Sep 29, 2023 - Health

Blue cities rethink their embrace of progressive drug policies

A small memorial outside a Bronx day care center where a 1-year-old child died and three other children were injured after alleged exposure to fentanyl. Photo: Spencer Platt/Getty Images

Blue cities that have taken the most progressive — and often controversial — steps to tackle the nation's drug crisis are beginning to question those strategies amid rising political backlash.

Why it matters: Public health experts emphasize policies that prioritize saving the lives of drug users — like so-called safe injection sites — but the worsening fentanyl problem is testing the patience of even the seemingly most tolerant cities.

Driving the news: The Philadelphia City Council appears ready to override the mayor's veto of its ban on supervised consumption sites where people can take drugs under the watch of health workers. San Francisco Mayor London Breed proposed drug testing for welfare recipients this week, and New York City is reeling from the suspected fatal fentanyl poisoning of a 1-year-old in day care.

  • These cities are among those that have most embraced "harm reduction" measures, which attempt to thwart the harms of drug use rather than punish it.
  • New York has the nation's only supervised drug consumption sites, although Rhode Island is planning to open one next year and a nonprofit in Philadelphia has been trying to open one. The Justice Department has long opposed these sites, but the Biden administration signaled it may soften federal opposition to them, according to the AP.
  • Other states, particularly those on the West Coast, have adopted measures that decriminalize drug possession and focus instead on treatment, but those efforts are also being second-guessed.
  • "I get a feeling that the fever has broken," said Keith Humphreys, a drug policy expert at Stanford University. "I think the pushback in New York is really just the tip of the iceberg. It's emblematic of what's going on all over the country."

The big picture: Those efforts in blue cities stand in contrast to the dozens of states that have enacted tougher fentanyl crime laws and laws that allow people who supply drugs that lead to fatal overdoses to be charged with homicide.

  • Fentanyl has rocketed to political prominence as it and other powerful synthetic opioids now account for more than two-thirds of fatal drug overdoses, which top 100,000 per year.
  • Republicans frequently — and sometimes inaccurately — tie fentanyl's proliferation to the country's migration crisis.
  • Many of the local policy changes are being driven by Democrats who are under pressure from constituents concerned about a drug crisis that's increasingly visible on their streets.
  • Both parties are "starting to really come around to, in some ways, [positions] similar to the '90s, where they were kind of trying to out-punish and [compete for] who's the more punitive party. And that's definitely visible," said Leo Beletsky, a professor at Northeastern University who studies the public health impact of laws.
  • "The sort of mainstream voters see this problem and they just don't want to see it," he added. "Maybe they've given up on it being solved, but they definitely don't want to see."

What they're saying: Measures now facing scrutiny are being unfairly blamed for the worsening drug problem, some experts say.

  • "Overdoses are up everywhere. Homelessness is up everywhere. Yes, it seems like those things seem to be getting worse in states like Oregon that have these drug reforms. They're also getting worse in states that didn't do anything at all or passed tougher drug laws," said Corey Davis, a professor at the NYU Grossman School of Medicine.
  • "We're seeing that our society has a lot of challenges, but it becomes much easier to blame specific drugs or efforts to address or help people for the problems rather than thinking about those structural drivers, the root causes of what's behind homelessness and overdose," Beletsky said.

Others also expressed sympathy for people concerned about drug use in their neighborhoods.

  • "It's not that people hate people who use drugs, but they want to be able to just walk their kids to school and to park their cars and not be robbed," said Humphreys, the Stanford expert. "When they can't, they get upset, and it's right to get upset."

Between the lines: Some experts say that the way drug use and addiction is talked about has changed, but the country's approach hasn't fundamentally shifted much.

  • "Ten years ago, you didn't hear police chiefs and sheriffs saying things like, 'We can't arrest our way out of the problem.' And they do say those things these days. And there were some relatively modest changes," Davis said. "But from my vantage point, there never was a real sea change."
  • Davis was the senior author on a study published this week that found when Oregon and Washington lowered criminal charges for drug crimes, there was no effect on overdose deaths.

Yes, but: Some harm reduction measures — particularly the use of medication-assisted treatment — are much less controversial and have garnered widespread bipartisan support over the last several years.

  • "I think the things that are generating a lot of pushback are accepting open-air drug scenes, so accepting public drug use, accepting public drug dealing," Humphreys said.
  • "And there's some pushback to decriminalization. Particularly families don't buy the idea that you have to wait for someone to realize they're not self-actualizing and to walk into treatment."
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