The opioid epidemic continues to ravage lives and communities across the United States. The current approach towards intravenous drug treatment cannot keep up with the rising need for flexible and innovative solutions. Across the world, other countries see the benefits of safe injection sites for people dealing with addiction as well as for their families and communities. Despite these positive health outcomes, there is pushback against groups attempting to operate safe injection facilities in the United States. Why aren’t safe injection sites everywhere? And how can health officials look past the penal legal structures of yesterday in a world where intravenous drug use continues to rise to the already staggering death toll.
Harm Reduction Model
Safe injection sites are based on the harm reduction model of substance abuse treatment. Clinicians using harm reduction models aim to help clients who are unable to be fully abstinent from a substance or behavior. This approach is backed by peer-reviewed clinical trials and provides additional tools for both medical practitioners and patients alike.
The current opioid crisis continues to prove deadly for those struggling with addiction and causes chaos for their families and communities. While current drug policies stigmatize and incarcerate, harm reduction strategies aim to address the public health crisis with a public health solution.
Syringe exchange programs are an example of a harm reduction strategy that helps combat HIV and Hepatitis infections in intravenous drug users across the United States. A third of the United States AIDS infections come from intravenous drug use. Fear of social rejection and arrest drive a person battling addiction towards unsafe syringe practices and unhygienic injection sites.
Safe injection sites are just another form of harm reduction. In Canada, Europe and Australia safe injection sites — or safe consumption sites — reduce overdoses, public injections and provide intravenous drug users with a safe environment and medical resources.
The War on Drugs created the legal and punitive system contributing to today’s opioid epidemic and public demonization of people battling addiction. Harm reduction strategies such as safe injections address the current dangers facing those with substance use disorders (SUD) with the long-term goal of shepherding people towards resources and recovery.
History of Safe Injection
The Netherlands was the first country to implement safe injection sites starting in the ‘70s. This example spread across Europe into the ‘80s and today there are legal safe injection sites in Germany, Norway, Denmark, Spain, Luxembourg and Switzerland. By 2001, Australia had joined the movement opening their first safe injection site in Sydney. Canada opened their first safe injection site in Vancouver in 2003. Today, there are at least 100 legal supervised injection sites operating worldwide, mostly in Europe, Australia and Canada.
These safe injection sites have proven to be very helpful in combating the present-day issues in communities suffering from intravenous drug use. In the United States, safe injection sites are still federally illegal. There are pushes for safe injection sites across the country in San Francisco, Portland, Denver, New York, Boston and Seattle. Philadelphia is currently the city closest to opening its first legal safe injection site, but not without federal pushback and community outrage.
Still, despite the pushback and legal boundaries, wherever health officials implement safe injection sites positive results follow.
Benefits of Safe Injection Sites
Despite fears and controversy, safe injection sites have incredible positive health outcomes with little impact on crime or increased drug use. When people are given a safe place to consume a substance that they already intend to consume, it can help them get treatment. In most cases, safe injection sites pop up in structures already available like clinics or homeless shelters. At these sites, people can come to use and find healthcare, drug testing and professionals to monitor them while they inject. Naturally, there are less overdoses, better access to clean needles and prevention of accidental fentanyl overdoses.
Though outrage surrounding the Philadelphia safe injection site proposal is rooted in fear of the community unraveling, there is evidence for safe injection sites improving overall community safety. Based on safe injection sites in Vancouver and Sydney, community members and business owners witnessed a significant reduction in public injection, discarded syringes and injection-related litter. There was also no noticeable increase in crime or drug dealing. The only perceivable negative effect was the increase of loitering outside of the facility. Whether loitering would dissipate with more clinics available is currently unknown and requires further research.
Safe injection sites are also fiscally beneficial. They lower the need for overdose related ambulances and hospitalizations as well as risk of medical care needed for infection and drug-related diseases. The improvements to community and financial incentives are a potential route for state legislators to approve safe injection sites without dealing with federal drug policies.
Pushback Against Safe Injection Sites
Critics of supervised injection sites say that it encourages drug use and brings crime into communities already in need of support. Federal drug law also poses challenges. Where needle exchange programs can operate within the law, supervised injections provide a space for the use of controlled substances. This means law enforcement would be able to prosecute clients, employees and the companies running the facility at a moment’s notice. To run safe injection sites, law enforcement must allow or at least ignore facilities in their jurisdiction.
Some states and municipalities are able to get around federal drug law by legalizing substances like cannabis or psychedelics at a state level. This path could work for safe injection sites as a state authority provides the strongest defense against federal intervention.
Another obstacle for the widespread implementation of safe injection sites is the lack of empirical research about their benefits. In order to conduct random clinical trials, researchers would have to give treatment to some users and not others which bring up ethical dilemmas. Any evidence gained from any studies is considered observational analysis, which often is not strong enough to back a legal argument.
Though there is no evidence of increased crime and community degradation surrounding safe injection sites, people still do not want them in their neighborhoods. Part of this stems from the negative connotation and judgment surrounding intravenous drug use and addiction as a whole. When addiction is seen as a moral failing, those with addictions are seen as a scourge to be dealt with punitively.
Medical research sees addiction as less of a moral failing, but rather a condition best treated with support and resources. Just as other positive harm reduction strategies, supervised injections can help keep a person with a SUD alive to find support and resources. In the desperation of addiction to intravenous drugs, research shows that access to safe and private places to inject under medical supervision gives people the best chance to avoid negative health consequences.
Some healthcare activists are going rogue and implementing safe injection sites in undisclosed locations around the United States. Data from one location shows that more than 90% of clients at the supervised injection site would have otherwise injected in a public place. Of those clients, 67% would have disposed of their equipment unsafely. When given the resources — in the case of this safe injection site — addicts made the choice to access the resources presented to them. The focus on their perceived decision to use did not stop medical practitioners from presenting them with another choice to use safely. The implementation of this could help people dealing with addiction all over the world and hopefully address an epidemic long perpetuated by antiquated legislation.
Why do you think people resist safe injection sites? For our international friends, do you have any insight on safe injection sites in your communities? We would love to hear your thoughts in a comment below.