Though the continued opioid (and now fentanyl) crisis may be a reason to despair, there are many individuals, social movements, and other organizations who are working to address problems associated with substance use. Social science, public health, biomedical, and legal scholars and researchers are diligently producing more evidence-based knowledge to guide societal efforts toward more humane and pragmatic responses to substance use.

8.6.1 Harm-Reduction Movement

Figure 8.7 Transformation: The Alchemy of Harm Reduction [YouTube Video]. Please watch at least the first 9 minutes of this hour long video. It describes an innovative harm reduction program in New York. As you watch, please consider how this approach changes the conversation around harmful drug use. Also, how can syringe exchange be a starting place for creating social transformation?

Harm reduction offers a lens through which we can understand and address issues associated with substance use. The first minute of the video in Figure 8.7 provides a list of the ways that harm reduction creates a safer environment for everyone. Harm reduction can be understood as a set of practices. It can also be understood as a social justice movement. The philosophy behind harm reduction revolutionizes the way we respond to human problems, namely addiction, drug overdose, and HIV.

Harm reduction uses a grassroots approach based on advocacy from and for people who use drugs and accepts alternatives to abstinence that reduce harm (Marlatt 1996). According to the Harm Reduction Coalition, the central harm reduction organization in the U.S., a core principle of harm reduction philosophy, “accepts for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.”

Syringe exchange programs, or their more current name—syringe service programs—were one of the early harm reduction efforts made to address the AIDS crisis of the 1980s and ’90s. The Harm Reduction Coalition states that “Syringe service programs (SSPs) distribute sterile syringes, safer drug use supplies, and education to people who inject drugs.” The current opioid crisis in the United States is causing a dramatic increase in infectious diseases associated with injection drug use, such as HIV or hepatitis C. Syringe service programs are known to reduce HIV and hepatitis C infection rates by an estimated 50 percent (Platt et al. 2017). When paired with medication-assisted treatment to treat opioid dependence, syringe service programs can reduce HIV and hepatitis C transmission by over two-thirds (Platt et al. 2017 ; Fernandes et al. 2017).

Sometimes people oppose syringe service programs because they think it might enable drug use. Research shows the opposite. According to the U.S. Centers for Disease Control and Prevention (2019), new users of syringe service programs are “five times more likely to enter drug treatment and three times more likely to stop using drugs than those who don’t use the programs.”

Syringe service programs can also prevent opioid overdoses by educating people who use drugs about ways to prevent overdose. Syringe service programs provide training on how to recognize an overdose and how to use naloxone or Narcan, a harmless medication that reverses opioid overdoses. Often syringe service programs will distribute overdose prevention kits that include naloxone (CDC 2019).

8.6.2 Decriminalization of Small Amounts of Drug Possession in Oregon

On November 3rd, 2020, Oregon became the first state in the United States to decriminalize the personal possession of illegal drugs. By approving Measure 110, Oregon voters significantly changed the way drug possession violations are addressed. People found with smaller amounts of controlled substances (such as heroin, cocaine, or methamphetamine) are issued a Class E violation, which is punishable by a $100 fine. Alternatively, people in violation can have the fine waived if they complete a health assessment at an addiction recovery center.

Measure 110 also created a new drug addiction treatment and recovery grant program funded by the anticipated savings due to reduced enforcement of criminal drug possession penalties, as well as marijuana sales tax revenues (Lantz & Neiubuurt 2020). Advocates for Measure 110 saw it as a way to eliminate drug policies that were having a disproportionately negative impact on Black and Indigenous people of color This law also shifted the societal response to drug use from a punitive, moralistic approach to one that involved treatment and compassion.

Figure 8.8 Store for Magic Mushrooms in the Netherlands. How do we use social construction at work in the conversation around the decriminalization of psilocybin?

During the same election vote in 2020 Oregonians also approved Measure 109, which directs the Oregon Health Authority to license and regulate the manufacturing, transportation, delivery, sale, and purchase of psilocybin products and the provision of psilocybin services (Oregon Health Authority n.d.). Psilocybin is the main psychoactive component of magic mushrooms (figure 8.8). This substance has been utilized for thousands of years in spiritual ceremonies in indigenous cultures (Lowe et al. 2021). Psilocybin is considered a psychedelic hallucinogenic drug that produces both mind-altering and reality-distorting effects.

Following negative stigmatization of the substance due to its use within the hippie counterculture movement, in 1970 the federal government changed the classification of psychedelics (including psilocybin) to be Schedule 1 drugs, which ended all scientific research on psychedelics. Research interest in the therapeutic uses of psychedelics resumed in a 2004 pilot study from the University of Los Angeles, which investigated the use of psilocybin treatment in patients with advanced-stage cancer.

Since then, significant amounts of research into the use of psilocybin to treat an array of health concerns from anxiety to cluster headaches has taken place. Measure 109 in Oregon required a comprehensive review of the scientific literature on psilocybin’s therapeutic uses. This review found research that suggests that psilocybin can reduce depression and anxiety. The FDA has designated psilocybin as a “breakthrough therapy” for the treatment of depression, which means that psilocybin treatment may be a significant improvement over existing therapies to treat depression Psilocybin therapy involves the administration of the substance in the context of counseling support in the weeks before and after dosing (Abbas et al., 2021). Though Oregon’s regulated psilocybin treatment programs will not be up and running until 2023, they offer hope to those suffering from mental health disorders for whom other treatments do not work.

8.6.3 Collaboration and Innovation

Figure 8.9 A Small-Town Plague: A New Approach to Opioid Addiction [YouTube Video]. This 9.52 minute video describes community partnerships that support reducing harmful drug use in communities. How do these approaches leverage existing interdependence, individual agency and collective action to reduce harm?

Some communities are using innovative agency partnerships to reduce the harm that problematic drug use causes. Many more steps need to be taken. Kleinmen (2011) suggests the following:

1. Providing legally prescribed heroin and/or substitute opiates, including methadone and buprenorphine, for people dependent on illicit opioids. This provision has proven effective in several other nations (Oviedo-Joekes et al. 2009)
2. Providing access to safe, medically monitored facilities where people can inject drugs. These sites prevent drug overdoses, reduce dangerous injection in public places or restrooms, and provide access to drug treatment.
3. Encouraging primary care physicians and other health-care providers to screen more carefully for substance use disorders.
4. Abandoning DARE, the school-based drug education program established in the 1980s. According to Kleiman et al. (2011:201), “the continued dominance . . . of DARE—a program that has never been shown to actually reduce drug use—is a scandal.”
5. Reintegrating former drug dealers and those in recovery into society. They should have full access to public housing, educational loans, and other benefits, and they should be allowed to vote in states that now do not let them vote.
6. Providing harm-reduction services and supplies. The provision of new syringes, naloxone, and fentanyl test strips can reduce harm and save lives for those who inject drugs and/or use opioids .