Last summer, the Biden administration took a bold step by allocating funding in the 2022 budget specifically for harm reduction services. For harm reduction advocates, this signaled a positive shift toward broader political support of harm reduction as a vital public health tool. Unfortunately, when pressed to defend harm reduction, the Biden administration has not answered the call.

Faced with unfounded criticism about the types of harm reduction supplies and services allowed to be purchased with the money from the 2022 budget, the Biden administration chose to fold to critics rather than stand firmly in support of all forms of harm reduction. Although Press Secretary Jennifer Psaki stated that crack pipes were never a part of the safer smoking equipment referenced in the grant application for harm reduction funding, the administration signaled they are not fully committed to harm reduction strategies by denouncing them as a harm reduction tool. If harm reduction is going to succeed as a public health tool, leaders must embrace all forms of harm reduction, not merely the ones that are politically convenient.

Despite definitive evidence that harm reduction strategies improve public health, many harm reduction strategies are still controversial. That is one reason why it was so important that the Biden administration took a stand for harm reduction by creating this grant program. However, there are several ways that the administration can be a better champion for harm reduction.

First, the administration should craft more uniform messaging related to harm reduction. Rather than extolling the benefits of harm reduction only in reference to the opioid epidemic, the administration should stand behind harm reduction for all drugs and risk behaviors. Similarly, this messaging should demonstrate that harm reduction is not exclusively for people who use drugs. Harm reduction is all around us. Prescription drug take back programs, designated drivers, wearing personal protective equipment, mandatory motorcycle helmet laws, smoking cessation programs, using condoms and drinking less soda can all be considered harm reduction. Normalizing harm reduction as something everyone does will make talking about harm reduction for people who use drugs less controversial. From a policy standpoint, if the administration does not lead the way with harm reduction, then states and localities will not feel empowered to expand harm reduction services. Leading with their messaging is perhaps the simplest way the administration can take a stand for harm reduction.

There are several other actions the administration can take to show their support of harm reduction. One important policy that the administration could change is the prohibition on syringe services programs using federal funds for purchasing sterile syringes or needles. Doing this will help syringe services programs operate, as many of them run on small budgets. It will also signal to states and localities that the administration is in support of expanding access to sterile syringes.

Another barrier to expanding harm reduction services is federal statute 21 USC § 856 of the Controlled Substances Act, colloquially known as the “crack house statute.” This statute is interpreted as the law that prohibits overdose prevention centers at the federal level. Several cities are in the process of opening overdose prevention centers; however, the uncertainty of their legality at the federal level is slowing the process. As a first step toward clarifying the legal status of overdose prevention centers, the administration can encourage Congress to convene a taskforce to explore the best way to repeal or amend 21 USC § 856. This taskforce should consist of multiple stakeholders from public health, public safety, legal and medical backgrounds, as well as advocates for people who use drugs. The administration throwing their weight behind exploring repealing or amending 21 USC § 856 would signal strong support for expanding harm reduction services in the United States.

Finally, the administration can support harm reduction efforts by endorsing strategies that go beyond harm reduction for opioid use. Smoking is another health behavior where harm reduction strategies can be employed. Causing more than 480,000 deaths annually in the United States, combustible cigarettes are one of the most harmful products available. However, the advent of reduced-risk tobacco products, such as nicotine pouches, e-cigarettes, snus and heat-not-burn products, allows smokers to transition to less harmful products if they cannot or do not want to abstain completely from using nicotine. Supporting policies that give smokers less harmful ways to consume nicotine is another way that the administration can signal their support for harm reduction as a key strategy for protecting public health. Specifically, the administration can encourage risk-proportionate taxation of tobacco products rather than tax equalization and work with the Food and Drug Administration to ensure that reduced-risk tobacco products remain available for adult smokers in a way that protects public health.

The administration has taken unprecedented steps to advance harm reduction as a public health strategy. Yet their inconsistent support of various forms of harm reduction chips away at the foundation they have laid. By being steadfast in their messaging around harm reduction strategies and supporting the expansion of harm reduction services, the Biden administration can build a stronger public health framework and save lives.

Image credit: Matthew

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