An overdose is often a lonely way to die. Overdoses happen when a toxic amount of a drug, or a combination of drugs, overwhelms the body’s basic functions, first slowing and eventually stopping the brain’s drive to breathe. If someone notices the signs of an overdose — lips turning blue, restricted pupils, unresponsiveness, a loss of consciousness, among others — it can generally be reversed with drugs like naloxone, which saves thousands of lives a year. But someone must be there to notice.
Yet one of the most consistent patterns in the more than 64,000 deaths attributed to opioid and other drug overdoses in 2016 was that the victims’ last moments went unobserved. Last year, the number of deaths was most likely even higher.
In the face of this emergency, dedicated public health officials and policymakers have suggested some vital solutions. One important, rigorously tested harm-reduction method, however, is still rarely discussed in the United States: supervised drug consumption sites, also known as safe injection sites. This must change. All evidence so far shows these facilities have proved incredibly effective at slashing overdose deaths in every country that has welcomed them. If lawmakers are serious about ending the opioid crisis, American cities and states should follow their lead.
At safe injection sites, trained staffs provide clean needles, administer naloxone when there are overdoses and offer long-term treatment options. People bring their own drugs — most often heroin.
It may seem counterintuitive: Give drug users space and support to inject themselves with potentially deadly substances, even while encouraging them to stop.
But dozens of studies suggest that these sites curtail overdose deaths and increase participation in drug treatment. Despite millions of injections that have occurred at more than 90 facilities internationally over the past three decades, not a single overdose death has been recorded.
The Trump administration has threatened to prosecute safe injection sites under federal law. But just as cities and states have legalized medical and recreational marijuana, they could also pass laws authorizing these sites, preventing the local police from intervening. Federal law enforcement could then either turn a blind eye, as it’s largely done with marijuana, or bring states to court.
People are dying at a staggering rate from overdoses — more in one year than the number of American soldiers who died during the entire Vietnam War. So some cities are already, rightly, taking the risk. Seattle and San Francisco are both on track to open sites, and Philadelphia recently approved the idea as well. Boston, Ithaca and New York City are considering their own facilities.
At the first supervised site in North America, which opened in Vancouver in 2003, there was a 35 percent reduction in overdose deaths in the immediate vicinity, compared with a nine percent reduction in the rest of the city, according to a study published in The Lancet.
And four separate studies have shown a positive association between using a safe injection site and starting addiction treatment.
Neighbors and city officials sometimes challenge sites like these because they fear they will promote drug use and increase crime. Research instead suggests that they lead to increases in public order, with fewer discarded needles on the street and less drug use on the sidewalk, and have no impact on drug-related crimes.
Such sites certainly don’t solve the problem of drug overdoses — Vancouver has had a recent spike in fentanyl-related overdose deaths, for instance. But they’re effective as part of a larger harm-reduction movement, which assumes that no matter how many well-intentioned programs exist to prevent people from starting or continuing to use drugs, there will always be people who shoot up. It’s better for everyone, the thinking goes, if they do that as safely as possible, with clean needles that are discarded properly. If the goal is to get drug users into treatment, the first step is to make sure they don’t die.
So far, President Trump has advocated the opposite approach, focusing on law enforcement instead of harm reduction and promising to be “really, really tough” on people who deal drugs — an old idea that hasn’t worked to save lives. The administration’s 2019 budget plan proposed $13 billion over two years to address the opioid crisis, but it didn’t include much detail about what, exactly, that money would fund. In December, the attorney general’s office made its position on safe injection sites clear in response to a proposed facility in Vermont: “It is a crime, not only to use illicit narcotics, but to manage and maintain sites on which such drugs are used and distributed.”
“In short, opiate addicts need treatment, not a place to continue using,” the office wrote.
Advocates agree on the need for evidence-based treatment and services to help homeless drug users find housing or mental health care, but that’s not a reason to prosecute people trying to save lives at safe injection sites.
There is at least one unauthorized, invitation-only site in the United States that a small nonprofit has been secretly running, in an unadvertised location, for more than three years. Staff members have been able to reverse all eight overdoses that have occurred on-site.
Critics of such sites raise legitimate concerns about normalizing drug use that could be fatal. But so far, the wealth of available evidence shows two things: Most of America’s past policies have failed catastrophically, and the regions that have tried these sites have saved people.
States and other cities should follow the lead of Seattle and Philadelphia to open safe injection sites. One of the most meaningful things the Trump administration could do to help drug users and their families is to stay out of the way.