Safe injection facilities save lives, can provide bridge to treatment
Note: This article, written by District Attorney David Sullivan, originally appeared in a Hampshire Gazette column on January 16, 2018.
I’m going to say something most people would never expect to hear from a district attorney: Supervised injection facilities — in other words, places people can go to inject drugs in a medically supervised setting — are worth considering.
Sounds pretty radical, but we’re in the midst of an opioid overdose epidemic the likes of which our country has never seen before. A medical examiner for the state has said an entire generation is being decimated. This constitutes a crisis, and we must respond in kind. Business as usual is not acceptable.
To me, the concept of supervised injection facilities is a logical extension of approaches aimed at reducing harm, like syringe exchange programs and making Narcan available to first responders and loved ones of opioid users. It is not enabling their drug use, as some critics say, but rather, meeting users where they are in an effort to save lives.
For the record, supervised injection facilities are not just places people go to use drugs. They provide clean needles in a setting with medical professionals on site who can help when people are in need or save their lives if they overdose. They also offer education on safer use practices, and provide information about treatment and recovery options.
The idea is increasingly embraced by the medical community. Last year, the Massachusetts Medical Society voted to advocate for the opening of a pilot supervised injection facility in this state. The executive committee for Hampshire HOPE, this county’s opioid prevention coalition, discussed the topic in recent meetings and although they haven’t taken a formal position, coalition members see it as an idea worth further study.
Last May, I attended HR 17 Montreal, an international four-day conference which focused on a wide range of harm reduction techniques. In its 25th year, this biannual conference draws people from all over the world to attend talks and breakout sessions on cutting-edge approaches, including this one: “Supervised Injection Services in Toronto: Mobilizing Support to Save Lives.”
At this conference, I sat with people from countries in Africa, the Middle East, Asia and Europe from all sectors, including law enforcement, medical providers and community activists to find common ground in our efforts to stem the deaths caused by this opioid epidemic.
Medically supervised underground injection facilities have been operated all over the world since the 1970s, but the first official legal facility opened in Berne, Switzerland in 1988. Since then, some 100 above-ground supervised injection facilities have opened in Germany, Spain, Denmark, France, as well as several other European countries, Canada and Australia. According to reports from those countries, these facilities reduce infections and transmission of blood-borne viruses including HIV and Hepatitis C, as well as the prevalence of injection drug use in public spaces. To date, there are no legally sanctioned facilities in the United States, although one is poised to open in Washington State and another in San Francisco.
Advocates and medical professionals for years have operated underground facilities because they are desperate to save lives.
Saving lives is my number one reason for supporting the concept. In 2016, there were 2,069 unintentional opioid related deaths in Massachusetts, which amounts to six per day. Here in Hampshire County, there were 36 unintentional opioid overdose deaths in 2016; That number was 20 in 2017 (though that figure is yet to be confirmed by the state).
By any count, that’s too many. Addiction is a powerful disease, and in order to combat it we need to have many tools at our disposal. When confronting a crisis, you must rely on time-tested strategies, but also rethink the way you’ve been doing things, trying new, even controversial, ideas.
Every time a person uses drugs alone, there is a chance that he or she will overdose and die. In addition to providing a safer using environment, supervised injection sites offer a pathway to recover from addiction by providing a bridge to treatment. These facilities offer the kind of human connection that might make a difference in helping a user pivot toward treatment. And for some people treatment isn’t a goal in that moment, but these facilities offer a sanitary place to use drugs where they can learn safer use techniques and make connections with people who care about them.
For people who think this idea is too radical, I would say this: In order to save lives, we need to look in a clear-eyed, rational way at what works and what doesn’t work. This is why district attorney offices around the country, this one included, have launched drug diversion programs, drug take back days, prevention and other non-punitive initiatives. The magnitude of the opioid crisis has required that we shift the focus away from viewing drug users and addiction only through the lens of criminal punishment.
The number one goal for me in responding to the opioid crisis is to do whatever it takes to save lives while also keeping the community safe. Safe injection sites do not increase crime rates. They offer a place for people who might otherwise use alone to be near someone who can respond if they overdose. Some people might say this takes harm reduction too far. But we’re in the midst of a crisis that is killing people all over the country on a daily basis. I think that calls for some outside-the-box thinking.
Supervised injection facilities are not suitable for all communities — they may not be cost effective except in large cities. But I think they, and the approach they take in treating drug users with care, are an option worthy of consideration as we suffer the toll this epidemic takes in lost lives and shattered families and communities.
Northwestern District Attorney David E. Sullivan is co-chair of the Hampshire HOPE opioid prevention coalition run out of the city of Northampton’s Health Department. Members of the coalition contribute to a monthly column in this space about local efforts underway to address the opioid epidemic.