美国国家公共电台 NPR Fight The Opioid Epidemic, All Agree. But Strategies Vary Widely（在线收听）

DAVID GREENE, HOST:

Now, across the U.S., states are pouring resources into fighting the opioid epidemic. A handful of them have even declared public health emergencies. And Arizona did just that earlier this year. But some advocates say that until state leaders let go of these entrenched attitudes toward drug addiction, more people are going to die. Will Stone from member station KJZZ in Phoenix reports.

WILL STONE, BYLINE: It's no secret why people come to George Patterson on Tuesday afternoons in a mall parking lot.

UNIDENTIFIED MAN #1: Are you going to take these dirty ones?

GEORGE PATTERSON: Yeah, right there.

STONE: And not the pharmacy down the street.

PATTERSON: All you have to do is find us and you can come get it. You don't need to bring your ID, you don't need to, you know, sign anything. You just get what you need.

STONE: What the IV drug users gathered around his car need are clean needles and naloxone, the opioid overdose reversal drug. So they turn to volunteers like Patterson, who run Phoenix's only syringe exchange program called Shot In The Dark.

PATTERSON: A lot of them don't trust people. A lot of them have a lot of trust issues, understandably, with the health care industry, with what's going to be put on their record.

STONE: More than a dozen states have laws that explicitly allow syringe exchanges. Arizona doesn't, though. That means these volunteers operate under the radar, trying to reach people like this man, who wouldn't give his name.

UNIDENTIFIED MAN #2: There's still a lot of people that don't even know about it, you know? And they're still using dirty needles. It shouldn't be so hidden.

STONE: This summer, Arizona's Republican Governor Doug Ducey declared the opioid epidemic a public health emergency, claiming two lives every day. But Patterson feels that hasn't necessarily translated into more help for the people he sees here.

PATTERSON: Instead of focusing on ways that you can connect with the IV drug-using population, show them that their health matters and prevent all the people that are likely never going to stop using IV drugs, they, like, leave them out here to pick up dirty needles out of parks and give themselves diseases.

STONE: Needle exchanges seek to reduce the negative consequences of drug use without forcing abstinence, a concept known as harm reduction. The surgeon general has determined such programs improve health outcomes like reducing HIV and hepatitis C rates, and they don't promote drug use. But that hasn't convinced some of Arizona's most influential law enforcement figures.

BILL MONTGOMERY: It's a well-intentioned, misguided program.

STONE: Bill Montgomery is the top prosecutor in Maricopa County, which covers the Phoenix metro area.

MONTGOMERY: We don't have a free-case-of-beer-a-month program for alcoholics. It sends the wrong message too and it's not providing the treatment.

STONE: This is a common argument against syringe exchanges, that they enable drug use. Proponents of harm reduction, however, point to research that people who access these programs are actually more likely to seek treatment. Still, Montgomery says there are better solutions to the opioid epidemic. And he isn't out to prosecute drug users when he doesn't have to.

MONTGOMERY: Law enforcement really does look at treatment first as an option for those who are addicted.

STONE: He points to Arizona's Angel Initiative, which lets people turn themselves into the police and get treatment. Expanding that program is part of the state's wide ranging opioid action plan. Experts from Arizona helped craft the policy roadmap, which recommends improving access to treatment and naloxone. It also proposes more regulation of the medical community and prescribing practices, a focus that Dr. Jeffrey Singer says is misguided.

JEFFREY SINGER: Our policies right now are aimed at the supply site. And all they're doing is driving the death rate up. They're not driving use down.

STONE: Because users are turning to heroin and fentanyl, says Singer, who's a fellow at the libertarian Cato Institute and a surgeon. He says Arizona should embrace harm reduction strategies.

SINGER: My job is to save lives and to ease suffering. The law enforcement people need to have that same attitude. We just have to take our personal biases out of it and just focus on the goal, which is less death and less disease.

STONE: In fact, the state asked a group of treatment providers for their top recommendations for its action plan. Among them, legalizing syringe exchanges. But that was nowhere in the final version. The state says that's because it doesn't directly reduce opioid overdoses or deaths. For NPR News, I'm Will Stone in Phoenix.

GREENE: That story was part of a reporting partnership with NPR, KJZZ and Kaiser Health News. And speaking of the nation's opioid crisis, we do have a correction to a segment we aired yesterday. We were talking about the McKesson Corporation, the nation's largest drug company. And we said the Trump administration reached a settlement with McKesson dealing with alleged over shipments of opioids. In fact, that settlement was announced on January 17. That was during the last days of President Barack Obama's term.