Drug Injection Sites Save Lives

(with Mark Eisenberg and Jim Stewart)

Imagine being severely addicted, cut off from family and finances; desperate. Now imagine a supportive place where you could manage and hopefully transcend your addiction and related problems. Such places, called supervised injection facilities (SIFs), are a proven, effective way to confront the devastation of lives lost among the severely addicted and under treated. And Governor Baker’s presence on the Opioid Taskforce is an opportunity to bring them to America.

We have mourned too many deaths; as doctors, pharmaceutical companies, insurance companies, and street dealers push instant miracles—quick fixes—on the vulnerable. It is of little import whether those victims had character flaws, unlucky genes, an acquired brain disease, or confronted unspeakable emotional or physical hurt. They are everywhere and anyone.

But addictive drugs and people have always been with us. And so we must ask:

Why are so many dying?

The circumstances under which many ingest are often more life-threatening than the powerful drugs themselves.

Users are isolated, stigmatized, and fearful of the authorities. Fear of arrest leads to furtive, unsafe practices, yielding contagious blood and soft tissue diseases. And death.

Under these circumstances, most users cannot know the potency or actual contents of their drug—imagine downing a beer and discovering too late that it was 200 proof. Or contaminated. Zero tolerance—the demand for abstinence or else—in both treatment programs and prison yields people whose tolerance drops such that the first time they relapse, they may be killed by formally manageable doses.

It is as though those addicted to opioids, even with insurance and a place to live, are medically homeless. And they pay for that homelessness with their health and their lives. And so we must ask:

What should we do about it?

Politicians and police departments are mercifully moving from punitive, zero tolerance policies towards a more supportive harm reduction approach, including needle exchanges, Narcan and other acknowledgments that neither the drugs nor those using them are going away.

These changes are part of a welcome move towards effective treatment, which is labor intensive, hands on, and non-punitive. It features connection, caring, and respect. And it demands responsibility on the part of the addicted.

Which brings us to perhaps the most potent medical tool in this effort:  Supervised Injection Facilities—the answer to medical homelessness.

At such facilities, people bring in and ingest street-bought drugs under the supervision of supportive medical professional who can test for potency and contamination. There are roughly one hundred SIFs, confronting death, disease and addiction in over half a dozen countries. And after literally millions of such injections, there has yet to be a fatality. Overdoses are routinely and safely reversed. Supported by the AMA and the Massachusetts Medical Society, and featured in publications such as the British Medical Journal and The Lancet, this medical intervention been shown to work in hundreds of peer reviewed studies without negative side effects.

This logical extension of the modern harm reduction approach connects the isolated, protects the vulnerable, educates the innocent, and reassures the fearful. It brings people to treatment, which is readily offered but not forced. It is a portal to hope proven to reduce public disorder, not an additional burden on burdened neighborhoods.

This approach acknowledges that the drugs are dangerous and that drug misusers are multiply challenged, but SIFs provide the same second chances and unconditional support that help more privileged addicts. SIFs buy them needed safety, support, and time to confront their demons.

There are obvious technical legal hurdles, as well as the inevitable initial opposition. Not surprisingly, every harm reduction move, (before they are retrospectively supported), was initially opposed by claims that it “condoned” drug use or “gave up” on the addicted. But similar hurdles and opposition have been overcome in six counties. The wheel needn’t be reinvented.

The oath to do no harm includes the imperative to not withhold viable, proven treatments, whether in the form of a pill or a policy. SIF’s are a proven, life saving medical treatment. We have, all of us, mourned too many unnecessary deaths. How can a measured, effective response to the epidemic not include this treatment option?