Letting people take illegal drugs under medical supervision?

Letting people take illegal drugs under medical supervision?

This transcript has been edited for clarity.

Hi. I am Art Caplan. I am the director of the division of medical ethics at NYU Grossman School of Medicine in New York.

New York City is at the forefront with a highly controversial agenda. It has two centers that function as overdose prevention centers, where people who use drugs and take heroin or other drugs can come under the supervision of a medical professional or a trained person. One is in Washington Heights in Manhattan; the other, I believe, is in Harlem.

These two centers will supervise people who use drugs. They have all the anti-overdose drugs at their disposal, like Narcan. If you overdose, they will help you and try to advise you to stop taking drugs, but they won’t insist that you do. You can go there, even if you are a drug addict, and continue to do drugs under supervision. This is called a risk reduction strategy.

Some people note that there are over 100 centers like this in the world. They are in Canada, Switzerland and many other countries, and they seem to work. “Working” means more people seem to be quitting drugs slowly – not huge numbers, but some – than if you don’t, and overdose death rates drop dramatically.

Incidentally, the establishment of these centers has other advantages. They save money because when someone overdoses in the community, you have to pay all the ambulance and emergency room costs, and there’s risk to first responders because of fentanyl or ‘other stuff. There are fewer needles littering parks and public places where people inject. You have everything under control when they enter a center, reducing the burden on the community.

It turns out you have less crime because people just aren’t hurting or robbing other people for money to get their next fix. Medicines are provided to them. Crime rates in the areas of the world where these centers operate appear to be falling. There are a lot of positives.

There are also a few negative points. People say it shouldn’t be the job of the state to keep people addicted. It’s just not the right role. Everything should be aimed at getting people to stop using, perhaps including criminal penalties if that’s what it takes to get them to stop using.

My own view is that it didn’t work. Implementing harsh prison sentences to try to fight the war on drugs just doesn’t seem to be working. Last year we had 100,000 drug overdose deaths. This number has climbed. We all know that we have a terrible epidemic of drug overdose deaths.

It seems to me that these centers involved in harm reduction are a better option for now, until we find interventions that can cut the desire or urge to use drugs, or antidotes that are effective for months or years, preventing people from getting high, no matter what medications they take.

I’m going to come out and say I think the New York experiment worked. I think it saved over 600 lives, they estimate, in the past year, which would have been overdoses. I think from a cost perspective, it’s effective. [Reductions in] related damage and injury from needle scatter, theft, etc. are all positive. There are even a few people who quit using drugs through counseling, which is a better outcome than what we get when they end up on the streets.

I think other cities want to try this. I know Philadelphia does. I know New York wants to expand its program. The feds aren’t sure, but I think it’s time to try an expansion. I think we have something that, while far from perfect and I wish I had other tools, is perhaps the best we have. In the war on drugs, small victories must be reinforced.

I’m Art Caplan from the NYU Grossman School of Medicine’s Division of Medical Ethics. Thank you very much for watching.

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