Many traditional drug policy goals have focused on raising the price of illegal drugs through seizures, reducing the demand for drugs through prevention programs, or promoting treatment to get those that use drugs into rehabilitation. In all cases, the focus has been about shrinking the population of drug users either indirectly, by reducing their consumption through elevated prices, or directly, by transitioning users into drug treatment programs. While these interventions have worked to some degree in the past, they are increasingly limited by the greater lethality of today's street drugs. For example, some who are overdosing on highly potent fentanyl (consuming it as a fake tablet, say) might not even suffer from a substance use disorder, and thus would not benefit from drug treatment. Additionally, those who would benefit from treatment can't do so if they suddenly die from mistakenly consuming fentanyl that is concealed in heroin or cocaine. Although drug supply and demand reduction efforts are necessary, they alone are now insufficient to stem rising overdoses.

There is some movement toward expanding harm reduction efforts in the United States, however. Many states and localities are increasing access to naloxone, the overdose reversal agent. Although this form of harm reduction has saved lives, it cannot prevent an overdose, only reverse it after the fact.

Getting naloxone into the hands of those who need it can help reverse opioid overdoses. But this alone may not be enough. In Vancouver, Canada, trained staff are supervising drug consumption and distributing prescription-grade alternatives to those who have received methadone treatment but are still using street-sourced heroin. These and other interventions have so far not been approved in the United States but warrant further consideration as recommended by the commission's report.

Apart from supervising consumption and offering other possible therapies (for example, additional medications to treat opioid use disorder) and tools (for example, test strips), changing the messaging around drug use is increasingly important. Such messaging could raise awareness of the presence of fentanyl in the drug supply, which in turn could encourage individuals to consume street-sourced drugs with a trusted friend or use with naloxone at hand. Messaging might also better describe the means to dose more cautiously or slowly, which also might help reduce the risks of a fatal overdose. These efforts can help empower individuals that use drugs to avoid an overdose death.

Read the full article about harm reduction by Bryce Pardo and David Luckey at RAND Corporation.