Faced with an unrelenting rise in overdose deaths, the mayors of San Francisco, Philadelphia, Seattle and New York are determined to open the country’s first safe injection sites. These are places where drug addicts can go to shoot up in a clean, supervised setting without fear of arrest and with help on hand if something goes wrong.
It’s easy to understand why: in New York City, someone dies from a drug overdose every six hours. Other cities are confronting equally daunting challenges spawned by the nationwide opioid crisis, which killed more than 72,000 Americans last year.
But safe injection sites are the wrong strategy. They perpetuate drug use and enable addicts to surrender to a life of drugs at a time when we should focus all our resources on helping addicts enter life-changing treatment.
Governor Jerry Brown of California, in rejecting a proposed bill that would have authorized San Francisco’s safe sites, underscored this point of view. “Fundamentally, I do not believe that enabling drug use in government sponsored injection centers - with no corresponding requirement that the user undergo treatment - will reduce drug addiction,” the governor said.
So instead of safe sites where addicts can get high, one solution would be to open treatment transition centers where substance abusers are forced to make a commitment to recovery and rebuilding their lives.
A model for such facilities would include medications to reduce drug cravings, special assistance for safe injection, and mandatory participation in drug treatment on site with the help of former addicts trained as peer counselors.
Instead of a free pass to come and go as they please to inject drugs, addicts would be limited to 60 days at the center, in anticipation of a seamless passage to longer-term care.
By comparison, the safe injection sites envisioned by the four cities would provide clean needles and a comfortable setting, as well as information about treatment options. This lacks the mandatory treatment rule, which is essential because a drug user isn’t likely to voluntarily take this step without significant pressure.
San Francisco’s prototype safe site, for example, is structured around preventing people from dying of an overdose, not stopping them for using drugs. The design creates a welcoming environment, with a “chill room” for relaxing after shooting up and décor resembling a “high-end medical clinic,” according to the website Citylab.
Typically, safe sites also provide overdose reversal drugs and kits to test for fentanyl - the powerful synthetic opioid fueling the spike in overdoses – in the drugs addicts bring in. As an addiction psychiatrist with more than 50 years experience, I know that saving lives is critical, but concentrating solely on harm reduction is short sighted.
Treatment transition centers would ensure that addicts don’t overdose and and also get the help they need to enter treatment.
Safe injection sites have existed for decades in Europe, Australia and Canada, but outcome data is still not convincing. Preliminary studies suggest that in some cases the sites can reduce overdose deaths and help addicts into treatment.
But more definitive, long-term studies about safety and effectiveness are lacking, especially in the unique U.S. urban settings where sites are now being planned –a view shared by Surgeon General Dr. Jerome Adams.
Safe sites are also illegal under federal law. U.S. Deputy Attorney General Rod Rosenstein warned he would take “swift and aggressive” action to close them down in any city.
There are no easy solutions to this epidemic. But as Governor Brown noted in rejecting safe sites, “our paramount goal must be to reduce the illegal use of drugs and opioids that daily enslaves human beings and wrecks havoc in our communities.”
Establishing transition treatment centers rather than safe injection sites would be a positive step forward as part of a comprehensive national anti-opioid strategy.
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