Safe Injection Sites: The Debate

Many fear that our nation may very well lose the war on drugs. Others feel that we have already lost.  As soon as we begin seeking solutions to one problem, it seems that another soon presents itself. As the opioid epidemic rages around us, many feel that harm reduction is the only option we have left.
There are efforts in at least 13 U.S. cities to open supervised injection sites.
Safe injection sites make it possible for heroin addicts to use their drug of choice without fear of using infected needles. Providing clean, sterile needles, many supervised injection centers also manage instances of overdose. They focus on harm reduction rather than addiction treatment. Proponents of such sites reason that they cannot stop heroin addicts from abusing drugs, but that they can at least foster a life-saving environment to keep overdose rates from going up.

Addiction can happen to anybody.

What is Harm Reduction

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.
The idea is to reduce the health, social and economic harm associated with drug or alcohol use, not reduce the actual usage of the abusing substance. During the 1980’s government officials in Europe were looking for ways to fight the growing HIV epidemic, and needle exchange programs and methadone treatments were born.

Key Harm Reduction Issues

Discrimination Against Drug Users
DPA is working to end discrimination against people who use drugs by reducing the stigma associated with both recreational and problematic drug use and advocating for compassionate, judgment-free approaches to addiction.
Drug Overdose
Accidental drug overdose is currently the leading cause of death in the United States for those under 50. Most of these deaths are preventable. We are leading the national effort to reduce drug overdose deaths by promoting sensible solutions and better policy at the state and federal level.
Naloxone
Naloxone is an inexpensive, FDA-approved generic drug that works to reverse an opioid overdose without any potential for abuse. Far too many people are still unable to access naloxone. We’re working to save lives by ensuring that more people are equipped with naloxone and are able to help in overdose emergencies.
Good Samaritan Laws
People using illegal drugs often fear arrest if they call 911 when they witness an overdose. The best way to encourage them to seek medical help is to provide them immunity for drug law violations, an approach often referred to as Good Samaritan. We push for the broadest protections possible to ensure people do not hesitate to get live-saving help for someone who has overdosed.
Supervised Consumption Services
Supervised consumption services (SCS), also called overdose prevention centers and supervised injection facilities (SIFs), are legally sanctioned facilities designed to reduce the health and public order issues often associated with public drug consumption by allowing on-site, supervised use of drugs. We advocate for supervised consumption pilot programs in the U.S.
Syringe Access
Sterile syringe access programs help lower the risks of HIV and hepatitis C by limiting syringe sharing and providing safe disposal options. We support wider access to sterile syringes by ending policies that criminalize syringe possession and limit sterile syringe distribution.
Drug Checking
Drug checking (also known as pill testing or adulterant screening) allows people who use drugs to identify the substance they intend on taking and helps prevent harms associated with unknowingly consuming a substance adulterated with a dangerous contaminant like fentanyl. We advance policies that permit the wide scale use and distribution of testing supplies and equipment as well as drug checking research.

Has Harm Reduction been Successful?

This question lends itself to more questions. Has it been successful in more people finding recovery? Finding an accurate answer to that is nearly impossible. Mainly because the data relies on the self-reporting of patients. With so much stigma and shame associated with addiction, not many will be honest about staying clean or relapse.
Does the implementation of a needle exchange program help reduce the spread of HIV? According to the findings from an NIH-funded study, the average monthly rate of new HIV infections among drug users in Washington, D.C. dropped by approximately 70 percent after the city implemented a needle exchange program in 2008. 

Do Safe Injection Sites Work?

According to CFP Canada, they do. When people think of safe injection sites or clean needle exchanges, their primary concern is HIV or AIDS. Certainly, safe injection sites allow heroin users to engage in drug abuse without these concerns. One of Vancouver’s safe injection sites even resides within an AIDS treatment facility. By keeping AIDS patients from injecting drugs on the streets, they feel they can stop the spread of infected needles. Speaking in terms of demographics, there is no telling how many lives such a measure might save. This applies not only to habitual heroin users, but also to initiates who may not think to question the origins of the paraphernalia involved in their drug abuse.
Reactions to overdose depend upon the site in question. In Vancouver, medical professionals remain within close reach in case of overdose. But in some continents, only first responders to medical emergencies retain the right to administer Narcan to overdose victims. This is why an illegal pop-up site in Vancouver claimed overdose as the primary reason for their existence. As a volunteer told CBC News:

“Everybody is going full-tilt and it’s just not enough. People are dying. It’s just really shocking. Really what we are doing is illegal and we didn’t ask, but we are saving lives anyway.”

Proponents of safe injection sites also feel that such facilities may discourage crime. To be clear, most such sites will not allow the purchase or sale of illegal drugs. They only provide the needles and means to use them in a safe environment. But some proponents feel that safe injection sites put a damper on those who sell their drugs alongside paraphernalia. Instead of engaging in discussion with dealers who might sell infected needles, users acquire the drugs from one source before using it safely. 
In Vancouver, it costs approximately $3 million (CAD) per year to run a single injection site. The illegal pop-up site mentioned above estimates their costs at $150 per day. This translates to an estimated cost of $54,750 per year. In other words, illegal sites actually discover more cost-effectiveness in their methods than those approved by their local government. This presents an interesting dilemma, in which breaking the law may save lives more efficiently than following the letter of the law. As one can imagine, this only presents a fraction of the controversy behind safe injection sites.

Controversy and Criticisms

While safe injection sites present a possible solution to the spread of diseases such as HIV by providing clean needle exchanges, critics note that they may fail in presenting one other troublesome disease—the disease of addiction. When Seattle proposed the implementation of two safe injection sites, proponents argued that they could recommend treatment to users. In fact, supervised injection sites across the globe generally provide resources to help addicts stay clean. Nonetheless, critics remain justifiably skeptical that most users would elect to stay clean when provided a facility that allows them to shoot up with impunity.
Of course, the primary goal of supervised injection sites is to reduce overdose deaths. The site in Vancouver appears to have reduced overdose deaths in the surrounding neighborhood by at least 35%. But other sites, such as the Sydney MSIC, appear to yield no noticeable community impact whatsoever. Some research did return evidence of fewer heroin-related medical emergencies during the center’s hours of operation. This evidence remains a source for skepticism, however, it makes no mention of the increased police efforts shortly after the site’s opening. It does make sense that safe injection sites would reduce overdose rates, but claims to this effect currently rely on conflicting data from a relatively small sample size. One therefore cannot say with utmost certainty that such sites will reduce fatalities in the midst of the heroin epidemic.
This public policy argument pertains not only to the points above, but the crime argument as well. The argument is that, concerning possible reductions in crime, safe injection sites present a flawed solution at best. Safe injection sites cannot provide users with drugs, only clean needles and supervised administration. Even if these facilities would allow for legally sanctioned use, the purchase and possession of heroin remains illegal. It does warrant mention that safe injection sites appear to cause no increase in local crime. Nonetheless, those who utilize safe injection sites must still break the law in pursuit of their drug of choice.
Local governments that try to authorize safe injection sites may find themselves on the wrong side of the law as well. One might recall the medical marijuana facilities raided by the federal government, despite being legal in California. Proposed safe injection sites in the United States would run a similar risk. When Mayor Svante Myrick of Ithaca desired to open a supervised injection site, he sought authorization from New York Governor Andrew Cuomo. And when NPR reminded him that he could try to open the site without authorization as long as it was not directly refused, he responded:

“We’ve no interest in putting time and money into something that will get shut down later.”

Safe injection sites already struggle with cost-effectiveness. Government officials in Canada feel that the $3 million used to operate the Vancouver facility should go toward treatment. Meanwhile, the Sydney MSIC in Australia costs enough to potentially fund four hundred treatment centers. Most likely, American sites would face the same struggle. Given that the federal government could simply choose to shut them down at any time, Myrick might be right. Safe injection sites seem like a good idea for many reasons, but the risk might easily outweigh any alleged benefits.

Verdict on Safe Injection Sites

It seems difficult to deny that safe injection sites wield the potential to save lives. Heroin users find in these facilities a place to use their drug of choice without fear of overdose or disease. And many sites will attempt to direct them toward treatment. Considering the potential for lower crime rates as well, one can certainly understand why so many people support these facilities. After all, we should consider every life saved a miracle. Once we stop addiction from taking lives, perhaps battling the disease itself will become easier.
On the other hand, safe injection sites appear to normalize drug use. Supervised injection facilities reward addicts simply for using drugs less dangerously. They also drain government resources, potentially without merit considering how easily such sites could get shut down. Furthermore, all data suggesting lower rates of crime and overdose seem dubious at best. In short, we really have no idea whether the proposed benefits of safe injection sites truly exist. Legally administering heroin to addicts based on such faulty data does not constitute a solution. It is sheer recklessness.
Considering the slim likelihood that we will ever see safe injection sites in the United States, it might be a moot point either way. In the meantime, we must focus on solutions already on the table. We must focus on increasing funding for treatment centers, as well as local outreach programs, awareness and—most importantly—addiction treatment remain the best solutions we can offer those who struggle with addiction.
Do safe injections sites have something to offer, or are they a disaster waiting to happen? Feel free to share your own thoughts in the comments below.

Amanda Daniels

Amanda Daniels is the Director of Social Media for Amethyst Recovery Center.