Being an addict (especially one who uses intravenously) is dangerous. Aside from the obvious fact that shooting drugs can easily kill you, the lifestyle comes with a shitload of crime, disease and degradation. The more drugs you use, the more you don’t give a fuck because you feel like you’re going to die if you don’t get high. The deeper into addiction you go, the greater the stakes. More drugs cost more money, which means increased chance of violent crime and less regard for personal health and safety. Blessedly, places with progressive views on drug use, like the Netherlands, Australia and Germany, have implemented harm reduction strategies for years.
One such approach is to provide supervised injection sites for those who regularly use drugs intravenously. These are legally sanctioned facilities where people who use IV drugs can come after they score to inject drugs under medical supervision. The facilities are designed to reduce the health and societal problems associated with injection drug use. Now, according to a recent CBC News report, the Canadian government has proposed new legislation that will open the door for these types of facilities throughout the country. The question on everybody’s mind is thus: are these safe injection sites the antidote to the opiate epidemic or just something that enables addicts to use more?
Get High, but Don’t Die
Supervised injection facilities typically provide sterile injection equipment and access to medical staff that can administer naloxone, a drug used to reverse the effects of an overdose from opioids. Anybody who has ever desperately shot up in a filthy gas station bathroom (was that just me?) knows this is a huge improvement over typical illicit drug using conditions. Some sites also offer information about drugs, health care, treatment referrals and counseling. They are usually opened in neighborhoods where drug use is prevalent so that they can reduce the public nuisance associated with illicit drug use, including improper syringe disposal and public drug use.
Before you scoff like an overprotective parent who thinks granting teens access to birth control is going to make them have sex, consider the fact that there are already more than 100 supervised injection facilities operating in nine countries that seem much cooler than the good old US of A. These include Switzerland, Germany, the Netherlands, Norway, Luxembourg, Spain, Denmark, Australia and Canada. The Vancouver, Canada supervised injection site, called Insite, opened in in 2003. It is the first (and only) facility of its kind in North America.
Help or Harm?
Insite is operated by a large healthcare company and depends on government funding from the British Columbia Ministry of Health Services. It’s located in Vancouver’s Downtown Eastside neighborhood, an area infamous for crime and drug use. When I was a young junkie in Seattle, I remember hearing about the Downtown Eastside; people said it was a magical place where you could score dope in alleys and then shoot up right out in the open (apparently, police didn’t even bother with drug users in that neighborhood since there was too much other real crime to worry about). The excitement we felt at the prospect makes me shudder now.
A 2011 study found fatal overdose rates decreased by 35 percent in Vancouver after the opening of Insite. Unfortunately, the latest spike in opioid abuse has not been confined to the US—it’s hit all of north America hard. In the first 10 months of 2016, 622 people in BC died of drug overdoses, compared to 397 during the same period in 2015. The strong opiate Fentanyl, which is sometimes used on the street to cut heroin, was detected in many of the deaths. Now Insite can’t keep up with the demand and addicts in the neighborhood are back to shooting up in the alleys.
According to a report by CTV News in Vancouver, community activists have taken it upon themselves do something about this. A group calling themselves The Overdose Prevention Society has set up a pop-up harm and overdose reduction tent to keep users safe. They provide clean needles, injecting supplies and carry naloxone in case of overdose. The work they do is technically illegal, but so far no one is stopping them. The first tent was set up in September and another followed at the end of November. The Society says it has already saved more lives than it can count with this type of guerrilla activism.
Drug addicts are a notoriously difficult population to study. The exception to this rule is in cases where community agencies build trust among clients over a period of time. For this reason safe injection facilities in other countries have been researched and evaluated for years and been the source of much valuable data about IV drug users. There is ample evidence that they reduce HIV and hepatitis transmission risks, prevent overdose deaths, reduce the number of people shooting up in public and improperly discarding syringes and increase the number of people who enter drug treatment. But they only help people find help if they offer counseling and referral services. Unfortunately, many facilities do not.
No safe injection facilities currently exist in the United States, but the nonprofit group Drug Policy Alliance is advocating for pilot programs in San Francisco and New York City. Two additional sites have been proposed for Seattle as a result of the work of the city’s Heroin Crisis Task Force. These groups are working to expand the national dialogue on drug abuse to include more emphasis on harm reduction policies, rather than traditional drug control measures mandating abstinence.
Personally, I have mixed feelings about these types of facilities. On one hand, I do believe we need to fight back against the opiate epidemic from multiple fronts. It would be naive to think that everybody can kick heroin and maintain total abstinence in the traditional 12-step fashion (even though I did). I wholeheartedly believe in other harm-reduction strategies like Medication-Assisted Treatment (MAT) and needle exchange programs. But, I also see the point of those who believe keeping addicts strung out without offering resources for treatment is negligent. The best approach is to create more safe injection sites, but also be sure to double down on addiction education and treatment efforts.