WR 121 Tues-Thurs 10a.m.
10 May 2018
2.2 : Safe Injection Sites: Key to Solve Drug Crisis
As of last year, President Trump declared the opioid epidemic a public health emergency, starting that “It is the worst drug crisis in American history.” Drug overdose death rates in the United States have been rising continuously. According to the Center for Disease Control and Prevention, drug overdoses exceeded 596,000 in 2016; by comparison, about 592,000 Americans died in the Vietnam War. Why has the number of drug overdoses increased continually? Is there any way to prevent injection drug users from overdosing? Safe injection sites are legally sanctioned and medically supervised facilities designed to reduce nuisance from public drug use. Safe injection sites are a good solution because they may drop drug-related deaths and reduce risky behaviors that can lead to human immunodeficiency (HIV) and Hepatitis C (HCV) transmission through shared needles and benefit to our community.
“First safe injection sites emerged in the Netherlands in the early 1970s. Many of the original safe injection sites were actually cafes that were not meant to have a room specifically for injecting, but these cafes evolved to include injection rooms as well as supervision, medical care, and counseling options,” said Elliot (Elliot 20). The first safe injection site approved by a government in North America, was opened in Vancouver, Canada in late 2003 (Kerr and Mitra 73). Recently, two cities in the United States, one in Philadelphia and one in Seattle will allow safe injection sites to open for heroin users, in an effort to reduce a staggering epidemic of opioid overdose.
Usually drug users who inject heroin start by abusing prescription drugs. To achieve stronger and more powerful effects of heroin, they misuse their drugs. “A small dose of heroin makes someone feel calm and a little bit sleepy, but a large of dose of heroin makes the users fall asleep and your body can forget to breathe. Also, it can depress heart rates which causes heart failure,” said Scott Weider, MD (Weider). In the end, drug overdoses make them die, lonely without medical help because usually drug users live alone and there is nobody to help them. If there is a safe injection site nearby, it could save their lives. Vancouver’s safe injection sites showed that fatal overdoses dropped by 35 percent in the neighborhood surrounding the site in the two years after it opened in 2003 (Kerr 436). The study showed that significant amount of lives is saved by the intervention and supervision by safe injection sites.
At injection sites, injection drug users take their own drug into the facility. Upon entering, they must register and get clean needles. They are then allowed to go to one of the private cubicles in which they can inject the drugs that they have brought with them. According to a Drug Policy Organization, Safe injection sites provide a medically stable, clean and secure place for users to inject while reducing the visibility of drug consumption on the street under the care of medical professionals (Drug Policy Organization). Medical staff are on hand to address health needs and respond to over dose. A counselor is present to counsel with and refer injection drug users who want to seek rehabilitation treatment (Drug Policy Organization). In addition, safe injection sites provide an opportunity for multiple contacts with health care staff, social workers, and other individuals who can help guide drug users more toward healthier choices, such as drug treatment programs, primary health care, and other social services.
However, there are several concerns. One concern is that providing a place for injecting will encourage injection and drug overdoses instead of reducing them. On the other hand, proponents say these sites will discourage drug overdoses. According to Sutherland’s study, overdose deaths decreased from 253 to 165 per 100,000 people a year within 500 meters of site injection sites (BD 378). A similar study, also conducted that there was about one overdose at the safe injection sites per 1000 injections (BD 378). Pud Med Central indicated that “near safe injection sites in 2017, average monthly ambulance calls with naloxone treatment for suspected opioid overdose decreased from 27 to 9,” (Pud Med Central). From those studies, it is clear that safe injection sites can help reduce overdoses. Another concern raised by opponents is that safe injection sites will increase crime rates due to drug trafficking. Drug trafficking is the selling, transferring, giving, and delivering of illicit drugs. However, proponents say safe Injection sites don’t affect crime rates. The literature regarding disorder in neighborhoods where safe injection sites have been established has demonstrated that safe injection sites are not associated with either an increase or decrease in the crime rate for the area around the facilities. (Wood and Montanr 25) All of the existing studies concluded that the opening of safe Injection sites didn’t lead to an increase in crime.
Another benefit is that safe injection sites can cut down disease transmissions. Many drug users don’t have good health because of various factors such as poor hygiene and risky behaviors such as needle sharing, using unsanitary equipment, and hurried injections. Poor hygiene and risky behaviors can cause serious public health issues, such as human immunodeficiency (HIV) and Hepatitis C (HCV), two of the most common diseases transmitted among injection drug users. Usually, HIV is a sexually transmitted disease, however, drug injection is a major route of transmission. It has been found that the levels of infection of HIV can rise very rapidly within injection drug users’ communities once the virus has been introduced. In some cases, the rates of infection have doubled in as little as two years (World Health Organization).
In contrast to HIV, it is generally thought that HCV is primarily transmitted through sharing of drug paraphernalia. HCV can also be transmitted through sexual contact, and from an HCV-infected mother to her unborn baby (Center for Disease Control and Prevention). It is clear from these facts and statistics that the disease in injection drug populations is a serious public health issue. It is extremely important for the injection drug user populations to be reached and prevention interventions implemented in order to control the spread of serious diseases, not only within the injection drug user populations, but also into the general population. “What’s significant is that Incite attracted people who previously were at high risk of sharing syringes, but after the facility opened were seeing reductions in this dangerous behaviors, “said Thomas Kerr, Associate Director of BC Center in the article “Hospital Security Guards Increasingly Using Force against Vancouver Patients, Raising Questions of Care” (Lupick and Kim). Mostly, disease transmissions come from injection drug users’ risky behaviors. Like Kerr said, safe injection sites will encourage drug users to do safe practices and stop spreading the diseases. Over all, the studies mentioned indicated that safe injection sites could have positive effects in helping stabilize the health of Injection drug user population.
Drug overdose deaths continue to increase in the United States. Safe injection sites will be a good solution. In places such as Canada and Europe, safe injection sites have been shown to prevent overdose deaths, reduce the spread of disease such as hepatitis C and HIV and help get drug users into services including drug treatment programs. In addition, the sites can get drug users off the streets and out of public view, and reduce needle litter. Would you like to let them die, lonely without any help? Or Would you like to save their lives if it can prevent?
BD, Marshall, et al. “Reduction in Overdose Mortality after the Opening of North America’s First Medically Supervised Safer Injecting Facility: A Retrospective Population-Based Study.” Lancet, vol. 377, no. 378, 2011, pp. 378.Center for Disease Control and Prevention. “Understanding the Epidemic.” Center for Disease Control and Prevention, 30 Aug. 2017, www.cdc.gov/drugoverdose//epidemic/index.html. Accessed 5 May 2018.
Drug Policy Organization. “Supervised Consumption Services.” Drug Policy Organization, 28 Feb. 2017, www.drugpolicy.org/issues/supervised-injection-facilities. Accessed 6 May 2018.
Kerr, Thomas, and Sanjana Mitra. “The Establishment of North America’s First State Sanctioned Supervised Injection Facility.” International Journal of Drug Policy, vol. 17, no. 2, 2006, pp. 73-82.
Lupick, Travis, and Alexander Kim. “Hospital Security Guards Increasingly Using Force against Vancouver Patients, Raising Questions of care.” The Georgia Straight Vancouver, 18 Nov. 2017. health, www.straight.com. Accessed 5 May 2018.
PubMed Central. Nov. 2017, www.ncbi.nlm.nih.gov/pmc. Accessed 4 May 2018.
Richard, Elliot. “Establishing Safe Injection Facilities in Canada Legal and Ethical Issues.” Canadian HIV/AIDS Legal Network, 29 May 2014, p. 20.
Tyndal, Wood, and Lai Montaner. “Impact of a Medically Supervised Safer Injecting Facility on Drug Dealing and Other Drug-related Crime.” Substance Abuse Treatment, Prevention, and Policy, vol. 1, no. 13, 2006, pp. 25-28.
Tyndall, Kerr. “Drug-Related Overdoses within a Medically Supervised Safer Injection Facility.” International Journal of Drug Policy, vol. 17, no. 5, 2006, pp. 436-41.
Weiner, Scott. “Safe Injection Sites and Reducing the Stigma of Addiction.” Harvard Health Publishing, Harvard Medical School, 2 June 2017, www.heath.harvard.edu/blog/safe-injection-sites-reducing-stigma-addiction-2017060211826. Accessed 8 May 2018.
World Health Organization. “Advocacy Guide: HIV/AIDS Prevention Among Injecting Drug Users.” World Health Organization, 2004, www.who.int. Accessed 5 May 2018.