By C. Jarrett Dieterle

Introduction In January 2020, the world of alcohol rules seemed to be mired in a kind of stasis. It had been 85 years since Prohibi琀椀on, but the broad legal structure governing alcohol remained remarkably unchanged. Just three months later, in March 2020, everything changed. The COVID-19 global pandemic that gripped America and the broader world led to unprecedented realignments in our way of life. Governments began issuing mask mandates, social distancing orders, and even rules around how—and if—businesses could con琀椀nue opera琀椀ng. In response, innova琀椀ons like to-go and delivery alcohol took hold across the country, leading to a substan琀椀al shi昀琀 in how alcohol was regulated. Now, three years later, opposi琀椀on to these changes has started to become more prevalent. Most of the pushback has been focused on concerns that less stringent alcohol regula琀椀on could create nega琀椀ve externali琀椀es. One of the prime areas of concern has been underage drinking and whether enhanced alcohol delivery will lead to a spike in youth drinking across the country. This study breaks down the latest underage drinking data to help provide a more informed debate around America’s pandemic-era alcohol reforms.

R Street Shorts No. 128, Washington, DC: R Street, 2023. 7p.

By Chelsea Boyd

The United States is in the midst of an overdose crisis. One promising harm reduction intervention that could prevent overdoses and curb the crisis is overdose prevention centers (OPCs). OPCs are facilities where people who use drugs (PWUD) can consume pre-obtained substances under medical supervision. In addition to supervised consumption services, OPCs o昀琀en provide other harm reduction and basic services, such as syringe exchange, treatment referrals, wound care, public assistance referrals and more. The first OPC opened in Switzerland in the 1980s, and OPCs now exist in at least 11 countries Evidence supporting OPCs largely comes from the facilities operating in Canada and Australia. Evaluations of these centers have shown that they are remarkably effective at decreasing health harms associated with drug use, and there has never been a reported overdose death at an OPC. Additionally, OPCs have been shown to reduce syringe and consumption equipment sharing, decrease overdose deaths in the area around the center, prevent new HIV and hepatitis C infections, increase treatment uptake and decrease public injecting and syringe litter. Studies also have found that OPCs do not increase crime or drug use. Nevertheless, in both Canada and Australia, advocates who wanted to open the facilities faced uphill battles that left the OPCs in legal limbo for many years before ultimately receiving permanent legal authorization. The United States currently has two locally sanctioned OPCs in operation in New York City, and several states and cities are working toward opening OPCs despite their federally illegal status under the Controlled Substances Act (CSA). Although no jurisdiction other than New York City has opened an OPC in the United States, these centers have been authorized by policymakers at the state, county and local levels. In addition to New York City, Philadelphia, Seattle, Rhode Island and California have made progress toward authorizing OPCs. Policymakers at every level of government can take action to facilitate the opening of OPCs. Local policymakers and groups, such as mayors or city councils, can authorize OPCs, although this path provides the least protection from state or federal interference. States can pass legislation that authorizes OPCs through pilot programs, which allows them to be rigorously evaluated and ensures that an OPC’s existence does not conflict with state law. Nevertheless, federal action legitimizing OPCs is also necessary. Congress could consider amending the CSA to clarify that OPCs do not violate the act or stipulate that federal funds cannot be used to enforce the CSA in regard to OPCs. Alternatively, the administration could release a memorandum stating that the federal government will not interfere with OPCs operating under state or local authorization, or the Department of Justice could release a similar statement. The challenge with either of those actions is that future administrations could decide not to honor these statements. Regardless of how OPCs are authorized, policymakers can apply pragmatic approaches to authorize them in their jurisdictions. These include getting community buy-in, working with law enforcement, formalizing requirements for operation and evaluation and ensuring that the facilities and policies are designed to meet the needs of the populations they serve.

R Street Policy Study No. 265, Washington, DC: R Street, 2022. 19p.

By Stacey McKenna

To combat rising rates of drug overdoses, the United States government has begun to embrace a public health response that has been saving lives for decades: harm reduction. This pragmatic public health approach aims to mitigate the health risks associated with a range of behaviors rather than insisting people quit them altogether. Despite the benefits of harm reduction programs, stigma, paraphernalia laws and weak or inconsistent protections from such laws can undermine the uptake of their services. In addition, a small but growing body of evidence indicates that, despite the legalization and expansion of these programs, successful implementation may also be limited by outdated local, state and federal policy. To better understand how outdated policy might create barriers to providing optimal harm reduction services, we interviewed 10 harm reduction providers serving diverse populations across the United States. These interviews revealed two primary areas of concern that harm reduction providers perceived as hindering the services they offered, both of which relate to government overreach: the overregulation of operations and the excessive restrictions on how funding can be used. To remove these barriers and enable harm reduction organizations to save more lives, we suggest that—instead of supporting legislation that regulates the details of harm reduction practice—lawmakers support bills that emphasize organizational autonomy for these groups. Doing so would allow harm reduction providers to tailor programs as needed, remain flexible in the face of changing science and provide more effective services to their communities.

R Street Policy Study No. 262 July 2022, 9p.