One Mayor's Ambitious Plan to Fight the Addictions That Are Ravaging the American Heartland

The upstate city of Ithaca, New York, today rolled out a comprehensive plan to deal with drug use from a public health perspective with a strong harm reduction component. The Ithaca Plan: A Public Health Approach to Drugs and Drug Policy, calls for the creation of a Vancouver-style Four Pillars (prevention, treatment, harm reduction, law enforcement) approach to the city's problems, particularly with heroin and opioid drug use.

The plan comes a little less than two years after Mayor Svante Myrick formed the Municipal Drug Policy Committee, which engaged in broad-ranging consultations before revealing its recommendations this week. The consultations included local law enforcement and public health officials as well as drug reform and harm reduction advocates. More than 350 community members, officials, and other stakeholders participated in the process.

"I came to this project after 25 years of working in very close proximity to the ‘war on drugs,’" said Gwen Wilkinson, Tompkins County District Attorney, who co-chaired the Municipal Drug Policy Committee that created this report.  "Massive amounts of government resources have been expended and millions of people have been incarcerated, with outrageous racial disparities.  Despite this, drugs are still pouring into our community.  We need to have a new perspective on public safety." 

"While much of drug policy is driven at the state and federal level, there is a great deal that municipalities can do to create more effective drug polices," said Mayor Myrick. "Given the way that drugs and drug policies are harming our community, I know we need a totally new approach. I’m pleased that we’ve arrived at a plan that includes broad community participation and innovative recommendations to improve the health and safety of Ithacans."

The audacious plan calls for considering harm reduction interventions that have never been implemented in the United States even though they've been proven effective in other countries, including most dramatically supervised injection sites and heroin maintenance therapy. It also calls for a smarter, more integrated municipal approach to drug policy and a turn toward innovative policing strategies that are aimed less at punishment and more at problem-solving.

Among the key measures recommended in the Ithaca Plan are:

  • Consider a Supervised Injection Facility: Supervised injection facilities (SIFs) are controlled health care settings where people can more safely inject drugs under clinical supervision and receive health care, counseling, and referrals to health and social services, including drug treatment. SIFs have been rigorously studied and found to reduce the spread of infectious disease, overdose deaths, and improperly discarded injection equipment, and to increase public order, access to drug treatment and other services, and to save taxpayer money.
  • Research Heroin Assisted Treatment: Heroin Assisted Treatment (HAT) is a form of medical care that involves the carefully regulated and controlled prescription of heroin for people who have failed on other drug treatments. Research has shown that HAT can reduce drug use, overdose deaths, infectious disease, and crime, while saving money and promoting social integration.
  • Create of an Office of Drug Policy: One the central problems with drug policy in Ithaca and elsewhere is that agencies often work at cross pursues with little coordination.  By creating a central Office of Drug Policy, Ithaca will be able to coordinate its response to drugs and work to implement the recommendations in The Ithaca Plan.
  • Open a 24-hour Crisis Center: A central finding of the Municipal Drug Policy Committee was the need of a centralized place to help people navigate the treatment and social service systems. Creating a centralized crisis center will facilitate entry into treatment, provide a much need space for people in immediate crisis, and help coordinate across systems of care.
  • Implement of Law Enforcement Assisted Diversion: Law enforcement officials frequently act as the first point of contact for drug-related offenses, but criminalization generally results in more harm than good. Law Enforcement Assisted Diversion (LEAD) is a pre-arrest or pre-booking diversion program that has been piloted and evaluated in Seattle, WA. Instead of arresting and booking people for certain petty offenses, including low-level drug possession and sales, law enforcement immediately directs them to housing, treatment, and other services.
  • Create a Youth-serving Apprenticeship Program with Local Businesses: Economic and community development build healthier and safer communities. Strong emphasis on youth employment, like an apprenticeship program, can improve academic achievement and lessen the likelihood of boredom, disengagement, and lack of civic engagement, all of which are factors contributing to drug use or illicit involvement in the drug trade.

"I am so proud of our community for leading the way in acknowledging substance abuse as a public health issue, and responding accordingly," Said Lillian Fan, Assistant Director of Prevention Services at the Southern Tier AIDS Program and Co-Chair of the Municipal Drug Policy Committee. "If we know of ways to prevent overdose and the spread of diseases like HIV, there is no excuse not to try them."

"Municipalities have a vital role to play in reversing our failed drug polices," said Kassandra Frederique, New York State Director at the Drug Policy Alliance, who was also involved in drafting the plan. "Ithaca is leading the way by showing how cities can create effective and innovative solutions to drug problems by listening to their citizens and local experts and by drawing on the rich research base about what works."

Largely in response to the rising toll of death and addiction from heroin and prescription opioids, harm reduction measures such as needle exchange programs, "911 Good Samaritan" laws, and the broadening of access to overdose reversal drugs, have become increasingly accepted and non-controversial. But actually getting more radical harm reduction measures like safe injection sites and heroin maintenance programs up and running would be a major advance.

Calls to do so are growing increasingly loud. Earlier this month, Maryland state Delegate Dan Morhaim (D-Baltimore County) filed a package of bills that included supervised injection sites, heroin maintenance, and drug decriminalization, while efforts are afoot in cities including New York, San Francisco, and Seattle to get supervised injection sites up and running. A California bill to allow for supervised injection sites is expected to be filed shortly.

But all those efforts, including the Ithaca Plan, will have to overcome political and legal hurdles at the federal, as well as the state and local levels.

"There are questions we have to answer. We obviously can’t do this tomorrow," Myrick said. "We have got to iron out what’s legal and what’s possible. Our first priority has got to be saving people’s lives and our second priority is liability."

Myrick said he will ask the state Health Department to declare heroin use a state health crisis, which, he said, would obviate the need to winning approval from the state legislature. The Health Department has so far not publicly responded to the notion.

And then there is federal law. The provision of controlled substances through either supervised injection sites or heroin maintenance program could run afoul of federal "crack house" laws aimed at shuttering places that allow for drug use and sales. Although such harm reduction interventions are a universe removed from black market retail drug sales, zealous federal prosecutors or DEA agents could use such provisions in a bid to prevent or shut down heroin maintenance or supervised injection sites.

Still, the federal government has largely managed to turn a blind eye to medical marijuana and legal marijuana in states where it is legal. That suggests a certain flexibility when it comes to rote enforcement of the drug laws. The Ithaca Plan isn't going to magically happen tomorrow, but the political and legal hurdles need not be insurmountable. Indeed, the public health demands they be overcome. 

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