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'Crack Pipe' Dispute Threatens Biden's Harm Reduction Drug Plan

President Biden came into office vowing to make “harm reduction” — a public health approach geared toward helping drug users stay safe rather than abstain — a pillar of his drug policy agenda, at a time when illicit fentanyl has driven a surge in overdose deaths. His strategy is in danger of being derailed by a Washington drama over “crack pipes” that is more about political gamesmanship than public health. The clash is a revival of decades-old fights over clean needle exchange programs that addiction experts hoped had finally been laid to rest. Lawmakers of both parties introduced legislation to bar federal funding for “drug paraphernalia” in response to a story in the Washington Free Beacon, a conservative website, asserting that federally funded addiction treatment programs would distribute pipes for smoking crack cocaine as part of “safe smoking kits.” White House officials said tax dollars would not be spent on pipes, the New York Times reports.

With the Beacon story ricocheting around the conservative ecosystem — amplified by Republican including Senators Tom Cotton of Arkansas and Ted Cruz of Texas — Congress is pursuing plans not only to bar federal funding for “crack pipes,” but to impose restrictions on a new program that would have, for the first time, allowed federal funds to be spent on sterile needles for “syringe services” programs. Multiple studies have shown that distributing new syringes to drug users reduces the spread of blood borne diseases among drug users, including H.I.V., hepatitis C and lethal heart infections. Some harm reduction programs do include sterile pipes — which are used for smoking methamphetamine and fentanyl as well as crack cocaine — in such kits, with the intent of preventing infectious disease or injury in drug users who might otherwise rely on contaminated paraphernalia. Harm reduction workers often try to steer users toward smoking rather than injecting, which poses a higher risk of infection and overdose. There is no evidence that the Biden administration intended to pay for distribution of pipes. Nonpartisan fact checkers have debunked the claim.

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