Let’s give out heroin, for free, to anyone who wants it. This is not a provocation meant to make you gasp or to elicit angry clicks—rather, it’s a proven strategy for reducing the harm of opioids that’s already in use in several countries across the globe. We face two drug-related crises in the United States. The first we can all agree on: Drugs are killing people at unprecedented rates. Over 90,000 people die each year from overdoses in the US, an amount that has quintupled since 1999. The second crisis is disputed, but no less deadly: Our drug policy leaves people to fend for themselves, while we waste time and resources.
The carceral solutions don’t work, and yet we continue to spend billions of dollars a year on the War on Drugs, attempting to arrest our way out of a public health crisis. But even as some politicians try to shift funding away from policing and prisons, the non-carceral solutions that take their place—sending people to rehab and detox—are neither scientific nor effective. In fact, these abstinence-based programs don’t just fail to stop the worst outcomes; they greatly increase the risk that opioid users will die. Statistically, it’s safer to keep using opioids than to go to rehab.
If we want to save hundreds of thousands of lives, we cannot assume that forcing people to stop consuming drugs is the only way forward for everyone. The idea that abstinence works is more about our fear of drugs than it is about science: Rehab programs have an abysmal success rate.
Instead, we must look at the facts. People use opioids like heroin because they are in pain, whether emotional or physical, and until that source of pain is addressed, drug use will continue. It’s easy to blame Purdue Pharma for the current crisis, and needless to say, it played a part. But Purdue did not shut down factories in the Rust Belt, render millions of American workers jobless, cause our wages to stagnate for 50 years, or start wars that left tens of thousands of returning veterans injured, traumatized, and alone.
Until we remedy the trauma of living in our current moment, we must acknowledge that people will seek out drugs to quell their pain. And once we acknowledge this, we must follow the best available science to ensure that drug use is as safe as possible.
For people who want to get off heroin and other opioids, opioid-assisted therapies have proved to be the most effective solution. Giving drug users buprenorphine, a partial opioid agonist (meaning it satiates the opioid receptors in your brain but doesn’t get you really high), reduces the risk of overdosing by 80 percent. That’s a miraculous result, and yet finding a buprenorphine program is extremely difficult in much of the US.
Decriminalization is also a crucial step forward: It destigmatizes drugs and keeps users out of a cycle of abuse and imprisonment. But decriminalization doesn’t address the main cause of opioid deaths: Illegal drugs are unregulated and thus untested, and as a result their strength varies tremendously. Worse, they’re often contaminated with much more dangerous opioids like fentanyl, which now accounts for most opioid overdoses.
Programs in which nonprofits, researchers, or governments simply give people drugs have been piloted in at least six countries, and they’ve been successful. A study of a 15-year heroin-assisted treatment program in Swiss prisons, for example, found no deleterious effects; its participants lived and worked just like the rest of the prison population.
In Vancouver, Canada, activists are so convinced that handing out reliable drugs is the only solution to the overdose crisis that they’re doing it themselves, illegally. Eris Nyx, a member of the Drug User Liberation Front, told me that she’d seen other interventions fail. So she and other members of the DULF began to buy heroin, cocaine, and methamphetamine in bulk, worked with labs to test the supply, and then distributed it for free to people already using the drugs.
“The whole crux of this issue is the regime of prohibition,” Nyx said. “The death is from the volatility in the drug supply, so the fix is to give people drugs with a predictable content.”
But the DULF’s operation is not ideal. The government is against it, criminal organizations don’t like that it’s giving away drugs, and the group is small—it can’t really make a dent in the overdose crisis.
The only solution, Nyx said, is to safely supply drugs and allow them to be distributed in stores. That might seem like a pie-in-the-sky proposal, but we already do it for a drug that kills almost 100,000 Americans a year: alcohol. “We’re just a few people, and this is a global, UN-level issue,” Nyx told me. “I’m just some person that has watched other people die and wants that to stop.”