'Crack pipe' rhetoric is not only wrong, it's deadly. Harm reduction efforts save lives.

The backlash and firestorm from the right has been disturbing.

When the Biden administration stopped accepting applications on Feb. 7 for its harm reduction program that pays for, among other things, "safe smoking kits," some conservatives took to social media with sky-is-falling rhetoric.

The program amounted to crack pipe distribution "to minority communities in the name of 'racial equity' " according to Sen. Marco Rubio, R-Fla. Similar sentiments circulated on social media from other members of the Republican Party, conservative commentators and, eventually, some of the American public.

These claims, of course, were proven untrue. Smoking kits, and other items distributed through the grant program, include hygienic supplies that help individuals who used controlled substances remain safe. These public health strategies are at the heart of the grant program, not crack pipes.

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But beyond the false rhetoric and racist undertone is a sad and dangerous truth – misinformation on this topic is not only disquieting but also potentially deadly.

Addressing overdose deaths 

Smoking safety kits have shown promise in reducing smoking-related disease transmission and health problems. 

In December, with little fanfare and little public attention, the Department of Health and Human Services announced that it had set aside $30 million for the grant program to help tackle our country’s devastatingly high rate of overdose deaths.

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Our nation’s overdose numbers have reached record high crisis levels. And past approaches to treating addiction with prison and punishment have failed. In an effort to improve our nation's fight against addiction, the administration pledged to devote modest funding to services predicated on fundamentals of harm reduction. These programs allow treatment providers to work to mitigate the dangers of substance use, rather than demand abstinence. Since December, the program drew little notice – until this month.

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Some of the outrage has certainly stemmed from decades of misguided messaging on what can safely reduce drug deaths and end addiction. President Joe Biden is attempting to replace "just say no" with smarter, evidence-based strategies.

Headlines chastising the Biden administration were off the mark. And the kits, as effective as they can be, are one small piece of the program. 

Harm reduction can also include overdose prevention in the form of safe injection sites. The nation's first official site opened last November in New York City and has saved lives, but was also met with backlash.

These sites are dedicated spaces where people can use drugs under the supervision of trained medical staff. Communities around the world are finding them to be a powerful way to reduce overdose deaths and connect people who use drugs with trusted treatment providers. More than 120 such sites are open in nearly a dozen countries. Although people consume potentially fatal drugs in these spaces, not one has ever seen a single overdose death, according to the Drug Policy Alliance. 

This grant program covers a wide array of supplies, including clean needles, which serve a comparable purpose for heroin users as pipes do for meth and crack users. 

But headlines and outrage focused on crack – long connected in the public consciousness with Black Americans and violent crime. That focus undoubtedly wasn’t about the danger of the drug but about stoking false associations and fears. And these alarmist tweets and headlines obscured a far more important question. The nation should have been asking: Will the Biden administration's program ultimately reduce suffering, avoid illness and save lives?

Much of the evidence indicates that it will.

Alternative to failed policies

A 2019 report found that when crack users in Mexico City were given safe smoking kits, they became less likely to use pipes made from toxic materials or to share paraphernalia. Winnipeg, Canada, was distributing safe smoking kits as far back as 2004, and a study published in 2015 found that the program contributed to a significant drop in Hepatitis C transmission. 

Withholding these resources will not stop people from using drugs. It just stops them from using safely.

The “just say no” approach has been a colossal failure. In the decades since the war on drugs began, the number of people who die annually from drug overdoses has grown by a mind-boggling 1237%. Harm reduction services help people stop using drugs by enabling them to build trusting relationships with treatment providers and find the daily stability they need to consider treatment.

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Some critics opine that harm reduction strategies will encourage more people to begin using or lead to other adverse consequences– but the evidence indicates that this is not happening in communities embracing harm reduction. In fact, a study of one of the first overdose prevention sites in Vancouver, Canada, found that overall overdose rates in the surrounding neighborhood decreased 35% after the site opened, compared with only 9.3% in the rest of the city.

Drug use is driven by a complex set of factors – many of them social, emotional and economic. But it does not appear that people are encouraged to use by the promise of safe spaces or safe equipment.

The alternative to decades of failed policies can be found in dedicating resources to things like smoking safety kits, safe injection sites and other public health-based strategies.

It's time to chart a new way forward. Let's not accede to overblown headlines and misinformation that will cost lives.  

Miriam Aroni Krinsky, executive director and founder of Fair and Just Prosecution, is a former federal prosecutor.