What is harm reduction, the drug-treatment program that Sen. Ted Cruz has criticized?

Texans seeking help for substance use can call the Substance Abuse and Mental Health Services Administration’s free help line at 800-662-4357. They can also access services available in their region through the Texas Health and Human Services website.

Republican U.S. Sen. Ted Cruz criticized President Joe Biden last month for supposedly funding the distribution of free crack pipes — an assertion federal officials denied and called misleading.

Cruz was referring to the Biden administration’s $30 million grant program that aims to mitigate the fallout from the country’s opioid crisis and increased fentanyl overdoses. The program relies on what are called harm-reduction policies, which call for minimizing the detrimental health and economic impacts of drug abuse until users can get treatment rather than criminalizing addiction.

The senator’s comments focused on safe smoking kits, which typically contain alcohol swabs, lip balm and other protective materials meant to protect users from possible burns, blisters and transmittable infections such as HIV and hepatitis C. Some harm-reduction organizations include glass stems that can function as pipes in their safe smoking kits. But White House press secretary Jen Psaki denied that the federal program would fund the inclusion of pipes and said the federal government does not support direct or indirect funding for such items.

As conversations continue about alleviating the damage from opioids and fentanyl, here’s what you should know about Cruz’ claims and harm-reduction practices in Texas.

How were Cruz’s comments misleading?

In early February, Cruz sparked controversy when he tweeted “Biden crime policy: Crack pipes for all” and then later went on his podcast, “Verdict”, to further amplify the statement, which fact-checkers have said is false.

Cruz’s comments responded to a news article from a conservative publication that claimed the program providing funding for harm-reduction policies under the Biden administration would distribute crack pipes as part of safe smoking kits.

His statements that Biden was giving out crack pipes — in conjunction with messaging from other Republican senators — reverberated in conservative and right-wing information circles.

The fallout was significant enough that U.S. Sen. Joe Manchin, a moderate Democrat from West Virginia, joined Republican U.S. Sen. Marco Rubio of Florida to introduce legislation prohibiting federal funds for purchasing paraphernalia like pipes and needles.

But federal officials denied claims the program would fund pipes. In a joint statement, Health and Human Services Secretary Xavier Becerra and National Drug Control Policy Director Rahul Gupta said their agencies are focused on “using our resources smartly” to reduce the harm and fatalities caused by drug use.

“Accordingly, no federal funding will be used directly or through subsequent reimbursement of grantees to put pipes in safe smoking kits,” they said.

What is the harm-reduction approach?

Harm reduction offers a science-based alternative of recognizing addiction as a disease, as opposed to traditional and nonscientific approaches that have criminalized drug usage.

For the most part, harm reduction does not look to cure the addictions of the people served. Instead, it works to ensure people on drugs stay alive and as healthy as possible until they can receive proper treatment.

Advocates understand that drug use entails significant risks, but also believe that people — especially those dealing with addiction — need love and support.

“There are going to be people that use drugs,” said Claire Zagorski, a harm-reduction and drug policy researcher at the University of Texas at Austin’s College of Pharmacy. “I want to meet those people wherever they are.”

Zagorski said harm reduction is economically smart — people who overdose or injure themselves while using can end up with a hospital bill that they cannot pay.

Marcia Ory, a public health professor at Texas A&M University and chair of the school’s opioid task force, said the harm-reduction approach accompanies a shift in perception about addiction. Evidence shows that people who get addicted to drugs don’t have a lack of willpower but instead undergo bodily changes that entice them to want more drugs.

Ory, whose task force provides training on harm reduction and naloxone administration, said if criminalization were successful, fewer people would have addiction and fewer lives and families would be ruined.

“I would hope that harm-reduction strategies would become the norm, that they would be prevalent, that the view of addiction would be away from a criminal perspective toward a medical perspective,” said Ory. “These strategies have been around for some time, and the issue is being able to utilize them to the fullest, because that’s what’s going to save people’s lives, families, communities.”

What do harm-reduction practices look like?

Programs can distribute an array of products that all aim to reduce harm from drug use. That can include safe injection kits with clean syringes and fentanyl testing strips, which are a relatively cheap way to check for the presence of the deadly narcotic that is increasingly a contaminant in other drugs.

“Because fentanyl is becoming more prevalent — it’s deadly — it’s all the more reason why some of those harm-reduction strategies are so important,” Ory said. “The assumption is that if you have drug paraphernalia freely available, that that’s going to encourage drug abuse, that is not a scientific fact.”

Distributed items can also include naloxone, often known as Narcan, a medicine that can treat opioid overdose. Additionally, many programs also give out products for non-drug-related use, like safe sex kits and general hygiene kits with soap and toothbrushes.

Maria Jeffrey Reynolds, a spokesperson for Cruz, said providing tools that let people continue using drugs does not help.

“Programs that put people on a path to recovery from their addictions are true harm reduction programs,” she said in an email.

Are harm reduction policies being used in Texas?

As the state grapples with the ongoing opioid epidemic and a rise in fentanyl deaths, public health experts say that harm-reduction strategies can both help people with their drug addictions and curb fallout from the crisis.

Narcan is one product many harm-reduction groups in Texas distribute that the state has also embraced using. Recent settlements between the state and pharmaceutical companies implicated in the opioid epidemic provide millions of dollars’ worth of Narcan for the state.

But other strategies face a roadblock in Texas: State law criminalizes the possession and distribution of drug paraphernalia, which includes fentanyl testing strips. Clean syringes and clean pipes can also be considered paraphernalia.

During last year’s legislative session, a bill sponsored by state Rep. Jasmine Crockett, D-Dallas, aimed to remove criminal penalties for possessing paraphernalia. The bill passed out of committee but never came up for a vote by the Texas House.

Crockett, who is up for a congressional seat in south Dallas, agrees that a harm-reduction approach is the future for helping combat drug problems, in contrast to criminalizing drugs.

“You lock someone up who has an addiction, you don’t help them at all,” Crockett said. “You just put them away, and then you let them back out. Guess what? They still have an addiction. And they’ve not been given the tools and resources. And sadly enough, they’ve not been treated with the dignity that really they should be afforded.”

Those barriers prompted many advocates for harm-reduction policies to criticize Cruz for politicizing their work.

“It’s outrageous that somebody like Ted Cruz is even commenting on harm-reduction tools when a lot of the evidence-based tools that we need in the first place are illegal in the state,” said Paulette Soltani, director of organizing for the Texas Harm Reduction Alliance, which protested outside Cruz’s Austin office in March. “It’s a political issue at the expense of the lives of Texans.”

Disclosure: Texas A&M University and the University of Texas at Austin have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.