By: Shane Sullivan, Community Outreach Specialist at HIPS
In 2018, the District reported 213 opioid-related overdose deaths, or 30.3 per 100,000 people. Overdose fatalities ended the lives of over 70,000 Americans nationally, at a rate (14.6 per 100,000 people) that is accurately described as a crisis, but is less than half of DC’s. Through testing of drug samples by Ward, HIPS estimates that over 90% of the street heroin supply in DC contains fentanyl, a deadly synthetic opioid that is 50–100 times more potent than morphine. Mirroring national statistics, fentanyl has been involved in the majority of overdose fatalities in DC within the past few years.
In December 2018, in response to widespread criticism for political inaction, Mayor Bowser’s office (in partnership with the Department of Behavioral Health) announced their LIVE.LONG.DC plan with multiple goals, including reducing “opioid-related deaths by 50 percent in 2020.” While HIPS has finally been equipped through this initiative with an ample supply of naloxone (the medication used to reverse opiate overdoses, commonly known under the brand name Narcan), this goal falls short of the reality that overdose deaths can be entirely preventable; in fact, we have a model that’s been successfully replicated in ten countries over multiple decades to prove it: safe consumption spaces (SCSs).
In six years of doing outreach with HIPS, I’ve witnessed firsthand the impact of providing syringe exchange, safer injection equipment, naloxone, linkage to care, and other essential services for people who use drugs (PWUD). But outreach efforts and harm reduction supplies, while essential and still under-funded, cannot on their own heal the extreme stigma many PWUD face that perpetuates social environments ripe for fatal overdose (and of course cannot on their own solve our drug crisis, which is born from a complex intersection of structural racism; poverty; lack of accessible, quality healthcare and affordable housing; criminalization and incarceration; and a poisoned and largely unregulated drug supply). At HIPS, we provide naloxone and other compassionate harm reduction services to residents at the highest risk of overdose (or of witnessing loved ones overdose). As a society more broadly, however, we have normalized sending PWUD off on their way to use on the streets, alone, or in other high-risk settings instead of acknowledging this essential gap in services that SCSs fill.
My friend fatally overdosed exactly a year ago, on April 6th, in DC. She texted me the night she died that she felt too ashamed to accept help (a feeling compounded by a lack of response from the treatment centers she had already contacted). She had overdosed previously, multiple times, while using alone, revived by EMTs with no follow-up from anyone but her family and friends. I can’t say with certainty that she would have chosen an SCS over using alone, but I do know that she felt she had ‘burdened’ her family and friends too much already, and wanted the type of direct help from medical professionals that an SCS provides. Having previously tapered her use through Suboxone, and having contacted multiple treatment centers shortly before her death, I believe she would have at least considered using an SCS, particularly because of the low-barrier way in which most operate. Regardless, she should have been provided with that option, and might still be alive today had it been available to her.
Safe consumption spaces are not just a simple stopgap for overdose prevention (although it’s true that no one has ever fatally overdosed at any of the approximately 120 locations worldwide). They are places where PWUD can receive broader medical services like wound care, HIV/Hep-C testing, case management, medication-assisted treatment (MAT) or linkage to treatment, and additional services that HIPS and other harm reduction organizations already offer. They are also places where people with any type of substance use issue can use safely; while opioids were involved in 64% of DC’s intoxication deaths in 2018, there were at least 299 deaths overall related to intoxication that an SCS could more broadly address. Most importantly, like other harm reduction organizations, when operated successfully they are run by compassionate, competent service providers who are ready not just to respond to overdose, but who are also able to look past stigma to see the full person in front of them, regardless of what stage of use they may be in.
Source: DC Office of the Chief Medical Examiner
The shame my friend felt which led her to using alone is in no way a reflection of her character. She was a beautiful person and an amazingly compassionate friend whose life had immense, irreplaceable value. Using drugs — which she did to cope with significant personal trauma and chronic health conditions — does not change that even one iota. Instead, her shame is a mirror for us, as a culture, and how much we’ve utterly failed people who use drugs. Her last words to me (a person who has worked in harm reduction for my entire adult life and who was living ten minutes away from her at the time) were, “Just stop. I don’t deserve friends this good.” The truth is that she deserved so much more from all of us. She deserved so much more from a system that will again fail 70,000 Americans this year. She didn’t just need naloxone or treatment; she needed a place to use safely, supported by compassionate, non-judgmental healthcare providers, until she was ready to taper.
Highlighting naloxone access within the past couple of years has forced us to acknowledge the painful reality that we’ve already lost so many DC residents to preventable overdoses. We need to name that for what it is: a systematic failure of people who use drugs, particularly those most vulnerable due to racism, poverty, disability, and related social factors. I envision a future for DC wherein we can look back and say we learned from the enormous loss of life we’ve already sustained, that we finally began to treat people who use drugs with the dignity and respect they deserve. In the midst of our overdose crisis, establishing the city’s first safe consumption space is an essential step to recognizing that vision.