Critics Say Biden’s Drug Czar Pick Contradicts Efforts to “Harm Reduction” Policy | Biden administration


Joe Biden is on record as the first US president to adopt a concept known as “harm reduction” – a public health approach that seeks to reduce the harm caused by drug use rather than the traditional “just- Say-no-ism “by past governments.

Government officials said last week that the federal government will now support harm reduction policies – like giving sterile syringes to people who inject drugs – to curb the transmission of infectious diseases.

But the Biden government has appointed Rahul Gupta as the new director of the Office of National Drug Control Policy, despite the West Virginian having a controversial relationship with harm reduction policy in the past.

The appointment of Gupta, a personal friend of West Virginia Senator Joe Manchin, has raised concerns among some drug politicians who see the move contrary to the government’s stated goals of changing the focus on harm reduction policies.

The biggest criticism of the new “drug czar” comes from public health experts who recall the role it played in closing West Virginia’s largest syringe service program in the state capital of Charleston – now home to what the CDC is referred to as “Most With HIV” has outbreak in the nation “.

After the discontinuation of the program, which Gupta backed, the state formalized new legislation that is likely to end almost all of its harm reduction programs, despite facing several new HIV clusters linked to injectable drug use.

When Gupta began serving as the director of the West Virginia Department of Health in 2015, the state entered a new phase of the opioid crisis. Prescription pill use fell, but only because it was replaced by people who injected heroin and fentanyl. The number of overdoses in West Virginia that year more than doubled the number of people killed in car accidents.

Across the country, the increase in injection drug use has led to an increase in new HIV cases, particularly in small towns. In rural communities across the country, where possession of syringes without a prescription is often criminalized, opioids still have two options: reusing (and perhaps sharing) used needles, or going through potentially fatal drug withdrawal.

A community of 3,700 in southeast Indiana rose from fewer than five HIV cases to 235 seemingly overnight in 2015. Surrounding local governments, desperate for solutions, decided to resist small-town conservatism and give an idea a try usually found in large cities. One of the grassroots labor that has been used for years: harm reduction.

While these governments could not stop people from using drugs, they were able to reduce the harm associated with their use – especially the impact their use had on public health. A syringe program was launched in Scott County, Indiana to provide sterile syringes to people who inject drugs. The results were staggering.

In less than a year, there has been an 88% decrease in syringe exchanges – a major victory in combating the spread of HIV. Public health experts across the country identified the Indiana action as the first step in preventing HIV transmission from people who inject drugs.

Following the Indiana outbreak, the CDC identified 220 counties in the US at high risk for HIV outbreaks related to IV drug use. Of the 55 counties in West Virginia, 28 were on this list.

Officials in the capital of West Virginia, Charleston, started an injection program through the local health department. The West Virginia Public Health Bureau, then headed by Gupta, established national guidelines and the Kanawha Charleston Department of Health’s sterile syringe program began operations.

But in West Virginia, where Donald Trump’s kind of conservatism led to a record-breaking 42.2% win margin in 2016, the rhetoric of giving injections to people who use drugs has been a big hit.

The KCHD syringe program served nearly 25,000 people in the three years of its existence. For a city of 49,000 people, the program met massive demand for clean syringes. But by 2018, conservative politicians and residents alike had successfully rallied against the program.

An ugly public feud brought former Mayor Danny Jones and his supporters against the program and anyone who supported it. Jones, who had stated in an interview that people who use drugs “should be locked up until they are clean,” made a number of changes to the program, including appointing a police officer to design it.

The biggest criticism of Dr. Gupta, from his time as the state’s public health commissioner, came from an examination of the syringe program his office was assigned by Jones. Disregarding CDC recommendations to break down barriers to entry and guidelines from his own office, Gupta’s audit called for the syringe program to be suspended because participants did not need to seek drug use first before they were given access to clean syringes.

Dr. Robin Pollini, an epidemiologist at West Virginia University, and six other harm reduction experts across the country wrote letters opposing Gupta’s findings, saying that his main criticism – that treatment options are not prioritized over syringe access – shows that he gets the point the mitigation totally missed.

In an interview with the Guardian, Pollini said, “The report was arbitrary in accusing the program of failing to adhere to practices not even required by state certification guidelines” – guidelines endorsed by Dr. Gupta’s own office.

When Gupta decided to leave West Virginia in 2018, there were fewer than five HIV-related IV drug-related HIV cases in Charleston and the surrounding county. Since then, the number of new cases has risen to 85, prompting the CDC to dispatch a team of disease intervention specialists.

“You warned us there was going to be a massive HIV outbreak.” said April, who contracted HIV from IV drug use in Charleston last year and didn’t want her last name used. “I thought they were just trying to intimidate us so we wouldn’t use it. But they were right. “

She added that she and people she had used drugs with did not have to share needles while the program was up and running. “But as soon as it closed, people started selling them, just like they did.”

But beyond the immediate public health crisis sparked by the closure of the state’s largest sterile syringe program, the legacy of Gupta’s audit lives on in the form of new legislation that has made it illegal for harm reduction programs in West Virginia that Follow CDC guidelines.

Proponents of the bill saw his report as an example of a health official advocating higher thresholds for syringe programs. As a result, three of the 28 West Virginia counties originally classified as high risk for HIV outbreaks have suspended their syringe programs, citing the restrictions on their programs by the new law.

Three years after Gupta decertified the KCHD program, it is easy to find people on the streets of Charleston desperate for housing and access to medical care. A man named Tommy said access to clean syringes had completely dried up since the program ended.

Desperate to recycle old needles, he described how people desperate to straighten a used needle use the flint on matchbooks to reshape old needles that have been bent with use. He said the current market value for a clean syringe on the street is about $ 5. Alternatively, people can get a used one for between $ 1 and $ 2.

Given the havoc on their state’s public health in recent years from people who misunderstand harm reduction or who totally oppose it, Dr. Pollini a question about the newly confirmed head of the ONDCP. “Does he understand these programs better than he did three years ago?” Asked Pollini.

The White House was asked to comment but did not respond.


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