President Biden's drug czar appeared to be on the verge of supporting a radical shift in U.S. drug control policy.
When asked for his opinion on supervised consumption sites, where users bring their own drugs to take under the supervision of trained workers in case they overdose, Dr. Gupta lit up. He said he couldn't weigh in until he caught himself.
Three years after blocking the site, the Justice Department is expected to make a decision on whether to allow it to operate. A record number of overdose deaths are caused by synthetic Fentanyl.
All of us are waiting for the department to make a decision.
The Biden administration's support for supervised consumption would be a major turning point in how the government addresses an epidemic of addiction and overdoses that has persisted for decades. Instead of discouraging drug use, such sites try to keep users from dying by providing sterile equipment and trained personnel who can reverse overdoses on the spot.
The most progressive federal drug strategy has been overseen by Dr. Gupta.
The aim of the strategy is to reduce the risk of dying or acquiring infectious diseases among drug users. sterile needles to use in injecting drugs, tools to check drugs for Fentanyl and other lethal substances, and a medication that can revive people who have overdoses are all part of a central piece. The approach is supported by Mr. Biden.
Alex Kral, an epidemiologist and drug policy expert, said that the White House support for the approach was late by a few decades.
The Centers for Disease Control and Prevention said last week that overdoses rose again to record-breaking levels in 2021, a year-to-year increase of nearly 15 percent. Black and Native American communities have been hardest hit by the surge.
According to the administration, it wants to reduce overdose deaths by 13 percent. 165,000 people could die from overdoses if harm reduction interventions aren't increased.
Some addiction experts think that Dr. Gupta is unlikely to lead the strategy. Four years ago, he was blamed for the demise of harm reduction programs in Charleston, W. Va., after he signed off on a report that criticized a heavily used site.
When he was in charge of public health in West Virginia, he supported more than a dozen harm reduction programs.
Fentanyl, not the pharmaceutical kind, but a synthetic version produced in Mexico, is a "Pandora's box" in the nation's drug supply. Small differences in quantity can mean the difference between a drug user's usual dose and one that is fatal. It is often combined with other drugs, such as meth and cocaine, to make counterfeit prescription pills.
A recent study of pills seized by the drug enforcement authorities found that a lot of pills marketed asOxyContin, Xanax, and Adderall now contain Fentanyl. A greater share of overdose deaths have been caused by Xylazine, an animal tranquilizer that can have harsh effects on humans.
Naloxone, a medication invented in the 1960s that can quickly reverse opiate overdoses, took many years to come into mainstream use in the US, with federal agencies reluctant to study and fund its use until the last decade. The F.D.A. approved a generic version of the drug. The popularity of syringe exchanges was slow to gain broad acceptance.
The nation is trying to curb overdose deaths. At an architecture firm in New Hampshire that keeps the medication on site, Dr. Gupta observed that he had become familiar with the dummies used for such demos.
The goals laid out by the drug control office show how far the office has come since it was created in 1988. The early leaders had experience in law enforcement.
One of Barack Obama's picks for the job, Michael Botticelli, was a former drug user.
West Virginia has had one of the highest rates of overdose deaths in recent decades and Dr. Gupta is the first medical doctor to occupy the position.
A professor of family and community medicine at the University of California, San Francisco said that Dr. Gupta's arrival at the White House was the culmination of the shift from the moralistic debate around drugs.
He said that it should be turned over to the doctors. The anti-shame approach is to say we love you and we are concerned about you.
West Virginia had made progress in implementing harm reduction programs despite Dr. Gupta's condemnation of the Charleston needle exchange audit. There was a large H.I.V. outbreak among people who injected drugs.
State legislators piggybacked on the report last year and passed a bill that severely restricted how syringe exchange programs could operate, calling for identification and the return of used needles. Penalties would be imposed on sites that did not comply with the new rules.
According to Joe Solomon, the founder of Solutions Oriented Addiction Response, or SOAR, there were a number of counties that didn't open their programs. They didn't have the money to fight that in their communities.
Mr. Solomon stated that Dr. Gupta was benefiting from a more comfortable political environment in which to promote harm reduction.
He called him "reformed" after pushing him to support harm reduction.
He sees the need for harm reduction. We need to put all the tools out because of the crisis.
The social and economic causes of addiction, especially among the poor, have been illuminated by the experiences of Dr. Gupta.
Many states and cities are just starting to talk about the benefits of harm reduction. In a recent analysis of overdose deaths, the Centers for Disease Control and Prevention found that only a small percentage of the cases had been administered with the antidote. He is trying to get the FDA to allow the sale of the drug over the counter.
In Salt Lake City and Kentucky, local health departments have taken up needleexchange programs.
The director of Kentucky's drug control policy office pointed out that there are more than 80 such programs statewide. He said that local health officials had to take uncomfortable positions with the same people.
During a visit to Maine's state prison, Dr. Gupta praised a medication treatment program for opiate addiction, another aspect of harm reduction efforts that addiction experts say is critical to stemming overdoses among the incarcerated and after release.
The Biden administration has adopted a consider-everything attitude. There are restrictions on the use of buprenorphine. Fentanyl test strips, which can be purchased with federal grants, are a tool that should be more widely used.
He said that they don't know there's a new contaminant. They will die at that point. Is that right? Is that correct.
The Justice Department's decision on supervised consumption could allow sites to function without fear of being disrupted by federal authorities. The White House may be able to publicly endorse the option.
The Department is evaluating supervised consumption sites, including discussions with state and local regulators about appropriate guardrails for such sites, as part of an overall approach to harm reduction and public safety.
As the first authorized sites opened in the United States last November, Dr. Gupta warned that research on supervised consumption sites in the United States was almost completely useless. In a review of 22 studies from other countries, it was found that such sites may reduce the risk of overdose and morbidity and improve access to care.
As overdose deaths reached once-unthinkable levels, many Republican governors and state legislature became more receptive to needle exchanges. They and medication-assisted treatment were supported by the Trump administration.
Fentanyl strips are gaining acceptance in some conservative states but remain illegal in others. A recent uproar about so-called "crack pipes" in a harm reduction grant program shows how the idea can be weaponized politically. Supervised consumption sites are still lightning rods.
The National Drug Control Strategy, which Mr. Gupta oversees, was the subject of a recent Senate hearing.
The phrase "harm reduction" was used almost 200 times in the new strategy.
The advocates of harm reduction say that Dr. Gupta needs to push for more federal grants and that lawmakers should remove a restriction on using federal money to purchase needles for needle exchanges.
The first federal grants for harm reduction groups, a $30 million program funded by the American Rescue Plan, were far from what is needed to keep organizations afloat. Lauren McGinley, the executive director of the New Hampshire Harm Reduction Coalition said, "Not receiving a grant means we all dedicate a lot of time that could be spent on way more impactful work fund- raising for the long list of supplies we can't use state or federal funds for
Jessica Parnell said her group relies on charity gaming funds to pay for the number of needles she needs. She started offering glassware in safer smoking kits and expanded the number of days it served people.
She said that it had gone off. It is safer to use an alternative to injection than it is to use it.
There is a harm reduction program in the trunk of her car that she offers to the community: sterile water, clean cookers, condoms, Band-Aids, and fentanyl test strips. She said that the better the odds of people coming back, the more local the operation is.
She said that they want to be humans regardless of the decisions they make.
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