Banner by Khusbu Patel and Daniel Arnabar

Reconsidering Safe Injection Centers

by Elsa Carey

Accounts of the opioid epidemic have increasingly plagued news outlets for the past several years, including horror stories of 115 people fatally overdosing every day and videos on social media of zombie-like addicts wandering the streets. Both opioid abuse rates and overdose numbers have been exponentially increasing over the last decade. According the National Institute of Health, in 2015 2 million citizens in the United States suffered from a prescription opioid-related substance abuse disorder, and over 33,000 people fatally overdosed. In Alleghany County alone, overdose mortality increased by 60 percent from 2013 to 2015 to claim 400 lives in one year. The United States’ stance on the opioid crisis and ‘Just Say No’ has taken a hard line with addicts that are suffering from substance abuse issues and have yet to have a positive effect. Penalties for even small-scale possession often include large fines and some jail time, both of which only create worse situations for addicts without offering any solution to the root cause of the problem.

But now that it is clear we have a problem and it shows no signs of slowing down, the question we are left asking is “What can we do?” Although there are a small number of programs in place to help addicts cope with their addictions, stigma and prejudice have prevented public health efforts from making a significant step in the direction of ending this epidemic. Despite the fact that Pennsylvania has the fourth highest opioid-related mortality rate in the United States (according to 2016 CDC data), there are only three needle exchange programs across the entire state and the implementation of others are not legal. This criminalization of syringe possession in Pennsylvania is due to the misled belief that legal needle access promotes drug use, when in fact it only tolerates more widespread problems, such as dangerous needle sharing and the subsequent spread of blood-borne diseases, as well as endanger local communities with used discarded needles. Approximately 120 safe injection sites are currently established in many countries around the world, making safe injection centers a new public health initiative which have shown considerably positive results, in both long- and short-term effects. However, the strong social and political hostility towards the introduction of safe injection sites in the United States should be reconsidered, for the general stigma behind the opposition is not justifiable and evidence that demonstrates the benefits of these centers far outweighs personal prejudices against drug use.

Safe injection centers are facilities where addicts can inject themselves with their own drugs, using clean syringes provided by the centers and with medical personnel present to supervise injections. Their implementation is a controversial idea, as many people believe that by overseeing drug injections, the centers are endorsing drug use. However, this common misconception not only prevents new and progressive methods of combating the opioid crisis, but actually propagates many dangerous aspects of drug use, including the spread of infectious disease and potential for overdose.

The first and most important goal of safe injection centers is to ensure that addicts don’t harm themselves or overdose. Using data taken from North America’s first safe injection site, located in Vancouver, 1 in 1,000 injections at the site result in overdose, but none so far have been fatal, due to the ability of employees to be able to respond efficiently and quickly. After the site was opened, statistics have shown that overdose-related deaths in Vancouver have decreased by 88 per 100,000 people per year. Staff also test the purity and content of drugs, ensuring that they are not laced with fentanyl, which is a rising cause of overdose. Because sterile needles and syringes are provided by the centers, needle sharing clearly drops, which immensely decreases the spread of infectious diseases, predominantly HIV and hepatitis C. Between 2010 and 2012, the CDC reported a 75 percent% increase in new hepatitis C infections, and in 2016, the CDC report demonstrated that of known causes, injection-drug use was over seven times more likely than the next leading cause to be the risk behavior to cause new hepatitis C infections. This ability to protect human lives both at the time of injection and much further down the line should be reason enough to take steps toward implementation in the United States.

Safe injection centers provide sanitary spaces and an open environment for addicts to be honest with themselves, something that can be difficult while in the throes of addiction. It also makes it much easier for people struggling with addiction to reach out for help. After run-ins with the law, addicts are often afraid to seek treatment and don’t know where to turn. Safe injection centers provide a safe space that can bridge that divide by being welcoming and accessible while having direct contact with long-term treatment centers, in which the road to rehabilitation truly begins. Safe injection sites can be beneficial to surrounding communities as well — the presence of addicts in a city can be a safety issue, as dirty needles often litter the public streets and drug-fueled crimes spike. One study done around the safe injection site in Vancouver demonstrated that within the first three months of opening, the number of users injecting in public, discarded syringes and other injection litter all decreased by approximately 50 percent. Providing people with a safe and clean space to gather and inject drugs means there is no longer reason to use publicly and dangerously, or alone and with used needles and other contaminated equipment.

Without any positive results in the movement against the opioid epidemic, novel strategies must be pursued to gain traction against the growing number of lives that this crisis has already claimed. The positive results around the world from safe injection centers are not something to completely dismiss. The value of human lives must now outweigh personal preconceptions against drug addicts. Although safe injection sites will not cure the problem, the harm reduction that it displays is a first step in the right direction towards conquering the beast that is America’s opioid epidemic.