What exactly is a harm reduction-focused opioid substitution therapy program, and why are progressives, libertarians, and even some conservatives coming together and pointing to it as a potential solution to the drug crisis? In this context, most are referring to a government-sponsored program where drug users go to a centralized location and receive a free dosage of either the drug itself or a substitute drug.

While these proposals remain controversial in the United States and are viewed with the same skepticism as needle exchanges, a variety of European countries (most notably, Switzerland) have seen success after implementing them.

Illegal vs. Legal Markets

Christian Schneider, London School of Economics

One of the leading arguments in favor of sponsoring substitution therapy programs is that they may be more cost effective than they first appear. Dr. Schneider suggests that, while there is a significant expense to creating and operating government clinics and providing free pharmaceutical-grade drugs, it may still be less than the direct and indirect costs of policing an illegal drug trade.

Switzerland’s often referenced as a model for drug reform policies, and it stems from their response to the heroin epidemic of the 1980s and 1990s. It peaked in 1990 when the country had a higher usage rate than any other European country with comparable tracking measurements. Almost immediately, the implementation of harm reduction and drug substitution programs began to reduce the illegal drug market.

A Dr.’s Orders

Jeffrey A. Singer, Cato Institute

Operating under the opinion that you are never going to eliminate drug addiction as a societal problem, only manage it, is often a nonstarter, but Dr. Singer insists that “harm reduction has a success record that prohibition can’t match.” In great detail in this 2018 report, Dr. Singer explores the medical perspective on medication-assisted treatment, needle exchange programs, safe injection sites, heroin-assisted treatment, removing restrictions on Naloxone (also known as Narcan, which is used to mitigate an overdose), and easing the restrictions on marijuana. Rather than advocating a particular approach, he advises that “policymakers should pursue an ‘all of the above’ strategy” and convert the War on Drugs into a War on Drug Related Deaths.

A Social Good

Michelle Chen, The Nation

It’s challenging to discuss the drug trade without addressing the humanitarian and societal problems that engulf both producing and consuming communities.

Worldwide, Chen cites that one in five prisoners are incarcerated for a drug crime, and writes “the social crisis wrought by the drug war is a US export, according to Hannah Hetzer, senior international policy manager for the Drug Policy Alliance, since the federal government ‘has absolutely been one of the key drivers of prohibition historically, and has also responded negatively when other countries have moved to reform drug policies.’ “But even as Trump defends the drug war’s status quo, the global approach to drugs is changing, through humane social-development programs and rational regulation.”