So many of Deborah Krauss’s friends and neighbors in Iowa have died of drug overdoses during the pandemic, the longest she has gone without someone dying is three weeks. Her calendar grew cluttered with funerals. “I lost count at 40,” she recalled as she organized supplies to help people consume drugs more safely. “And it just keeps happening.” The next day, Krauss was on the road, parked outside a Walmart in the small Iowa town of Osceola, her trunk brimming with boxes of syringes, fentanyl test strips and overdose-reversing medication. A former hair stylist, she recalled the stress of grooming an ex-boyfriend’s facial hair to make him presentable at his funeral after he died from an overdose in 2018. Krauss, 38, is one of the few practitioners in Iowa of a public health strategy known as “harm reduction,” a wide-ranging set of policies that President Biden and many federal and local health officials and physicians have made central to their efforts to curtail record-breaking overdose deaths, reports the New York Times. The strategy does not seek to cut people off from drug use. Instead, it aims to give them tools to use drugs in a safer manner, like the supplies in Krauss’s trunk.
In his State of the Union address, Biden, the first president to endorse the strategy, highlighted the federal government’s attention to some of the core features of harm reduction work, including a provision in a recent spending package that makes it easier for doctors to prescribe buprenorphine, an effective addiction medication that Krauss works to get to drug users. Two years after Biden took office, with the nation’s drug supply increasingly complex and deadly, the practice of harm reduction remains underfunded and partially outlawed in many states. The work is often conducted by organizations that run syringe exchange programs, with workers like Krauss, a former methamphetamine user, acting as brokers between drug users and the resources they need to manage their consumption. Those workers can face legal risk in the process. Krauss works for the Iowa Harm Reduction Coalition, one of the few harm reduction groups in the state. The coalition operates a syringe exchange program, which also routes drug users to medication-assisted treatment, where they receive drugs that can help manage cravings. Researchers at RTI International, a nonprofit research institute, estimate that there are only around 1,100 full-time workers nationwide like Krauss, aided by a cast of around 600 part-time staff members and roughly 2,000 volunteers. A national survey conducted by RTI found that the median annual budget of a syringe exchange program was roughly $100,000, far less than what is needed to cover salaries, supplies and travel expenses.