In California, overdoses have been falling for about a year. It’s a ray of hope largely attributable to a complex web of public-health outreach, individual behavior change, and a willingness to find local solutions to local issues. But the overdose crisis isn’t over. That’s because—as new research demonstrates—the drug supply is and will remain in flux.
And with every new substance that is added to the supply, not to mention new drug combinations, comes new risks. Saving lives will continue to require local innovation and real-time adaptability. Yet with newly introduced Assembly Bill 396 California risks leaning into its over-regulatory tendencies just when it needs on-the-ground flexibility the most.
The current overdose crisis is driven primarily by the rise and spread of powerful synthetic opioids such as fentanyl. The drug’s extreme potency is particularly dangerous on the illicit market because quality fluctuates and people don’t know what’s in their purchases. Furthermore, the very prohibitionist policies that incentivized fentanyl continue to push manufacturers to come up with new, often stronger, more dangerous substances.
Already, opioids even more potent than fentanyl are popping up across the country. A drug-checking program that tests samples from harm reduction organizations is tracking increases in carfentanil and nitazenes, as well as a growing array of sedatives that do not respond to the overdose reversal drug naloxone. In January, the lab identified 126 distinct substances in the supply, 13 of which were new to them.
Generally, California is proactive about helping people stay safe and alive in this unstable, opaque market by allowing access to a variety of tools, from naloxone to drug-checking equipment. In recent years the state has reduced barriers to addiction treatment and harm reduction while keeping legislation broad enough that programs can be tailored to local needs.
For example, last year the state authorized drug-checking equipment that tests for any possible contaminant, rather than only fentanyl. And, while these expansions are not the only factor responsible for recent overdose declines, policies allowing the interventions are certainly part of why fatalities have fallen. Unfortunately, California is now poised to reverse at least some of its own progress.
It may be obvious at this point, but it deserves to be said again: The government should not restrict people’s access to tools that can help keep them safe and alive. California should know this given its bans on flavored nicotine products like vapes, which boosted the illicit market and drove some people back to combustible cigarettes.
Similarly, while AB 396’s sponsor certainly has community well-being at heart, the bill would devastate the organizations at the center of the overdose fight—syringe services programs (SSPs). AB 396 would require SSPs to label individual syringes before distributing them, a practice referred to as “marking,” and to meticulously track them. The bill, one may assume, is supposed to reduce syringe litter by holding distributing organizations accountable with fines of $1,000 per “violation.”
None of us wants to find used syringes in public spaces. But this bill requires all programs to mark syringes, regardless of whether their community has a syringe litter problem, and it is unlikely to improve syringe disposal. Research shows that SSPs do not increase syringe litter and often reduce it because programs provide locally tailored safe disposal options such as take-home sharps containers and community collection sites, and typically host local clean-ups. So, if a community is seeing a spike in syringe litter, the first step to reducing it is asking why, not instituting a blanket mandate.
What’s more, a statewide requirement to mark syringes could place such an administrative burden on SSPs that they will be unable to operate at all. If this is the hidden agenda of the proposed legislation, it will be a disaster. SSP participants are five times more likely to enter treatment and three times more likely to quit using illicit drugs. The programs reduce the spread of infectious diseases, distribute overdose prevention tools, and provide a point of connection and treatment referral for people who tend to be isolated from our healthcare systems.
SSPs are essential to California’s fight against the overdose crisis. The state’s willingness to let local communities drive these policies is part of why overdose deaths are falling. However, with the drug supply constantly evolving, it is not time to start over-regulating these life-saving programs. Rather, California should continue to afford SSPs the flexibility to meet local, community needs and adapt to the deadly illicit drug market as swiftly as possible.
Stacey McKenna is a resident senior fellow with the R Street Institute’s integrated harm reduction team.