By Dunstan Prial

Fentanyl is the latest in a long line of weapons of self-destruction, which in recent decades has included heroin, crack, crystal meth and OxyContin. In a few years, another drug will come on the market that will replace fentanyl, and the cycle will repeat.

Unless policymakers change their approach to addiction.

Unfortunately, federal lawmakers, distracted by an all-consuming presidential election and escalating global conflicts, have lost focus on perhaps the defining domestic issue of the past decade.

October 1 marked the one-year anniversary of the expiration of the SUPPORT Act, which provided funding for the prevention, recovery, and treatment of opioid use disorder. This inability of Congress to reauthorize the money has devastated basic programs in fentanyl-ravaged cities like Paterson. Newark and Camden.

The SUPPORT Act was a rare act of bipartisan cooperation, and its goal was to save lives by distributing $20 billion across a range of treatment programs and educational resources, many of them rooted in innovative harm reduction methods.

That was before fentanyl, the powerful synthetic opioid, emerged as a cheaper alternative to heroin and OxyContin. Now fentanyl is in everything: cocaine, counterfeit benzodiazepine pills, even marijuana.

Fortunately, overdose rates are just starting to drop. But in the six years between the introduction of the SUPPORT Act in September 2018 and May 2024, an overdose According to the US Centers for Disease Control and Prevention, deaths in the US have increased by almost 40%.

Despite this alarming spike, the addiction problem has remained hidden among issues that are more easily polarized – such as immigration – even as 100,000 Americans die from overdoses every year.

Aside from acknowledging the scourge of fentanyl and blaming it for the rise in overdose deaths, Kamala Harris and Donald Trump have remained largely silent on the topic of addiction as a problem in its own right.

Instead, both candidates have framed the issue through a criminal justice lens, preferring to describe their plans to reduce the illegal shipment of fentanyl across the U.S. border. This is the same approach that led to the failed ‘War on Drugs’ forty years ago.

What is needed is a new approach that recognizes the reality of substance use while removing harmful stigmas. Harm reduction measures achieve both, and that’s where state lawmakers can have a profound impact.

I worked as a counselor at a substance abuse treatment center in Paterson for three years. Few American cities have been hit harder by the opioid crisis. Every day I saw how harm reduction can save lives.

I met opioid addicts who used medical marijuana to suppress cravings and ease the horrific withdrawal symptoms that fail many quit attempts. Yet most treatment centers — including mine — require total abstinence, a policy that can discourage opioid users from seeking treatment.

I met many others who were taking Suboxone, a prescription drug that helps reduce cravings and ease withdrawal symptoms. The catch is that Suboxone is opiate-based, meaning it can be addictive if abused.

The Biden administration was instrumental in increasing access to Suboxone prescriptions through telehealth, but the medication remains difficult to obtain in many parts of the U.S.

I met a crack addict who used opiates to overcome his fear of cocaine. He said he always shot at a safe injection site, where opiate users consumed their drugs under the supervision of trained personnel armed with naloxone, a nasal spray that reverses the effects of overdoses.

There are two consumption locations in New York City – in Harlem and Washington Heights – the only two in the US, while a third will open in Providence in December. The New York facilities, known as OnPoint, were used by 4,000 people in the first two years of their existence. The results: 1,100 overdoses were prevented and zero deaths.

Europe, Australia and Canada have the same 100% success rate across their combined 200+ sites. For decades, they have provided spaces that keep drug use out of dark public spaces, saving countless lives through routine fentanyl testing and the availability of naloxone.

Plans for safe injection sites in New Jersey and Philadelphia have been thwarted by political pressure and fear tactics. But opponents argue that the methods used in harm reduction enable – and even encourage – substance use.

Health Committee Chairman Senator Joseph Vitale (D-Middlesex) agrees that it is time to establish a pilot program with four injection sites in New Jersey because “the data shows unequivocally that these sites save lives .”

But harm reduction measures will not be accepted and adopted until policymakers muster the courage to move beyond tired clichés that stigmatize substance users as criminals and/or moral deviants to be punished and shamed. How many more deaths will it take?

Dunstan Prial is a substance abuse counselor in Caldwell.

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