By Clare Waismann
The opiate epidemic in the United States, especially heroin addiction, continues to rage. States and municipal governments are struggling to find a way to cope.
In 2014, more than 28,000 people died from opiate-related overdoses, the deadliest year on record, according to the Centers for Disease Control and Prevention (CDC). Now, some municipalities in the United States are turning to a counterintuitive idea to address the problem of opiate addiction and overdose: providing “safe sites” for those addicted to heroin to shoot up. Unfortunately, this might only exacerbate the problem by enabling heroin abusers to keep using in a safe haven environment, while failing to identify and treat their underlying problems.
Does this idea actually work? We review here. Then, we invite your questions or feedback about heroin injection centers at the end. In fact, we try to respond to all comments personally and promptly.
The Scope: A Focus on Heroin Abuse
More than 21 million Americans have some type of substance use disorder, and an astonishing 586,000 suffer from heroin abuse, reports the American Society of Addiction Medicine (ASAM). Among those who try heroin, nearly 1 in 4 will develop an opioid addiction of some kind. Additionally, some people who begin abusing prescription painkillers go on to use heroin because it is potent and cheaper than buying prescription drugs.
Sadly, this leaves hundreds of thousands of Americans vulnerable to the emotional, psychosocial and medical consequences of heroin abuse. There have been numerous reports of new synthetic opioids — some of which are hundreds of times more potent than morphine — popping up in regions around the country. Heroin is often laced with these synthetic opioids, making it more powerful than users realize. This is just one of the factors that has contributed to the skyrocketing rise of opioid-related overdose deaths in this country.
Creating “Safe Sites” for Heroin Users
A recent task force study in Seattle recommended that the city move forward with a controversial plan to create supervised clinics for heroin injection. Technically known as Community Health Engagement Locations, these so-called “safe sites” allow people addicted to heroin to shoot up in a supervised setting.
The purpose of creating safe sites in Seattle is part of a broader move toward “harm reduction” campaigns in the war on drugs. Why is harm reduction so important? Current drug policy is punitive toward those struggling with substance abuse. Possession or use of drugs such as heroin can lead to:
- Prison time
- Custodial changes or loss of parental rights
- Other harsh penalties that limit a person’s ability to get help
The idea behind supervised heroin injection clinics is to create a safe space in which those struggling with heroin abuse can use the drug without experiencing the risks associated with street use. At the clinic, individuals bring their own heroin but are provided with sterile needles to reduce the risk of hepatitis or HIV transmission. Clinic staff are also on hand with opioid antagonist drugs, which rapidly block the effects of opioids in the brain. These drugs can reverse an opioid overdose while it is occurring, preventing deaths.
Seattle is not the first locale to begin establishing heroin injection sites staffed by public health workers. The city is modeling its initiative after a similar program in Vancouver called InSite. During the 13 years of its operation, InSite claims it has never had a heroin overdose death inside one of its locations.
Evaluating the Evidence: Do Heroin Injection Facilities Actually Work?
Proponents of the harm reduction model of drug abuse believe that heroin injection sites may actually help people get clean over the long run. They argue that the most important thing is to get heroin users in the door to receive basic medical services in a safe, non-punitive environment. Over time, some heroin users at the injection facilities decide to get help. Thus, proponents of the safe sites argue that the facilities can help to combat opioid addiction.
However, the evidence in favor of these sites is limited. Despite having a heroin injection facility that has been in operation for 13 years, it is unclear that Vancouver’s InSite has had a positive impact on the overall heroin abuse in the city. Critics argue that drug dealers have flocked to the area, lured by the prospect of selling to InSite visitors who are allowed to possess heroin. Many argue that the site has led to higher crime, abandoned needles, and other dangers to those who live in the area. Plus, those struggling with heroin addiction are still vulnerable to drug overdose when they are not at a legalized injection facility.
How are we really treating heroin addicts?
At a more fundamental level, the proposal to establish safe sites in Seattle raises questions about how we treat those suffering from substance abuse. There is no question that the “War on Drugs” has failed. Punishing those experiencing drug abuse does not eliminate the source of the problem. Instead, we must think about how to expand treatment resources to the vulnerable people suffering from addiction. In many cases, people addicted to heroin first began using the drug to cope with immense physical or psychological pain.
First, we must expand access to effective opioid detox programs. After that, individualized mental health assessment and obtainable long term treatment is needed to address the underlying source of the addiction cycle. The resources being used for legalized injection sites would be much better spent on expanded access to education, drug detox followed by mental health treatment and social services for those vulnerable to opioid abuse.