A top federal drug official tacitly endorsed the idea of authorizing safe consumption sites where people could use currently illicit drugs in a medically supervised environment, arguing that evidence has effectively demonstrated that the facilities can prevent overdose deaths.
National Institute on Drug Abuse (NIDA) Director Nora Volkow commented on the harm reduction model at the STAT Summit last week.
She separately talked about the path forward for researching the therapeutic benefits of psychedelics to inform drug development.
While Volkow has frequently promoted harm reduction policies to treat addiction like a public health issue, her remarks about safe injection facilities stand out, especially as the Justice Department is in active litigation that started after the Trump administration challenged the opening of such a center in Philadelphia.
The official declined to specifically say what she would do if she were president and the lawsuit was dropped, but she said that safe consumption sites that have been the subject of research “have shown that it has saved a significant [percentage of] patients from overdosing.”
In the conference appearance remarks, portions of which where earlier reported by STAT, Volkow said that she’s personally followed up with clinics that provide the service to ask whether they’ve had success even with stronger opioids like fentanyl entering the illicit market, and she’s been told that the sites are reporting zero overdose deaths.
— STAT (@statnews) November 16, 2022
“Yes, it’s preventing people from dying,” she said. “We need to look at it as a solution in context,” adding that expanded distribution of naloxone is also contributing to saving lives of people who use drugs.
The comments represent one of the strongest positions in favor of safe consumption sites to come from a federal official, and they’re all the more notable given the federal government’s position in a lawsuit that’s so far blocked the non-profit Safehouse from providing the service.
That said, the White House drug czar recently said that the Biden administration is reviewing broader drug policy harm reduction proposals, including the authorization of supervised consumption sites—and he went so far as to suggest possible decriminalization.
Volkow, who recently said that drug criminalization has “created a structurally racist system,” also discussed the growing interest in psychedelics medicine at the STAT summit last week, though she said that research has not yet caught up on the issue.
“Now, the fact that the evidence is not there does not mean that they may not have a product,” she said. “This is, again, coming back to the science that says why it is urgent and imperative that we do research with the psychedelic drugs so that we can understand, first of all, what may be the molecular mechanisms of action.”
“If we can understand the active ingredients in the molecules of psychedelics, we may be able to get an insight about what may be therapeutic benefits and optimize them,” Volkow said.
With respect to safe consumption sites, New York City opened the first sanctioned harm reduction centers in the U.S. late last year, and officials have already reported positive results in saving lives.
A study published by the American Medical Association (AMA) in July found that the those facilities have decreased overdose risk, steered people away from using in public and provided other ancillary health services to people who use currently illicit substances.
Volkow said that she’s been communicating with the professionals who operate the city’s sites.
While the Biden administration is still investigating the clinical efficacy of such facilities, Office of National Drug Control Policy (ONDCP) Director Rahul Gupta said that the proposal to lift the existing federal ban is on the table.
DOJ said in February that it is actively “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.”
In October, the Supreme Court rejected a request to hear a case on the legality of establishing the Safehouse facilities, but the case is still before a lower federal court. Attorneys for the proposed site say that they’ve had “productive” conversations with DOJ in recent months, which is part of the reason why they’ve mutually agreed to extend the deadline for a federal response in the case several times.
Most recently, last week, lawyers for Safehouse and DOJ participated in a status conference before the federal judge in the case. The Biden administration has until December 5 to file a formal response in the lawsuit under the current timeline.
The National Institutes of Health (NIH) put out a pair of requests for applications (RFAs) in December for an effort that will provide funding for efforts to investigate how that and other harm reduction policies could help address the drug crisis.
Gupta previously said that it’s critical to explore “any and every option” to reduce overdose deaths, and that could include allowing safe consumption sites for illegal substances if the evidence supports their efficacy.
The secretary of the U.S. Department of Health and Human Services (HHS), Xavier Becerra, has also signaled that the Biden administration would not move to block the establishment safe injection sites, stressing that “we are literally trying to give users a lifeline.”
But a department spokesperson later walked those remarks back, stating that “HHS does not have a position on supervised consumption sites” and the “issue is a matter of ongoing litigation.” In any case, it would be up to DOJ to decide whether to pursue operators of the facilities under the Controlled Substances Act.
A New York Assembly committee advanced a bill in May to establish a statewide safe consumption site program, allowing regulators to authorize facilities where people could use currently illicit drugs in a medically supervised environment.
In a pair of setbacks for advocates, however, Vermont’s governor vetoed a bill in June that would have simply created a working group tasked with crafting a plan to open safe consumption sites and the governor of California vetoed a bill in August to permit a pilot program for the harm reduction centers.
Photo courtesy of Jernej Furman.