MANCHESTER, N.H. — During a recent interview here, Dr. Rahul Gupta, President Biden’s drug czar, appeared to be on the verge of supporting a radical shift in U.S. drug control policy.
Asked for his views on supervised consumption sites, where users bring their own drugs to take under the supervision of trained workers in case they overdose — a concept accepted in Canada and Europe but still technically illegal in the United States under federal law — Dr. Gupta’s eyes lit up. Then he paused, catching himself, and said he could not weigh in yet.
The Justice Department is expected to soon decide whether one planned site that it blocked three years ago can operate, giving more insight into the Biden administration’s views on the concept. Many public health experts believe it could help stem a record number of overdose deaths largely caused by synthetic fentanyl.
“All of us are enthusiastically waiting” for the department to weigh in, Dr. Gupta said.
Support for supervised consumption from the Biden administration would be a major turning point in how the government addresses an epidemic of addiction and overdoses that has endured for decades and now claims more than 100,000 lives a year. Instead of discouraging drug use, such sites aim to keep users from dying, with trained personnel providing syringes and other sterile equipment for using drugs and working to reverse overdoses on the spot.
Dr. Gupta is already overseeing what experts describe as the most progressive federal drug strategy since his office’s inception.
The strategy largely rests on the concept of harm reduction, focused not on helping drug users achieve abstinence but on lowering their risk of dying or acquiring infectious diseases. A central piece is providing sterile needles to use in injecting drugs, tools to check drugs for fentanyl and other lethal substances, and naloxone, a medication that can revive people who have overdosed. Mr. Biden is the first president to support the approach.
“It’s late by, I don’t know, a few decades,” Alex Kral, an epidemiologist and drug policy expert at RTI International, a nonprofit research organization, said of the White House support for the approach.
Dr. Gupta’s comments in New Hampshire came days after the Centers for Disease Control and Prevention announced that overdoses rose again to record-breaking levels in 2021, nearing 108,000, a year-to-year increase of nearly 15 percent. The recent surge has hit Black and Native American communities particularly hard.
The administration has said it aims to reduce overdose deaths by 13 percent by 2025. Without more harm reduction interventions, Dr. Gupta said, 165,000 people could fatally overdose each year by 2025.
Dr. Gupta, in the eyes of some addiction experts, is an unlikely flag-bearer for the strategy. Just four years ago, he was blamed for the demise of harm reduction programs in Charleston, W.Va., after he signed off on a report criticizing one heavily used site, leading to its decertification.
He now says the closure of the Charleston program was a significant mistake; in an interview, he emphasized that he had supported more than a dozen harm reduction programs in West Virginia when he was overseeing public health there.
Dr. Gupta describes fentanyl — not the pharmaceutical kind, but a synthetic version produced in illicit laboratories, often in Mexico — as a “Pandora’s box” in the nation’s drug supply. Because it is strong and sold in varying formulations, small differences in quantity can mean the difference between a drug user’s usual dose and one that is deadly. It is often combined with stimulants like methamphetamine and cocaine, or pressed into counterfeit prescription pills offered not only to chronic drug users but to experimenting teenagers.
A recent study of illicit pills seized by the drug enforcement authorities found that a substantial share of pills marketed as OxyContin, Xanax or the attention deficit hyperactivity…
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