Use the right tools in the right ways to address the opioid epidemic

Use the right tools in the right ways to address the opioid epidemic
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As policymakers grapple with next steps in responding to the opioid drug crisis, it’s common to hear concerns that “harm-reduction strategies,” such as needle exchange and safe-injection sites, only encourage continued drug use. These approaches, some argue, should be combated with good, old-fashioned law-and-order.

The reality is that addiction to heroin means the drug user is well past the point of being “encouraged” in their drug use. Addiction, by definition, means users continue the behavior despite its harms. So safe-injection sites and needle exchange, far from encouraging additional use, only transition unsafe to safer use, providing users more time to make the choice for sober living.


One argument against safe-injection sites is they attract drug-dealing and other forms of criminal behavior. Both of these arguments are refuted by data from Vancouver, Canada’s long-standing safe injection site. There, the site created huge reductions in ambulance calls for overdoses, HIV infections, injection-related infections and overdose deaths, with no increase in arrests for drug trafficking, assault or armed robbery.

From this and other studies, we know that users who are connected to harm-reduction services are much more likely to enter drug abuse treatment than those who are not, saving both lives and money. 

Another argument against harm-reduction approaches is they send a message that the government condones drug use. On the contrary, I would argue it sends the message that the government cares about its most vulnerable citizens and is managing our resources wisely. Government-sponsored facilities are not enticing teenagers to try heroin. New users come to opiates because of the drugs’ ability to make physical and psychological pain go away, not because of access to paraphernalia.

Addiction researchers have done great work on policies that are beginning to succeed in preventing new users from entering the epidemic. For starters, physicians have curbed over-prescription of opiate medications. This change in prescribing behavior has reduced the number of people who begin on prescription opioids, then switch to heroin. The death rate from prescription opiates has been flat for some time, but unfortunately street drug deaths continue to rise.

Public messaging about the dangers of these drugs is also successfully discouraging new use. When I talk to students on the campus where I teach, the consensus is “heroin is dangerous, everyone knows that!” For now, the message is successfully out, we just need to keep sending it.

The most hopeful thing about the opiate epidemic is the bipartisan, multi-faceted way that our country is coming together to solve it. We agree it is a public health crisis and that more drug treatment resources are needed. It is now time to apply our various tools in the right places. Law enforcement, treatment and harm-reduction tools must be used wisely.

Strict law-and-order approaches make the most vulnerable citizens feel even more marginalized and devalued. Therefore, law-enforcement efforts are best targeted at reducing supply to protect new experimenters who might try heroin recreationally. A teenager who can’t get heroin won’t be able to try it for the first time.

Data from Australia from the late 1990s and early 2000s shows that reduction in supply led to steep declines in both new user initiation and arrests for drug possession, with the steepest declines among the youngest users. Shutting down suppliers and their delivery chains is the place to employ our justice system.

Harm-reduction strategies are needed for truly addicted users, to keep them alive until they get into treatment. Once they are ready, treatment services must be in place. The federal government and many states have promised funds for more treatment services. Our medical schools and counseling programs must provide more training in addiction. Communities must support those in recovery and provide opportunities to build a better, drug-free life.

It’s time to approach the epidemic with all the tools at our disposal and a clear-eyed view of where and when they should be deployed to do the greatest good. Let law enforcement work on suppliers; let harm-reduction efforts keep people alive and keep the side effects of addiction to a minimum; and let treatment efforts work to return our citizens to productive, meaningful lives.

Nicole Schramm-Sapyta Ph.D. is an addiction researcher at Duke University and chief operating officer of the Duke Institute for Brain Sciences.