The Controversy Around Supervised Injection Sites


Substance abuse and overdose are a public health crisis. In 2018, nearly 70,000 people died from a drug overdose, making it the leading cause of injury-related death in the U.S. that year after car accidents. The rise in deaths due to opioid overdose in particular has been exponential. Between 1999 and 2018, we have had 3 waves of the opioid epidemic, during which 450,000 lives were lost to both prescription and illicit forms of opioids. 

One very polarizing response to the drug epidemic is the proposed implementation of Supervised Injection Sites (SISs). SISs are spaces where people can consume their own supply of a drug under the supervision of health care staff. The staff does not help administer the drugs to the individual, but they are trained to deliver emergency medical care in the case of an overdose. They also provide sanitary needles and other drug injection supplies and can screen drugs to see if they are laced with fentanyl, a substance that increases the possibility of an overdose. These facilities aim to reduce the number of deaths by drug overdose and help prevent the transmission of HIV and other types of diseases that can be transmitted via unsanitary drug injection practices. Lastly, SISs can direct users to resources if they choose to seek treatment for their drug addiction.

Despite the numerous benefits they offer, supervised injection sites do not have widespread support. There are currently about 100 facilities located across Australia, parts of Europe, and Canada. Drug policy advocacy groups, like The Drug Policy Alliance, have had to face countless legal battles in their efforts to bring SISs to the U.S. Opponents argue that these sites actively promote drug use in and around the areas they’re placed in. 

Even in instances where cities and organizations are granted the power to open up a supervised injection site, public backlash can act as another major barrier, signifying that the stigma around drug addiction plays a major role in the lack of support for SISs. Most recently, in February of 2020, a Philadelphia based drug overdose prevention non-profit organization called Safehouse received approval from a federal judge to open up their supervised injection site in South Philadelphia. It was strategically placed in an area with higher than average rates of substance abuse and overdose. However, the opening was stalled because the residents were so against the facility that they took to the streets to protest. A local estate agent started an online petition to block Safehouse’s efforts, arguing, like many critics of SISs, that it would increase drug use in the neighborhood. He stated, “If you’re really concerned, then make a rehab center.” 

When it comes to the efficacy of these sites, there is a lack of consensus, the reason being that SISs haven’t been implemented on a great enough scale for there to be considerable evidence totally for or against them. Not to mention, some studies include a hint of bias. What can be confirmed is that there have been no overdose deaths reported in any of the SISs located around the world. The nurses in these facilities are equipped with naloxone, a life-saving medication that reverses the fatal effects of an overdose from opioids like heroin and morphine. 

The majority of the research on SISs has been derived from just two sites: The Medically Supervised Injecting Centre in Sydney, Australia and Insite, a facility in Vancouver, Canada. In one study on Insite, for the population living in close proximity to the facility, there was a significant reduction in the number of deaths by overdose and a 67% decrease in ambulance calls for overdose revival. In 2014, a group of researchers reviewed 75 individual studies on the effectiveness of supervised injection sites and concluded that SISs promote safer drug injection conditions and increase access to drug treatment. Furthermore, the researchers did not find an increase in drug use or drug crime rates in proximity to the SISs. There was also a decrease in public injections and discarded syringes in public areas. 

Proponents of SISs believe that those who suffer from an addiction are less likely to seek help in a medical setting because of the criminalization and stigma associated with illegal drug use. Traditional primary care settings and the judicial system tend to view drug use purely as a lifestyle choice. SISs, on the other hand, have a non-judgemental atmosphere in which resources are offered regardless of the person’s circumstances. The aforementioned Canadian SIS has been studied several times since its opening in 2003, indicating that it has been associated with a 30% increase in enrollment for some form of drug detox program. Although the resources offered at SISs are voluntary, the people who use these sites generally face a lot of distress from their drug addiction. Addiction can have devastating effects on one’s life, yet the skeptics simply view these facilities as another place where you can go to get a fix. 

There are many risk factors that are out of an individual’s control which can lead to the development of a substance use disorder. For instance, having a substance use disorder is associated with low socioeconomic status as well as underlying mental health conditions like depression and anxiety. These risk factors could be mitigated if the most vulnerable communities had greater funding and if affordable mental health care were more accessible to them. It is ignorant for politicians to treat drug addiction as a moral failing when there are so many odds stacked against the individuals it affects.

According to the National Institute on Drug Abuse, effective drug addiction treatment is multidimensional, requiring a combination of medications for drug withdrawal, behavioral counseling, and treatment for possible co-occurring mental health conditions. It’s also crucial for the treatment plan to be long-term because substance abuse disorder is a chronic condition with a high rate of relapse. In reality, our healthcare system fails to meet the needs of Americans who live with a substance use disorder. Even those who want to get treatment lack the insurance coverage for such costly interventions. 

The Drug Policy Alliance states that SISs “are intended to complement – not replace – existing prevention, harm reduction, and interventions,” so as long as systematic barriers exist to make individuals more prone to drug addiction and less likely to receive adequate substance abuse and mental health treatment, SISs will be incredibly useful. Also, so-called injection sites have already existed before the introduction of these facilities. They include public bathrooms, alleys, and parks. Supervised injection sites may provide a safer alternative. If people are going to continue their drug use, it might be better that they do so in a clean environment where needles will be properly disposed of as opposed to being left in plain sight in a public space for children or other drug users to pick up.

 

References

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‌Ng, J., Sutherland, C., & Kolber, M. R. (2017a). Does evidence support supervised injection sites? Canadian Family Physician Medecin de Famille Canadien, 63(11), 866. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685449/

‌NIDA. 2019, February 28. Fentanyl DrugFacts. Retrieved September 29, 2020, from https://www.drugabuse.gov/publications/drugfacts/fentanyl

NIDA. 2019, January 17. Treatment Approaches for Drug Addiction DrugFacts. Retrieved September 29, 2020, from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction 

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Potier, C., Laprévote, V., Dubois-Arber, F., Cottencin, O., & Rolland, B. (2014). Supervised injection services: What has been demonstrated? A systematic literature review. Drug and Alcohol Dependence, 145, 48–68. Retrieved from https://doi.org/10.1016/j.drugalcdep.2014.10.012

Safehouse: Home. (n.d.). Retrieved September 29, 2020, from https://www.safehousephilly.org/

Spooner, C., Hetherington, K., & National Drug And Alcohol Research Centre (Australia. (2004). Social determinants of drug use. Retrieved from https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/TR.228.pdf

Supervised Consumption Services. (n.d.). Retrieved September 29, 2020, from https://www.drugpolicy.org/issues/supervised-consumption-services

TRUONG-NGOC, P. C. (2016, November 10). «ARGOS», salle de consommation à moindre risque. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:SCMR_Argos_Strasbourg_novembre_2016-4.jpg

Understanding Naloxone. (2020, September 08). Retrieved September 29, 2020, from https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/understanding-naloxone/

Understanding the Epidemic. (2020, March 19). Retrieved September 29, 2020, from https://www.cdc.gov/drugoverdose/epidemic/index.html

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