Vision

After five decades there is growing consensus that the War on Drugs has failed. Efforts to reduce the supply of illegal psychoactive drugs have proven ineffective. They remain cheap, abundant, and, with the rise of synthetics, increasingly deadly. The War on Drugs criminalized drug possession and caused tremendous damage in American communities, particularly among people of color. For example, despite having similar rates of drug use as white consumers, Black Americans faced significantly higher arrest and imprisonment rates and longer prison sentences for drug-related crimes. With the overdose crisis, the damage is not limited to communities of color. Deaths of despair, which include drug overdoses, have risen so highly in the United States that they have contributed to an overall loss in life expectancy among some demographic groups.^[1]  In Allegheny County, in 2023 the rate of overdose deaths for Black residents was over three times the rate for whites.^[2]  And by limiting access to health care among people who use drugs and other marginalized groups, the War on Drugs has contributed to a public health crisis.

Nowhere is the failure of the drug war more pronounced than in the tragic rise in drug overdose deaths in the United States. The government response to rising overdose deaths from greater prescribing of opioids in the 1990s contributed to a subsequent heroin epidemic. After policy makers and law enforcers cracked down on pill mills in response to the prescription drug crisis, users switched to cheaper, unregulated street heroin. This led to a full-blown heroin epidemic by 2010. According to the Center for Disease Control (CDC), opioid overdose deaths doubled in the US during this period. From 1999 to 2010, the opioid overdose death rate rose from 2.9 to 6.8 deaths per 100,000 people.^[3] Meanwhile the War on Drugs’ focus on militarized supply reduction stimulated demand for easier to smuggle synthetic opioids. Around 2013 the powerful synthetic opioid fentanyl began to replace heroin in the illegal drug supply. Fentanyl quickly penetrated illicit drug markets in the US and Canada. Once fentanyl supplanted heroin in North American drug markets, overdose deaths rose dramatically. The number of people who died from a drug overdose in the United States in 2021 was over six times the number who died in 1999. After reaching 106,000 deaths in 2021, US drug overdose deaths rose again to 111,029 in 2022, before dropping to 107,543 in 2023.^[4] For the past several years, overdoses have been the leading cause of accidental death in the United States, exceeding motor vehicle crashes and gun violence. While Europe has largely avoided a synthetic opioid crisis until now, there are growing concerns that fentanyl and another class of synthetic opioids called nitazenes are finding their way into the Continent’s illegal drug supply.  The constantly changing nature of unregulated drug supplies, itself a response to law enforcement pressure in the War on Drugs, means that people can never predict what substances, and in what dose, they are ingesting, driving death rates higher.

As the drug overdose epidemic has worsened in the US, some public officials have shown greater interest in certain harm reduction measures, including Syringe Services Programs (SSPs), naloxone distribution, and drug testing strips. Traditionally, drug policy under the War on Drugs has focused on criminalized supply reduction and abstinence-focused demand reduction.^[5] For decades, harm reduction, an alternative approach that seeks to reduce the harms associated with drug use (and drug policy) rather than drug use per se, found little support in the US. European countries, such as the Netherlands, Great Britain, and Portugal, were pioneers in harm reduction measures like SSPs and opioid agonist treatment (buprenorphine, methadone). The US lagged behind these countries. The Netherlands also has a long history of drug-checking and overdose prevention centers (OPCs).^[6] In recent years, policy makers in the US have shown greater openness to harm reduction, including traditional programs like SSPs, more recent measures like naloxone distribution, and drug checking technologies like fentanyl test strips.

Challenges remain, however. Despite several decades of public health research demonstrating the effectiveness of SSPs, they are still not legally available in twelve American states, including Pennsylvania. And despite more recent research showing that naloxone saves lives without increasing the prevalence of substance use disorders, many college campuses do not make the opioid reversal drug readily available to their students.

This state of affairs has created a demand—and an opportunity—to reconsider drug control policy. This conference will do just that, bringing together researchers, practitioners, policy makers, and people with lived and living experience to discuss the overdose crisis and harm reduction measures to address it. The conference will include experience and expertise of advocacy organizations such as Students for Sensible Drug Policy, the Pennsylvania Harm Reduction Network, and Prevention Point Pittsburgh.

The conference will also provide an opportunity for various Pitt professional schools and departments with an interest or past experience in drug policy interventions to collaborate and learn from one another. These include, but are not limited to, the Graduate School of Public and International Affairs, the School of Public Health, the School of Pharmacy, the School of Medicine, the School of Health and Rehabilitation Sciences, and the School of Social Work. The conference will address what the University community can do to promote effective drug policy within and beyond Pitt.