I came across an article a few weeks ago with the heading, “Biden administration denies funding handing out crack pipes to addicts to improve ‘racial equity.'” As similar articles came out across the United States and the United Kingdom, I was immediately bombarded with questions from friends and family members who were in disbelief that the government would do something as ludicrous as giving out crack pipes. Much to their surprise, I told them that it was actually a good idea, and I was wondering why the current administration decided not to do it.
The first thing I recognized from the articles was a disturbing lack of empathy that was worsened by the media saying things like, the president wants to “dole out crack pipes to drug addicts.” This is stigmatizing language and contributes to bias against — and a lack of compassion towards — people dealing with substance abuse. Unfortunately, the media (and social media) reaction caused the president to reverse course after initially committing to a major harm reduction initiative from the Department of Health & Human Services (DHHS).
Harm reduction is an approach to substance abuse that attempts to reduce the negative consequences of a behavior as opposed to trying to change or eliminate the behavior. In other words, if a patient is not interested in decreasing or stopping their drug use, a harm reduction approach attempts to decrease their risk of overdosing or contracting an incurable viral infection. One method of doing this is to develop harm reduction kits that contain antidotes for drug overdose and that also contain clean smoking and injection supplies that can decrease the risk of infection. The DHHS initially said that harm reduction kits could include pipes for smoking drugs like crack (crack-cocaine) and crystal meth (methamphetamine), but after the media and political backlash, they decided that kits would not include pipes. The administration put out a statement that said, “no federal funding will be used directly or through subsequent reimbursement of grantees to put pipes in safe smoking kits.”
Here are a few facts:
- 75 percent of crack users shared pipes in one study.
- Sharing pipes is an independent risk factor for acquiring HIV and HCV (hepatitis C virus) infection.
- Providing clean glass pipes and rubber mouthpieces leads to less injection drug use, less HIV and HCV, and fewer health problems related to drug use.
Harm reduction does not encourage or accelerate the behavior that creates the health risks. I received a lot of arguments from people that HIV and HCV are not transmitted by saliva, but this does not reflect the mechanism of action whereby clean pipes decrease viral transmission. The point is that we know that harm reduction works, and none of the detractors that I have encountered have provided any evidence to the contrary. I think that it is a shame that the government allowed stigma and the loud noise of political opponents, online trolls, and misinformed individuals to stop an intervention that could save lives.
Bonzo Reddick is a family physician.
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