Fentanyl overdoses have emerged as the leading cause of death for young Americans ages 18 to 45, but some state legislatures are pushing back against health measures designed to help people survive opioid addiction.
This week, lawmakers in Pennsylvania's state Senate voted heavily in favor of a ban on supervised drug injection sites, with 22 Democrats supporting the measure. It hasn't yet been approved by the state House.
"My constituents do not want safe injection sites in the neighborhood," said Philadelphia Democratic Sen. Christine Tartaglione, the bill's sponsor.
Tartaglione represents a part of the city where illegal drug use is a major public health crisis.
Similar clinics operate in New York City and in cities across Canada. People use street drugs under medical supervision and are given help if they overdose. In many cases they're also connected with health care services and counseling.
But the programs remain controversial.
"I think it enables addiction," she told WHYY, referring to safe injection sites. "We should be in the business of giving these folks treatment."
A record 1,276 people died of drug overdoses in Philadelphia in 2021, the latest year data is available. Drug deaths nationwide now regularly top 100,000 fatalities per year.
A nonprofit group called Safehouse has been negotiating with the U.S. Justice Department, hoping to open supervised injection clinics in Philadelphia.
If this measure is approved and signed into law by Pennsylvania's Democratic Gov. Josh Shapiro — who has signaled disapproval of supervised drug use sites — it could permanently derail that effort.
"It's disappointing that this effort [by the state Senate] was taken," said Ronda Goldfein, who sits on the Safehouse board of directors.
Decades of research contradict the claim that supervised drug use sites foster addiction. Data shows they can be effective "harm reduction" strategy, helping people survive overdoses.
"The evidence is clear," Goldfein said. "We're in an overdose crisis. The safe way to proceed is really look at all the options and not rule things because it doesn't seem right."
Critics say this kind of pushback against fentanyl harm reduction strategies threatens efforts by the Biden administration to shift the nation's response toward a public health model, rather than arrests and incarceration.
It isn't just happening in Pennsylvania.
From Colorado to Idaho to Nevada, state lawmakers and some governors — Democrats and Republicans — are escalating criminal penalties while acting to curb programs that help people consume illicit drugs more safely.
"It is bipartisan, everybody wants to say they're doing something on the fentanyl issue," says Ryan Hampton, a drug policy activist in recovery from opioid use disorder.
"Are we recriminalizing [people experiencing addiction]? Are we pushing forward policies that are going to harm more than help?"
In Idaho, a bill to limit funds for an overdose reversal drug
This spring, Idaho's Republican-controlled legislature passed a measure that would limit funding for distribution of Narcan — also known as naloxone — a drug proven to reverse opioid-fentanyl overdoses.
Critics of the measure say it would make it much harder for groups to receive federal grants allowing them to distribute the lifesaving medication.
The measure's sponsor, state Rep. Josh Tanner, a Republican, told the Idaho Statesman newspaper he wanted to make sure that people handling the drug are properly trained.
"I just wanted to make sure that it's actually going out to the right people, people that we can actually educate and give training," Tanner said. "The more we can educate the public, the better off we are."
But public health experts say this kind of restriction clashes with efforts to make Narcan, which is easy and safe to administer, more widely available.
The U.S. Food and Drug Administration just approved the sale of Narcan over the counter, without need for a prescription. A remaining hurdle limiting distribution is cost.
"That's a very real risk — that the stigma that already exists within the health care system against people who use drugs is going to get perpetuated in the way that Narcan is available," Nabarun Dasgupta, a senior scientist at the University of North Carolina who studies overdose prevention, said in an interview with NPR.
State distrust of harm reduction measures isn't new
This kind of backlash has been brewing for years, even in states hit hard by the opioid crisis.
Two years ago, lawmakers in West Virginia voted to curb needle exchanges, despite evidence that the programs were essential to curbing an outbreak of HIV-AIDS among people using drugs.
At the time, Dr. Michael Kilkenny, who heads the public health department in Cabell County, W.Va., told NPR the new state law would dissuade towns from offering clean needles even when there's clear medical need.
"Communities that were on the fence, they've been knocked off the fence in the wrong direction," he said.
Now measures like these appear to be accelerating as fentanyl deaths grow.
Nevada is the latest state moving toward enacting much tougher criminal penalties for possessing relatively small quantities of the synthetic opioid, with mandatory prison time for as little as 4 grams.
Supporters say new Democratic-sponsored tough crime laws in Nevada would serve as a deterrent.
But even some backers of the bill acknowledge concerns that many people experiencing opioid addiction could get swept into prison, where treatment and recovery programs are rare.
"I've had dreams, and frankly nightmares, over ensuring that in pursuit of this bill that we don't re-create the war on drugs from the crack cocaine days," Democratic Attorney General Aaron Ford told The Associated Press after introducing one of the bills.
During the crack cocaine epidemic of the 1980s, similar laws wound up incarcerating large numbers of Black and Hispanic people without significantly reducing the supply of drugs on the street.
A contest between "drug war" ideas and "harm reduction"
Kendra Neumann, a research analyst with the nonpartisan Colorado Health Institute, says state lawmakers are wrestling "a contest" between two often contradictory responses to the fentanyl overdose crisis.
The focus appears to be tilting away from harm reduction toward tougher policies, she said.
"People have felt since the pandemic there have been increasing crime rates. Homelessness in Colorado in particular has become more visible and a lot of people associate that with drug use," Neumann said.
"That has heightened the conversation about overdoses and about drug use."
Not all state legislatures are pivoting against harm reduction measures.
Last week, the Republican-controlled legislature in Kansas approved a bill legalizing possession of test strips that help people determine whether their street drugs contain fentanyl.
Advocates say the test strips save lives. Until now they've been banned in Kansas as illegal drug paraphernalia.
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