It’s been two years since New York City became home to the nation’s first legally sanctioned supervised consumption program, where people can take illicit drugs like heroin, crack and methamphetamine under medical supervision. By many accounts that program is thriving. More than 1,000 potentially fatal overdoses have been reversed and many people who use the facilities have been connected to support services, including addiction treatment.
In May, the National Institutes of Health allocated several million dollars for a long-term study of the program; and Minnesota has since become the second state (after Rhode Island) to clear a path for similar programs.
But that momentum is being undermined by an outdated federal law known as the crack-house statute, which makes even state sanctioned programs technically illegal because it prohibits owning, renting, leasing or operating any premises for the purposes of storing, using or selling illegal drugs. That has produced mixed messages from Washington, where health researchers think the program has real promise, while law enforcement authorities want to shut it down.
In August, just months after the N.I.H. grant to study the program, a federal prosecutor threatened to close its doors. The threat has so far come to naught, but experts say the resulting confusion has had a chilling effect. In Seattle and San Francisco and Boston and elsewhere, promising efforts have been put on hold as health officials and supervised consumption proponents wait for clarity.
Even in New York, uncertainty and divisiveness reign. Gov. Kathy Hochul has refused to allocate funds for supervised consumption, despite pleas to do exactly that from her own opioid settlement fund advisory board.
When one federal agency issues millions in grant money while another talks about forced closings, it’s difficult for even the most enthusiastic proponents of supervised consumption to know quite how to proceed.
Lawmakers should clear up this confusion, and the Biden administration needs to help.
President Biden and his administration have made important strides against the nation’s addiction and overdose crises. The administration has created new rules (and stepped up enforcement of existing ones) meant to improve health insurance coverage of addiction treatment. For the first time in decades, Biden officials have tipped the scales of federal investment away from criminalization and toward treatment, prevention and harm reduction (another federal first). They have also begun to assert and defend the rights of people who need treatment to receive it.
These are not, as the president’s critics have claimed, feeble attempts to pander to a pro-drug left. They are evidence-based solutions to a public health disaster that has already cost the United States trillions of dollars in economic fallout and more lives in the past 24 years than all its many wars combined. They are careful, crucial steps away from the nation’s failed, shameful — and in many cases overtly racist — war on drug users.
There are many ways the administration can build on the progress it has already made. One important move would be to address the 1986 crack-house statute. Mr. Biden himself was the author and chief architect of this law, which was enacted at the height of the crack epidemic when he was a senator from Delaware.
It was not a difficult statute to justify back then, when so-called crack houses proliferated in low-income communities and communities of color. But as advocates and some health officials try to expand harm reduction initiatives — to bring drug use indoors and to curb the nation’s unprecedented rate of overdose fatalities — this old law is doing more harm than good. As long as the statute remains in effect, anyone who operates a safe consumption facility, or funds one, or leases a building where one is situated, risks federal prosecution and more. (The law allows authorities to confiscate property and freeze institutional funds.)
Some people may disapprove of them, but supervised consumption sites are not nearly the same thing as crack houses. They employ trained staff members, work with health departments and the local police, routinely reverse overdoses, and make strenuous efforts to connect drug users to treatment and support. Crack houses, in contrast, are places where dealers and users gather to buy, sell and use drugs — nothing more.
Much more is needed for supervised consumption to succeed in the United States: money, infrastructure, willing partners in government, support from prospective communities. But the first step to securing any of those resources is to clarify federal policy.
Congress should repeal the crack-house statute. In the meantime, the president should issue a statement of nonenforcement similar to the one that President Barack Obama did for medical marijuana. He can say explicitly that a safe consumption site is not a crack house and that he will give the federally funded researchers a chance to do their work.
He would have to face down the usual critics, to be sure. But he would be armed with reams of evidence, and plain reason: Supervised consumption can save lives, is worth trying and in any case is already happening, not only in New York, but in towns and cities across the country. Those existing programs will be safer, more effective, and better regulated if they are free to come out of the shadows.
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