, the city said it has been working closely on it with the Justice Department.

Taken out of context, these measures may indeed seem extreme — but context is important. The rapid rise of the synthetic drug fentanyl in America’s drug supply has poured rocket fuel on an already deadly opioid crisis. Last year, a record number of Americans died from drug overdoses. More than 100,000 people lost their lives in the 12 months prior to April 2021.

A crisis this extreme requires new ideas. To the people working on the frontline of the opioid epidemic, these measures are long overdue, and essential for saving lives.

I saw this firsthand when I visited one of the first legal drug consumption sites in the US, at a former needle exchange in east Harlem. I watched a man inject heroin, mixed with fentanyl, in a private booth right in front of me. He found a vein with a tourniquet provided by the centre, and a needle too. He was watched over by trained staff who were ready to intervene in the case of an overdose.

In the two months since it opened its doors, the east Harlem site and its partner location in Washington Heights have intervened in 134 overdoses — 134 lives that could have been lost if they were out on the street. The centre also had straws for sniffing drugs and a smoking room at the back.

In the abstract, or on the nightly news, providing drug paraphernalia to users may seem radical. Here, in this small room, it felt the opposite. It felt humane and caring. It felt normal. In a society that has for so long treated addicts as though they are disposable, it felt like a corner had been turned.

When this latest round of moral outrage erupted, I called Sam Rivera, the executive director of OnPoint NYC, which manages the safe injection site in east Harlem. He has spent 30 years working in the fields of drug addiction and HIV-AIDS prevention, and lived through several similar panics.

“Early in the 90s when I started this work, even giving out condoms was judged,” he told me over the phone. “They said ‘You’re telling kids to have sex by giving condoms out in schools!’ Oh yeah, like we needed to tell them that. No, we’re giving them the right tools to stay alive.

“They are spinning it. They are making it seem like [the Biden administration] is supporting the use of crack. No, people are using. That’s a fact. These supplies give us an opportunity for them to use safely until they are ready to stop,” he added. “We meet people where they truly exist, and not this place where people want to place them.”

This is the central idea behind the Biden administration’s new drug policy. Rather than forcing drug users into the shadows, it places an emphasis on harm reduction. It accepts that drug users exist, and tries to keep them alive. In the process, it brings them into contact with rehabilitation services and addiction counseling.

As I was leaving the east Harlem clinic, one staff member said something that stuck with me. “The least interesting thing that happens in this room is the actual drug consumption,” she said.

I will echo her words: A little glass pipe is the least interesting thing about this new approach to drug addiction.