The U.S. Needs Safe Injection Sites and Prescription Heroin Because Dead People Can’t Recover From Drug Addiction
The United States has an insatiable appetite for illicit drug consumption. And recent trends suggest that a century of prohibition has hardly curbed the craving. The most recent data from the Center for Disease Control and Prevention shows that drug overdoses killed more people in the U.S. in 2014 than any year on record. Therefore, it seems unlikely that law enforcement can significantly deter drug use when the prospect of death and disease doesn’t dissuade most drug users.
Opioids, a category that includes prescription pain relievers as well as street heroin served as the catalyst for this spike in mortality. Opioid overdose deaths jumped 14 percent from the previous year, killing more than 28,000 people. But isolated for heroin, the kill rate surged 26 percent, and has more than tripled since 2010. To address this we’ve restricted legal access to opioid pain relievers, bolstered law enforcement measures to limit the heroin supply, and crossed our fingers in hopes that so-called treatment will do something about the demand. In short, we’ve employed the same failed policies but with a slightly greater emphasis on public health.
Sure, it’s good that the problem has garnered significant press coverage and prompted congress to pass the Comprehensive Addiction and Recovery Act. It’s also good that with our softer tone on drug policy we acknowledge the racist inconsistency in our approach to prior drug epidemics. But no sober discourse can flourish without first accepting the uncomfortable truth that, despite the noble ambitions of prohibitionists, it’s beyond absurd to think we can keep drugs out of our communities when we can’t even keep drugs out of maximum security prisons.
As Ethan Nadelmann, Executive Director of the Drug Policy Alliance, testified before a Senate Homeland Security hearing last June: “Research into the history, science, and politics of psychoactive drugs reveals that there has probably never been a drug-free society… So our true challenge is to learn how to live with drugs so they cause the least harm and in some cases the greatest possible benefit.”
The Drug Policy Alliance is a proponent of supervised injection facilities, sites that provide users with sterile injecting equipment to use pre-obtained drugs under medical supervision, but in an emotionally supportive atmosphere designed to coax addicts, ultimately, towards recovery or at least a more stabilized, dignified lifestyle. Such programs have existed for years in Europe and Canada, but were largely unheard of in the U.S. until earlier this year, when the mayor of Ithaca, NY endorsed a proposed safe injection site for his city. Like the mayor, one upstate district attorney who now backs the proposal had initially thought the idea was crazy until she researched the subject. Still, despite abundant evidence of positive public health outcomes, supervised injection facilities remain a controversial topic here in the U.S.
Research has shown that these sites help reduce public disorder such as discarded syringes and public drug use. They also reduce the transmission of HIV, Hepatitis-C, and bacterial infections, which is potentially more cost-effective than treating the illnesses. Most importantly, perhaps, with the U.S. averaging almost 130 fatal overdoses per day, these sites save lives. InSite, an extensively evaluated safe injection facility in Vancouver, Canada supervises hundreds of injections each day and has never recorded one fatal overdose since it opened in 2003. One study found a 35 percent drop in fatal overdoses near the facility, compared to a nine percent drop throughout the rest of the city.
Much of the U.S. apprehension towards safe injection sites comes from the seemingly reasonable fear that such a program would enable addicts rather than deter drug use. But one study found InSite users to be 30 percent more likely to enter detox, and that was associated with increased rates in entering long-term treatment. In 2011, the Supreme Court of Canada lauded InSite, saying that it’s been “proven to save lives with no discernable negative impact.” Toronto recently green-lighted three safe injection sites after the city council voted 36–3 in favor of a plan already backed by the mayor, police chief, and board of health.
While obduracy constipates our conversation, Canada has moved forward in addressing issues beyond the reach of safe injection sites. Vancouver’s Crosstown Clinic can now prescribe medically pure heroin as a last-resort measure to long-term addicts. Heroin-assisted treatment has also existed in Europe for many years. A comprehensive review of studies on heroin-assisted treatment found “robust and consistently positive therapeutic outcomes… for a population of high-risk heroin addicts for whom no effective alternative therapies are available.”
Johann Hari writes extensively about heroin-assisted treatment in his book “Chasing The Scream: The First and Last Days Of The War On Drugs.” Here’s how he sums up Switzerland’s program:
The number of addicts dying every year fell dramatically, the proportion with permanent jobs tripled, and every single one had a home. A third of all addicts who had been on welfare came off it altogether. And just as in Liverpool, the pyramid selling by addicts crumbled to the sand: people on the heroin prescription program for a sustained period were 94.7 percent less likely to sell drugs than before their treatment.
The treatment has a stabilizing effect on the lives of addicts who no longer have to resort to crime and/or prostitution to finance their addiction. It also protects them from the harmful contaminants of street heroin, providing an urgently needed safeguard from the lethal scourge of fentanyl-laced heroin.
Fentanyl-related overdose deaths became a spotlight issue after Prince was found dead in his Paisley Park mansion last April. I had only first heard of fentanyl a month earlier, in a front page New York Times story. But The American Journal of Public Health had raised concerns about fentanyl-related fatalities as early as February 2008, in an analysis of the legal and political hurdles for supervised injection sites in the U.S.
So, that means our awareness of fentanyl’s deadly potential and the efficacy of supervised injection sites precedes the Obama presidency, yet we just wasted two terms inexplicably baby-stepping toward marijuana legalization, and now face the Sisyphean task of revolutionizing drug policy under either Madam Super Predator or the world’s greatest nattering nabob of narcissism. We can talk about why our myopic dialogue ended up this way, but first we have to bring the drug warriors to heel.
No matter how uncomfortable state-sanctioned safe injection sites or prescribed heroin might make us, it doesn’t change the fact that dead people cannot recover from drug addiction. This raises a question of our societal values. Are we a society that values the concept of abstinence more than the sanctity of human life? If so, we forgo the right to call ourselves an advanced nation and a humane society.
