Santa Fe, New Mexico is emphasizing alcohol harm reduction in its plan to radically restructure the Southwestern municipality’s drug policy amid an alcohol-related death crisis.
On March 11, the Municipal Drug Strategy Task Force presented its proposal, The Santa Fe Plan, to the City Council. The Plan calls for the city government to support and/or fund evidence-based harm reduction strategies, like housing for people who are actively using drugs and using the Drug Policy Alliance’s* high school drug education curriculum in Santa Fe public schools. It also proposes, among many other things, a new city government position to oversee the roll-out of the Plan, researching injectable opioid treatment with hydromorphone, and advocating for state policy changes, like cannabis legalization and the decriminalization of drug-checking kits.
But one standout element of The Santa Fe Plan is how it centers people who drink problematically, who are often sidelined from drug policy discussion, as beneficiaries of its proposals.
“In Santa Fe, we’re the first ones to do it,” Task Force Chair Emily Kaltenbach told Filter, suggesting that the capital of New Mexico was breaking ground on including alcohol use among city-level harm reduction policies typically geared towards other drug users. The Santa Fe Plan was produced in the lineage of other cities taking bold policy positions on drugs. The Ithaca Plan, published by the city in upstate New York in 2016, forefronted harm reduction in an area where “Abstinence-based treatment programs predominate.”
Problematic alcohol use “wasn’t addressed in the Ithaca plan” to the extent that Santa Fe aspires, said Kaltenbach. “Even in the title” of The Santa Fe Plan, it’s emphasized: ‘A Municipal Public Health and Safety Approach to Alcohol and Other Drugs.'”
Kaltenbach noted that nearly all the proposals are applicable to both alcohol and other drugs, and are not specifically tailored to alcohol use at this stage in the proposal. But “it’s important alcohol is included,” she said, adding, “We know most often people are polysubstance users. If someone’s using alcohol problematically, they may also be using other drugs. The underlying reasons that it can be problematic can be similar across substances: Poverty, income inequality, housing—social determinants of health.”
Parts of the Plan have a history of being designed for and uniquely benefiting drinkers, like the proposal to “reduce barriers” to harm reduction housing. Sometimes colloquially referred to as “wet houses,” harm reduction housing has been shown to help people with alcohol use disorders to manage or reduce their use.
In Santa Fe, problematic use of the legal, normalized beverage—and associated fatal behaviors—is “shocking,” Kaltenbach said.
Out of a population of around 17,000 Santa Fe residents with substance use disorders, more involve alcohol (7,491) than involve opioids (4,561) and stimulants (1,713) combined. Almost half of all people with substance use disorders in Santa Fe County haven’t been able to access treatment.
Santa Fe stands out for its alcohol-related deaths. In January 2020, the county saw a rate of 57 deaths per 100,000 residents. In contrast, the overall United States death rate for that month was 34 per 100,000. People in the county are dying far more frequently from alcohol-related causes than from other drug overdoses, for which the death rate in January was 31 per 100,000.
“Cities have a unique role in drug policy reform,” said Kaltenbach. “We can make change at a local level that’s most acutely felt by the local community.” But it wasn’t just the leaders of the city that knew the urgency of addressing problematic drinking. “It’s important that this wasn’t a topdown approach. Alcohol was noted to be by far the most problematic [by interviewed community members].”
One stakeholder told the Task Force that “Alcohol is extremely prevalent and underlies everything; it is under reported, glossed over and minimized.”
So both politicians and the community played a role in making sure the city’s progressive approach to drug policy included a substance often overlooked by the harm reduction movement. “Both mayors who spearheaded this wanted to make sure alcohol was addressed,” said Kaltenbach. In 2017, then-mayor Javier Gonzalez passed the resolution that called for the formation of the Task Force. Mayor Alan Weber then formalized it after he took office in 2018.
Some parts of the Plan are already “underway,” said Kaltenbach, who hopes that they’ll be included in the next fiscal year budget. Other elements may take up to three to five years, she estimated. “We’re hoping that some city council members champion some of the proposals.”
Kaltenbach hopes the cutting-edge plan can serve as a “roadmap” for cities elsewhere. “We were given the green light to think outside the box and in innovative ways, and that shows in the plan.”
*The Drug Policy Alliance has provided a restricted grant to The Influence Foundation, which operates Filter, to support a Drug War Journalism Diversity Fellowship.