By Taylor Knopf

From Appalachia to Atlantic Beach, you’ll find hundreds of medical professionals and advocates desperately trying to prevent opioid-related deaths.

And yet, every day, an average of four North Carolinians overdose and die.

For years, my colleagues and I at North Carolina Health News have covered drug-related infection and overdose issues, as well as the resulting social impacts, such as the increased number of children in foster care, babies born dependent on opioids, job losses, incarceration and deaths. But last year, we were given the opportunity to learn about how other countries approach drug use.

Thanks to a grant from the Solutions Journalism Network, and a supportive editor, I spent seven days reporting in France and Switzerland, two places with a lot of experience with heroin.

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Because here’s the problem: More North Carolinians died in 2017 from drug overdoses than the state health department projected for the year 2021.

Life expectancy in the United States has now dropped two years in a row, for the first time in over five decades, according to the Centers for Disease Control and Prevention. Much of this is due to drug overdose deaths.

It’s not for lack of trying, however.

North Carolina, like many other states, has legalized syringe exchanges. Law enforcement and EMS personnel carry the overdose reversal drug, naloxone. And the state legislature passed a law limiting the number of opioids that can be prescribed for acute pain.

There’s been the beginning of a culture shift as people start to think about addiction as a chronic illness rather than a moral failing. Federal and state dollars have been allocated for addiction treatment. Meanwhile, N.C. law enforcement and state officials frequently repeat the mantra: “We cannot arrest our way out of this.”

However, North Carolina’s morgues remain full. The state’s medical examiner’s autopsy count has hit a record high. Much of that office’s work is now fueled not by prescription drug deaths, but by deaths from a combination of heroin and black-market fentanyl.

There seem to be other ways to tackle these problems, but they require a huge shift in perspective.

Decades ago, across the Atlantic, many European countries dealt with similar spikes in heroin use, overdoses and high rates of HIV and Hepatitis C infections, which spread through sharing needles.

In contrast to the U.S., countries such as France and Switzerland have reigned these in.

So I got on plane in November and visited Bordeaux, Paris, Geneva and Zurich. There, I observed innovative harm reduction programs unlike anything I’ve seen in my previous reporting. Some of these approaches are not legal in the United States, such as supervised drug consumption rooms and heroin-assisted treatment programs.

With the help of interpreters, I interviewed addiction psychiatrists, doctors, nurses, social workers, educators, policy influencers, drug users and a chemist.

I spent the majority of my reporting in France, which has an easily-accessible harm reduction network called La Fédération Addiction made up of more than 800 members including hospitals, sleep centers, treatment facilities, and needle exchanges.

This well-connected system enabled me, an American journalist with one week in the country, to see and talk to as many people as possible. This huge network also allows for a very holistic approach when serving people who use drugs.

graph shows number of overdose deaths rising more slowly
In North Carolina’s 2017 state opioid action plan, the state Department of Health and Human Services’ goal was to reduce the growth of opioid overdose deaths. Credit: NC State Center for Health Services

In Switzerland, I visited two heroin-assisted treatment programs, which do not exist in France. There I learned the Swiss have a different relationship with illegal drug use.

Unlike France, Switzerland had an “open drug scene,” meaning many people injected drugs in public spaces. One park next to Zurich’s main train station was nicknamed “Needle Park” due to thousands who flocked there to sell and inject heroin in the 1980s.

Because the Swiss had such a public drug problem, elected officials, law enforcement and the medical community came together in the 1990s and created a pragmatic “four-pillars law.” And Swiss citizens supported the measure, which included legalizing heroin-assisted treatment programs.

Over the next few weeks, I will explore what I found in my reporting on the French and Swiss approaches to drug use and harm reduction. Maybe we could learn a few lessons from countries that have dealt with these opioid issues before us.

Coming Monday: Switzerland couldn’t stop drug users. So it started supporting them.

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Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...

2 replies on “Why I went to Europe to learn about the American drug crisis”

  1. Thank you for this work reporting on an essential topic. Iceland has done some amazing work as well. I look forward to the others in this series.

  2. Thanks for the deep look into into this, and I look forward to seeing the up coming reporting. Your writing is engaging and dynamic.

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