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The Drug Crisis Is Getting Worse. Local Leaders Can Fight Back.

There are time-tested and newer interventions that have a track record of success. All of them are within the power of local officials and policymakers.

Vancouver’s Insite Supervised Injection Facility
Vancouver’s Insite Supervised Injection Facility was North America’s first supervised consumption site, where people can consume their drugs under the supervision of nurses or responders. (Photo: Vancouver Coastal Health)
While the COVID-19 pandemic is — justifiably — still grabbing headlines, another public health crisis has continued to rage. More than 100,000 people died from a drug overdose in the U.S. in 2021, with the overwhelming majority of those deaths involving opioids. That’s up 15 percent over 2020, and a more than fivefold increase since the turn of the millennium.

The surge is particularly bad in America’s cities. For some years, the drug crisis seemed most acute among rural and small-town Americans, particularly the white, middle-aged residents of former industrial areas profiled in books like Hillbilly Elegy. But due largely to the adulteration of the drug supply with potent new synthetic opioids, the crisis is now everywhere. Between 2000 and 2010, overdose deaths rose by nearly 200 percent in rural areas, compared to about 40 percent in big cities; between 2010 and 2020, the pattern reversed, with a 70 percent increase in rural areas and a more than 150 percent increase in big cities.

To local leaders, urban and rural, the tide of drugs may feel insurmountable. Is there anything they can do to stem it? In fact, there are a number of evidence-based interventions that mayors, county executives, other local policymakers, judges and law enforcement can bring to bear on the drug crisis. As I detail in a new Manhattan Institute brief, leaders on the front lines of the crisis do not need to wait for federal action. They can take steps right now to help those most at need in their communities.

Some of these are time-tested interventions, but ones that still may not be used widely enough. Drug treatment services — long-term, medication-assisted and accepting the risk of relapse — are the cornerstone of demand reduction. But of the 40 million Americans estimated to suffer from some kind of substance-use disorder, only 4 million are receiving treatment. Local government is a major provider of treatment services, particularly in prisons and other institutions; stepping up spending can save lives. Similarly, drug courts — special courts to which offenders can be diverted, and which use both carrot and stick to help them get clean — have a track record of success, reducing enrollees’ risk of recidivism.

Other solutions are newer, but vital tools as the crisis grows. The opioid-overdose-reversing drug naloxone can be a lifesaver, and evidence supports its use, particularly as a cost-effective tool with which to equip first responders. Another approach, popular in Europe but still catching on in the United States, is tracking the presence of metabolites of drugs in municipal wastewater, which can allow effective real-time surveillance of the crisis. Many cities stood up wastewater tracking in response to the COVID-19 pandemic; with this infrastructure already in place, wastewater tracking of drugs can be as cheap as $100 to $200 for an entire community, while allowing leaders to monitor changing drug use before it shows up in ERs or morgues.

Some of the approaches I reviewed are more experimental. Much media attention, for example, has been paid to so-called “supervised consumption sites,” where people with serious drug-use problems can consume their drugs under the supervision of nurses or responders armed with overdose-reversing medicine. In my read of the evidence, it’s unclear how big an impact these sites have, given their small scale (servicing only about 5 percent of an area’s drug-use sessions per day at one site, for instance), and particularly compared to investing the same money in treatment. That said, jurisdictions thinking about setting up a supervised consumption site should carefully review the evidence and make sure to track its effects on all relevant stakeholders.

While supervised consumption sites have grabbed headlines, another more experimental approach has gotten less attention but shows a great deal of promise. “Drug market interventions” are a policing tactic that involves coordinated simultaneous takedowns of all drug dealers in a concentrated drug market of the sort that still exists in many American cities. These operations have been shown to reduce both drug crime and violent crime, with effects persisting after the end of the intervention.

The value of all of these approaches is that they are within the power of local policymakers to enact and provide. As the drug crisis continues to decimate both rural and urban America, the time to do so — the time to act — is now.

Charles Fain Lehman is a fellow at the Manhattan Institute, working primarily on its Policing and Public Safety Initiative, and a contributing editor for City Journal. He also co-hosts the podcast Institutionalized.

Governing's opinion columns reflect the views of their authors and not necessarily those of Governing's editors or management.
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