Earlier this month, an article about government support of harm reduction services set off a wave of hysteria (Washington Free Beacon). Conservative media outlets honed in on a provision in an overdose prevention program from the Substance Abuse and Mental Health Services Administration that mentions funding for “safe smoking kits” (HHS). A furor ensued about the Biden administration providing “government-funded crack pipes.” When questioned by the press, the Health and Human Services Secretary Xavier Becerra and the Office of National Drug Control Policy Director Dr. Rahul Gupta released a joint statement that said that “no federal funding will be used directly or through subsequent reimbursement of grantees to put pipes in safe smoking kits” (HHS). Though this is false, harm reduction services are a life-saving intervention.
I am a person with a substance use disorder who has been practicing abstinence for quite some time. Sloppy reporting like this is always alarming to me because I recognize that the majority of people who use drugs are not going to stop immediately and criminalization leads to unnecessary illnesses and death.
Safe smoking kits are another example of harm reduction, the principle of meeting people who use drugs where they are at instead of criminalizing drug use. A harm reduction approach insists that people who use drugs get the supplies they need to be safe. This can mean clean syringes to prevent the transmission of bloodborne diseases, safe snorting supplies (which also reduce disease transmission), Narcan and naloxone (which reduce overdoses), and supervised consumption sites like the one that just opened in New York City (NY Times). It is also important to note that opioids cause physical dependence, and many users need a medically-supervised detox should they choose to stop. Some harm reduction activists also argue that there is a need for total legalization of drugs and access to a safe supply, particularly in the wake of the fentanyl crisis (Time).
According to Erica C. Ernst, the interim executive director of Chicago Recovery Alliance, a safe smoking kit contains two crack pipes, a push stick, two alcohol pads, a mouthpiece, and some chore boy (a copper scrubber that is used to create a metallic filter inside of a crack pipe). These clean supplies ensure that crack cocaine users don’t contract diseases from others. However, Ernst also pointed out that no federal funding can be used to purchase crack pipes for safe smoking kits. And CRA has tried.
Ernst said, “They will not fund it. We have not used the funding to purchase them. We cannot; they forbid it.”
Ernst also argues that maybe the government should support crack pipes for safe smoking kits. “Safe smoking is a harm reduction tool because of Covid, Hep-C, and any bloodborne or respiratory pathogen. If you are sharing a crack pipe, you can share Hep-C. You can burn your mouth and share. You can also use a crack pipe to step down from injection, which can lead to abscesses,” she told The ARD.
There’s an irrational cultural narrative that “hard drugs” can never be used responsibly, though moderate consumption of alcohol, an addictive and potentially lethal drug itself, is seen as unproblematic. “Maybe your use isn’t negatively affecting your life. That’s for you and your circle to decide. If one day you’re like, ‘hey, this is kind of getting in the way of my life, then maybe you do need to make some changes.’ I’m a firm believer that not all drug use is problematic,” said Ernst.
Just like illegal drugs are viewed entirely differently than alcohol, drugs associated with BIPOC and poor people are stigmatized the worst.
Crack and cocaine have no pharmacological difference (Drug Policy Alliance). Once inside the brain, crack and powder cocaine are identical. But crack is more stigmatized and punished more severely since it’s associated with working-class Black and Brown people It’s not a coincidence that conservative anger at harm reduction services took the form of outrage against “government-funded crack pipes” in particular.
Ernst said, “It’s super racist to say that we can’t hand out ‘those supplies’ to ‘those people.”
To sum it up: the federal government is not allowing crack pipes to be purchased with harm reduction funds. But maybe they should. Safe smoking is harm reduction and can save lives. The hysteria around so-called “government-funded crack pipes” is racist.
Millions of Americans use substances of some sort. Punitive laws, criminalization, and incarceration didn’t prevent many people from starting to use illegal drugs, and more criminalization won’t make them stop using drugs tomorrow. Forcing people to do so in unsafe, unsanitary, and sometimes fatal ways is indefensible when there’s an alternative. Supporting harm reduction organizations and carrying Narcan to stop opioid overdoses you witness is a matter of life and death.
Harm reduction organizations can’t buy crack pipes with federal funds.
Offering safe smoking supplies is effective for reducing disease transmission and injury, such as burns from pipes.
Harm reduction is an effective drug policy. Policies that push abstinence and criminalize drugs are ineffective and rooted in racist beliefs.