Overdose experts discuss harm reduction strategies and legislative paths forward at Brown Commencement forum

Jha turned to the rise in opioid addiction and overdose among Black and Latino communities, with a 20% mortality rate for African Americans, even as they comprise just 14.6% of the population. “What do you think is going on with rates among people of color?” Jha asked the panel. “What explains the fact that members of POC communities are dying at such a high rate?”

“One issue is the contaminated drug supply,” Bailer said. “For many years, opioid overdose was taking place primarily among injection users—that is, among white people. People of color felt they didn’t use those drugs and didn’t need to learn about Narcan. Fentanyl was not contaminating stimulants like cocaine, crack and methamphetamine at the time. Now it is.”

As co-chair of the Racial Equity Working Group, which advises the Overdose Prevention and Intervention Task Force of Rhode Island, Bailer is working to ensure that public health messaging about opioid use and the perils of fentanyl reaches diverse communities in a language they can understand. Through Project Weber/RENEW, Bailer and his team annually distribute thousands of units of Narcan, safer consumption kits and fentanyl testing strips. “We’re fortunate to live in a state that leads the way in these efforts,” he said. “These are strategies that other states will not even consider.” 

Dr. Beaudoin stressed that treatment centers and the medications they provide need to be widely accessible. “Methadone and suboxone are life-saving medications,” she said. “But methadone is highly regulated. It’s one of the only medications that patients need to pick up daily. And suboxone centers are located primarily in white communities. There are incredible barriers to treatment, even in the Northeast, which is more supportive of these services.” She added that 1 in 58 Americans will die of overdose—a staggering statistic.

Beaudoin went on to assert that overdose prevention is harm reduction, making an analogy to another critical public health intervention: seatbelts. “Seatbelts are different from prevention centers, of course, but they are similar in their end result. They both are evidence-based, harm-reduction strategies that save lives.” 

“Overdose prevention centers do what the title implies,” Bailer said. “We provide a safe place where people can come, feel valued—not judged or stigmatized. And the evidence shows that when we treat someone with dignity and support, they are more apt to get treatment and engage in recovery services by 30%.” He added that Project Weber/RENEW also provides case managers for sexually transmitted diseases and domestic abuse, and in 2023, they housed over 1000 people. “It’s a place for people to feel engaged, be part of a community, get into detox and change their lives,” he said.

Overdose prevention centers will remain illegal nationally until there is a change in the Crack House Statute, Coderre said, which prohibits the use of any site for the purpose of using or distributing controlled substances. 

Jha inquired if there was any chance that Congress would reassess this statute.

“Many members of Congress are interested in the issue,” Coderre said, “but not all. There was some disinformation about the government sending crack pipes to every house, threatening to create a political firestorm. So we have to be cautious about moving with the evidence.”

“We desperately need to change the way we think about substance use disorders,” concluded Beaudoin. “Some of us think addicted people can just stop and change their behavior. But addiction is a chronic brain disease: when we start thinking of it in that way, we start to treat it correctly.”