Modest Advance on Drug Harm Reduction

Unable to quell a steep increase in overdose deaths, New York City has opted to create a Municipal Drug Strategy Advisory Council that will include drug users and propose new policies and pilot programs that could save lives and give a helping hand to beleaguered opiate users.

However, the new inter-agency body, with community participation, will exert its influence only through moral suasion. The evolution of this new Advisory Council –– which under early proposals would have taken the form of a mayoral office with formal policy-making authority –– demonstrates that the stalemate on drug policy and reform here remains unbroken. New York City policy continues to careen between a prohibitionist reliance on criminal law and a public health focus on harm reduction and compassion. Sometimes, the city takes from column A, other times from column B.

It was neither the mayor nor the City Council that announced the new Advisory Council but rather harm reduction advocates.

“We are looking for an approach that is a bit more holistic,” said Alyssa Aguilera, the co-executive director of VOCAL-NY, in a phone interview. “The health department is doing harm reduction while the police crack down often on the same block.”


Joining Aguilera in pointing to the Advisory Council’s potential was Peter Schafer of the New York Academy of Medicine.

“We hope to see a more supportive and less punitive approach coordinated across the city agencies,” said Schafer, who is the Academy’s deputy director for Family Health and Disparities.

In a prepared statement, Schafer focused not on heroin users entering rehab to kick their drug habit but rather on “improving” drug users’ “health and well being,” and diminishing the punitive impact of anti-drug laws and stigma that force users “to hide their drug use issues” fearing “negative repercussions” from city agencies. Official opprobrium, he emphasized, is the greatest obstacle to successfully curbing the overdose crisis.

Advocates for community medicine want city decision makers to accept the obvious: drug users will always be here so just get used to it and adapt policies so they are consistent with that reality. Basing policy on the assumption that a person can only be helped if they enter treatment means the crisis continues with people shot, in jail, or bereft of breath dying from an overdose.

Police officials, of course, believe they are protecting the public by reducing supply, but recurrent crises –– whether cocaine, crack, meth, or heroin –– argue that prohibition doesn’t work.

Meanwhile overdose deaths have skyrocketed.

Looking at the surging overdose pattern overall in the US, Dr. Dan Ciccarone, a professor of Family and Community Medicine at the University of California at San Francisco, said, “It’s the steepness at which it’s climbing” that is “horrible.” Preliminary numbers for 2016 suggest “overdose deaths are growing at a rate comparable to the height of the HIV epidemic,” according to an Upshot report in the New York Times.

Here in New York, drug deaths have grown in every year since 2010. This has not always been the rule. From 2006 until 2010, overdose deaths declined an average of 22 percent a year, but after 2010 a dramatic reversal occurred. By 2012, deaths had risen from 541 to 730. Last year, the health department said, drug deaths totaled at least 1,075. That number is greater than the combined toll from homicides and vehicular accidents.

In 2015, Corey Johnson, the City Council Health Committee chair, introduced legislation creating a Mayor’s Office of Drug Strategy to create a coherent policy that bridged the yawning gap between prohibition and public health strategies.

The original bill would have created a full-time staff backed by the authority of the mayor’s office to forge a unified policy across all city agencies. Drug users and harm reduction workers in needle exchanges would have met agencies like the Police Department and the Housing Authority on an equal footing. Staff from the mayor’s office would have been responsible for drafting reports and negotiating policy.

That proposal died, and an Advisory Council with no full-time staff replaced a Mayor’s Office. The mayor, under the Advisory Council’s authorizing legislation, “will designate an agency or an office to prepare” short and long term plans and recommendations, but staff will carry out this work in addition to their existing duties. A report out of the City Council Committee on Mental Health, Developmental Disabilities, Alcoholism, Drug Abuse and Disabilities makes clear that no funding has been established for the Advisory Council.

The good news, however, is that there is a requirement that the Advisory Council consult with “stakeholders,” including harm reduction and treatment programs and drug reform organizations. The radical step here is that stakeholders must include “persons directly affected by drug use, persons formerly incarcerated for drug-related offenses, and experts.” Drug users and former drug users will have a seat at the table.

The last time opiate users died in large numbers from an epidemic was during the early years of the AIDS crisis. In response, an innovative prevention strategy radically curtailed new HIV infections by making sterile needles available to users. HIV prevalence rates among injecting drug users fell precipitously from 50-60 percent to just 5 percent. That success demonstrated that drug users are not obsessively self-destructive; using new sterile needles became routine for them.

Drug reformers today emphasize peer outreach and desperately want to see supervised injection facilities established, where a nurse would be on hand if a user overdoses. Many needle exchange programs are eager to fold this service into their existing programs.

If the modest Advisory Council approach the city finally embraced fails to produce new policies, it could mean another six years of New Yorkers dying preventable deaths — a sign we learned nothing from the AIDS crisis, where the unthinking blamed gay men’s sexual habits rather than finding ways that allowed men to have sex without transmitting the virus.