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Injecting a Solution



Summary/Abstract

Areas struggling with the opioid crisis are pushing to open supervised injection sites for users, but decades of U.S. drug policy and debate over their effectiveness stand in their way.

Content

AMID A PRESIDENTIAL call for ominous commercials and increased use of the death penalty to curb the U.S. opioid crisis, areas around the country are toying with a different idea to stop the deadly scourge: letting people use drugs freely but under supervision. 

The notion of so-called safe injection or consumption sites butts heads with what critics of President Donald Trump's recently announced plan to battle the epidemic consider a return to the "war on drugs" policies of the past. Such facilities allow people to use previously obtained drugs like heroin in a sterile environment under the supervision of medical professionals or trained staff, who would be available to educate on safe drug use, administer the counteracting drug naloxone in the event of an overdose and offer access to treatment or other social services if requested.

Approximately 100 of these types of legally sanctioned sites exist around the world, with the first established in Bern, Switzerland, in 1986. Vancouver's Insite, which opened in 2003, was the first sanctioned supervised injection facility in North America.

While none exist in the U.S., officials in places like San FranciscoSeattlePhiladelphiaNew York CityPortland, Maine; and Ithaca, New York, all have considered opening or allowing one, despite the threat of likely legal action by the federal government.

In January, Philadelphia officials announced the city would encourage private-sector development of consumption sites by nonprofits or medical organizations, and since have met with residents in neighborhoods that could host the sites – such as Kensington and Fox Chase – to discuss concerns about them. They have not announced a date for when a site might open.

Across the country, officials in Seattle and King County, Washington, approved the opening of two sites – including one in the city itself – more than a year ago and allocated $1.3 million in budget funding to help them do so. They, too, have faced opposition and are stuck on picking a location. 

Another front-runner to be first in the country is San Francisco, where safe-use facilities could open as soon as this summer. They may be backed initially by private funding to avoid liability issues. 

"We are still working out legal and siting issues and are not in a position to announce locations or partner organizations yet," Rachael Kagan, a spokeswoman for the San Francisco Department of Public Health, tells U.S. News.

On average, 115 Americans die each day from an opioid overdose, according to the Centers for Disease Control and Prevention. Studies have said safe injection sites mitigate risky drug behavior, reduce the frequency of overdoses, curb the spread of HIV and viral hepatitisdo not increase drug use or local crime and have the potential to save millions of dollars in the U.S. public health sector.

Proponents say the sites are proven tools that hold enormous potential for battling opioid abuse in the U.S. And they contend a return to a "war on drugs" strategy – initially touched off by President Richard Nixon in the 1970s, taken up by President Ronald Reagan in the 1980s, and recently revisited by Trump and Attorney General Jeff Sessions – will only deepen a punitive mentality that has proved ineffective in the past.

"There is something fundamentally wrong with the way that we approach drug policy [in] that, number one, this has been a problem for so long, and number two, that we keep pretending that it's a new problem, which also has been going on for 100 years or more," says David Herzberg, an associate professor of history at the University at Buffalo-State University of New York, who's working on a book about the history of addiction to pharmaceuticals in the U.S.

While government officials and critics have argued safe injection sites could encourage increased drug use and expose populations to more drug activity, Herzberg says drugs are already around, and the sites instead would provide safety and potential help for drug users while moving their activities out of the public eye.

"It provides them with contact with people who know stuff about drugs, and if they want help, they're seeing someone every day – it's not like they wanted help on Thursday, and, you know, by next Tuesday when they saw somebody, that moment was over," Herzberg says. "They stay in contact with people who care about their lives, and if opportunities to help them get better come up, then they get to take them – that's awesome."

Shilo Murphy, an activist behind the push for a Seattle injection site, says there have been "zero deaths in any consumption room in the entire world in all 30 years they've been in operation."

"On top of that, there've been hundreds of thousands of people referred to detoxing treatment and services," says Murphy, founder of Urban Survivors Union and The People's Harm Reduction Alliance. "They're not moralistic enough for people, but they are incredibly successful."

However, Dr. Jay Butler, the chief medical officer in the Alaska Department of Health and Social Services, says he's unsure if the evidence surrounding safe injection sites shows an actual, overall shift toward decreasing drug use and increasing treatment access.

Notably, Canada is grappling with a fentanyl-fueled opioid crisis of its own, and British Columbia – home to Vancouver and the Insite facility – has seen a spike in illicit-drug overdose deaths from approximately 500 in 2015 to nearly 1,000 in 2016 and more than 1,400 last year. Vancouver police also say around 200 potential overdose deaths were reversed at five safe consumption sites in a roughly two-month period from the end of 2016 to early 2017.

"It's definitely a harm-reduction tool. Is it ready for prime time? I'm not sure. We've talked a lot with our colleagues in Vancouver. What I haven't seen from Vancouver is data that it's making an impact [on its drug use epidemic], and I really struggle with that," Butler says.

"It's intriguing in terms of doing something to save lives, but … it's a tourniquet," he continues. "A gunshot wound to the leg, you put a tourniquet on it, but you don't then walk away and say, 'Hey, good luck with that.' You get people into definitive care. We're talking about things that will save lives, but they're not solving that person's problem, much less the larger public health issue."

Aside from the debate over their effectiveness, the sites would appear to run afoul of federal law. A portion of U.S. Code known as the "crack house statute" makes it illegal to "knowingly open or maintain ... any place" for the use of a controlled substance. Clients using the clinic also would be testing the federal prohibition on illicit drug possession.

"It's enabling and continuing people to use, and with all the fentanyl that's in the region right now, there is no safe way to use fentanyl, period. There just isn't," says Patrick Trainor, a spokesman for the Drug Enforcement Agency's Philadelphia Division. "To say that these safe injection sites are a way to use safely is not something that we agree with." 

Trainor says he also remains unconvinced that supervised injection sites would result in a big push for people who use drugs to enter treatment, especially if they're only on-site for a limited period of time. 

"To think that they're going to be engaged in that time period is just not a realistic thing in our experience," Trainor says.

Other federal authorities have come out against the potential sites as well. The U.S. Attorney's Office for the District of Vermont, for example, warned local advocates late last year that opening the sites would expose users, site workers, and overseers to criminal charges, and could result in "federal forfeiture" of the venues themselves.

"Such facilities would also threaten to undercut existing and future prevention initiatives by sending exactly the wrong message to children in Vermont: the government will help you use heroin," a statement from the office said. "It is a crime, not only to use illicit narcotics but to manage and maintain sites on which such drugs are used and distributed."

Still, Urban Survivors Union's Murphy contends there's no silver bullet for solving the opioid crisis, but that safe consumption sites are a piece of the puzzle that means fewer people dying from fatal overdoses. With medically trained staff on hand, people can continue to use drugs until they may be ready to seek treatment, at which point they'd have the opportunity and access to do so immediately, rather than having to wait days or weeks.

"The idea that we would choose not to use a piece of the puzzle has always surprised me," Murphy says. 

He also says he's not afraid of the likely legal battles looming over opening such a site, predicting the fight eventually will go all the way to the U.S. Supreme Court.

"It's around the drug war, and you're basically saying, 'This place was trying to save people's lives and stop overdoses, but the federal government wants these people to die,'" Murphy says. "That becomes the narrative, and I think that's a hard narrative for the feds to go with because the data [...] and the science is really behind safe consumption rooms." 

 

"The idea that we would choose not to use a piece of the puzzle has always surprised me," Murphy says. 

He also says he's not afraid of the likely legal battles looming over opening such a site, predicting the fight eventually will go all the way to the U.S. Supreme Court.

"It's around the drug war, and you're basically saying, 'This place was trying to save people's lives and stop overdoses, but the federal government wants these people to die,'" Murphy says. "That becomes the narrative, and I think that's a hard narrative for the feds to go with because the data [...] and the science is really behind safe consumption rooms."

 

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