That years of research back this approach and that other wealthy nations around the world have successfully tried it for decades shows just how far behind the U.S. is in its approach to drugs.
Consider needle exchanges, where people can get new syringes for drug use and discard used needles. These have been legally operating in parts of the U.S. since at least the 1980s with proven track records. Yet much of America remains reluctant to allow needle exchanges at all.
A needle exchange program, based on the empirical evidence vetted separately by Johns Hopkins researchers, the World Health Organization, and the Centers for Disease Control and Prevention, should be one of the least controversial ideas in public health. For decades, studies have repeatedly found that needle exchanges help prevent the spread of diseases, such as HIV and hepatitis C, that can spread through used syringes, while not increasing overall drug use.
Yet in Lawrence County, Indiana, officials decided to end their program. That wasn't due to any new scientific evidence. Instead, it seemed to be due to a wrong view that addiction is a moral failure rather than a medical condition — contrary to what most major medical organizations say. County Commissioner Rodney King, who voted against the program, told NBC News, "My conclusion was that I could not support this program and be true to my principles and my beliefs." He quoted the Bible before casting his vote.
If parts of the U.S. aren't willing to accept even a needle exchange, it's hardly surprising that there's a struggle to get supervised drug consumption rooms up and running in much of the country, no matter how much evidence there now is for them.
The same applies to other policy interventions for the opioid epidemic. Naloxone is an opioid overdose antidote that can literally save lives, yet in many states it can be hard to get because it requires a prescription — a big problem when an overdose can kill someone or do serious damage in minutes. Prescription heroin programs allow people to obtain a safe source of heroin instead of street drugs that can be laced with who knows what, and there's evidence from Canada and Europe to support them — but there's no serious discussion in America about trying them here.
Even the gold standard for opioid addiction treatment remains mired by stigma and old thinking. Medications like methadone and buprenorphine are proven to help a lot of people overcome their opioid addictions, with studies showing they cut all-cause mortality among opioid addiction patients by half or more. And the medications are backed by health groups like the Centers for Disease Control and Prevention, National Institute on Drug Abuse, and World Health Organization.
Yet it's common to see public officials and politicians malign the medications. Former Health and Human Services Secretary Tom Price, for one, argued that medications like buprenorphine are "just substituting one opioid for another."
This is a popular misconception, but it misunderstands how addiction works. The problem with addiction isn't necessarily drug use. Most Americans, after all, use all kinds of drugs — caffeine, alcohol, medication — with few problems. The problem is when that drug use begins to hurt someone's day-to-day function — by, say, putting his health at risk or leading him to steal or commit other crimes to get heroin.
Medications like buprenorphine let people with drug addiction get a handle on their drug use without such negative outcomes, stabilizing the dangers of addiction, even if the medication needs to be taken indefinitely.
This problem comes up again and again with addiction: It's not that the evidence isn't there for a policy or medical intervention, but rather that stigma and old thinking outweigh the evidence in people's minds.
"Some of it is we've had this war on drugs going on since [President Richard] Nixon," Davidson of the University of California in San Diego told me. "A huge amount of effort has gone into a particular way of dealing with drugs in society. There's a lot of institutional inertia around that. So suggesting something that, on the face of it, goes completely against what we've been trying to do for the last 40 or 50 years, people are going to push against that — particularly the people who have been doing this for years. People can be very slow to change their minds about things."
Until that changes, policy interventions that seem like common sense based on the evidence will continue to struggle to gain a foothold in the U.S. — and America will continue to fail to adopt even the bare minimum of harm reduction and treatment, much less try truly innovative ideas. So more people will die of drug overdoses that could have otherwise been prevented.