Opioids

Massachusetts Doctors Want a Safe Place for People to Use Illegal Drugs

Supervised injection sites keep drug users alive and prevent the spread of disease. So why doesn't the U.S. have a single one?

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Insite Supervised Injection Facility

The United States is currently home to zero facilities where users of illicit intravenous drugs can get high under a doctor's supervision. Seattle and King County, Washington recently announced plans to open two such facilities, called supervised injection sites. Later this month, the Massachusetts Medical Society will vote to ask their state to do likewise.

"It's about trying to get individuals into an environment, where they have a much better chance of surviving their substance use disorder, to a point in time where they actually are able to make progress in recovery," Dr. Dennis Dimitri tells Boston's WBUR. "We felt that the ethics of doing this were justifiable, that putting a program such as this in place would do more benefit than any harm." The trustees will ask their members to vote in favor of a supervised injection site pilot later this month.

Vancouver's Insite, a supervised injection site opened in 2003, has had 3.5 million visits, 5,000 overdoses, and zero deaths. (Seattle Mayor Ed Murray visited Insite, and it cemented his decision to bring the model to his city.) The Sydney Medically Supervised Injecting Centre in Sydney, Australia, opened in 2001. In the intervening decade and a half, it's received 860,000 visits during which 4,397 people have overdosed and zero have died.

Supervised injection sites, in other words, are really good at keeping heroin and opioid users alive. They're staffed by medical professionals and stocked with clean needles and the overdose reversal drug Naloxone. People who want to quit can talk to addiction experts about their options, like medication-assisted therapy. People who don't want to quit can use without dying, or contracting and spreading diseases like HIV and hepatitis. These facilities work so well that even Iran uses them.

And yet the U.S., which consumes more prescription opioids than any nation on Earth, has zero.

"I just don't think that that's the direction we ought to be going in," Norwood Police Chief William Brooks told WBUR, of the Massachusetts Medical Society statement. "It does feel like we're giving up, we're throwing our hands up, and I don't think we should do that."

Brooks is not a bad guy. He applauded Massachusetts Attorney General Maura Healey's deal with Amphastar Pharmaceuticals to subsidize the purchase of Naloxone for Massachusetts first responders, saying it was in "keeping with our core mission to protect human life."

But there are echoes of Maine Gov. Paul LePage in his reluctance to get on board with a safe injection site. This time last year, LePage vetoed a bill that would allow pharmacies to sell Naloxone without a prescription, saying access to the drug "serves only to perpetuate the cycle of addiction."

In a way, LePage was right: Keeping an overdose victim alive increases the odds that person will get high again, because their odds of ever using again are zero if they're dead. In a similar way, Brooks is right: Giving users a safe place and clean equipment is a concession to the reality of drug addiction.

More policymakers should make that concession, because the relevant policy questions are these: 1.) What keeps users alive? 2.) What curtails the spread of communicable diseases associated with illicit drug use? 3.) What brings problem users into contact with people who can help them? 4.) What treatments work for people who want to quit?

Right now, people are dying from drug overdoses because policymakers have allowed their distaste for aberrant behavior to supersede globally recognized best practices. Brooks, and others like him, can continue to hate heroin and Oxy and fentanyl, to despise the toll of addiction, to mourn the design flaws of the human brain. But it is unacceptable for harm reduction skeptics to block such efforts while decrying overdose deaths.

We can have a living drug war, or living drug users. It should be clear by now that we can't have both.

NEXT: Thoughts on the judicial nominations mess and nuclear fallout

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  1. Seattle and King County, Washington recently announced plans to open two such facilities, called supervised injection sites. Later this month, the Massachusetts Medical Society will vote to ask their state to do likewise.

    Why IV? Pills would carry less overhead.

    Also, the article kinda falls for the (inverse of the) gun-free zone trap. Most of these people ODing on drugs aren’t ODing in the middle of a lively dinner with the family or because they’ve let their housemates know their designated times, places, and dose cocktails when they get high.

    Like paying doctors to set up public booths where people can shoot up so that they can, subsequently, go home and shoot up a lethal dose when they come down.

    1. The Sydney Medically Supervised Injecting Centre in Sydney, Australia, opened in 2001.

      Also, when I Google ‘Sydney Heroin 2001’ my top several hits highlight how a massive shortage (drought even), starting in 2001 led to massive price inflation and quality reduction. Probable causes vary, but generally fall between two (3) the extremes of Australia’s drug task forces kick(ed) ass, the Taliban kick(ed) ass at imposing Sharia law in and shutting down opium production, and more regional regimes/cartels in control of opium production moved on to more desirable and lucrative products.

      Moreover, Australia’s seen a similar incidence of rising heroine and opioid deaths over the last decade in much the same trends as the US (up across the board prescription-based, rurally and male disproportionate). Not saying the center hasn’t exactly saved lives, but hardly a drug libertopia model able or desirable to be emulated in any event.

    2. Why IV? Pills would carry less overhead?

      That don’t supply drugs the users do.

      1. Right, but any poor schmuck off the street can watch a user take a pill and make sure he keeps breathing. CPR training might be a perk, but as long as everybody in the place doesn’t OD at the same time (they are being managed, right?). One CPR certified employee among several would be acceptable.

        IVs drugs require the admin to have BBP training, Hepatitis vaccinations, sharps containers…

  2. Fuck harm reduction, just legalize everything.

    1. That would reduce quite a bit of harm

  3. If privately funded, no problem.

    Otherwise,

    Fuck You Cut Spending

    1. Winner. It’s not my job to protect you from your own stupidity.

      1. Agreed. Libertarians whoop about personal responsibility and accepting the consequences of your own behavior until the consequences arise from drug use, then it’s time for The State to rush to the rescue with compassion and taxpayer money.

        1. I’d still prefer a system that goes the extra mile to cure people if the only alternative is one that kills them.

          1. We’ve been going extra miles every year since The New Deal, so we have a comprehensive, omnipresent welfare state. And now we want to extend even more benefits to people idiotic enough to voluntarily inject themselves with potentially lethal chemicals.

            Want to not die of a drug overdose? Then leave that shit alone.

            1. Right, but now were finally at the real last mile and you want to give up?

          2. There’s a simple effective treatment for opiate withdrawal. In a free market it would only cost a few pennies.

            1. A simpler, cheaper and healthier, free market way to deal with opiate withdrawal is to leave that shit alone.

              1. Hindsight is 20/20, ain’t it?

              2. That’s just, like, your opinion, man.

  4. The United States is currently home to zero facilities where users of illicit intravenous drugs can get high under a doctor’s supervision.

    But plenty of places to do it under a guard’s supervision. And I’m sure they can find money for more of that.

  5. Because drugs are bad, mmkay?

    1. Heroin and meth are pretty awful.

  6. Great. But who’s paying for it?

    If it’s private people, then great.

    If it’s the government, then boo.

    1. All of the proposed public shooting galleries have been proposed by municipalities.

  7. What brings users in contact with those that can help them? As the author of this article and your support for these injection sights it’s your job to answer these questions. I see nothing in the article which explains if there was actually much success in helping these people get off the drugs. Asking the question is a nice sentiment but is NOT support for your point. Also where are the perspectives of those in the neighborhoods where these sites are located? How would the author feel if one were placed in the vicinity of their front door?

    1. I see nothing in the article which explains if there was actually much success in helping these people get off the drugs.

      That’s not the point. The centers are solid gold optics, nothing less. TSA-style kabuki theater only instead of airline passengers, it’s drug users. How many American planes have been blown up by terrorists since the TSA has been created? None, that’s how many. Sure, terrorists walk across the border or are homegrown and even get interviewed by the FBI a couple times before they kill a dozen or more people and the TSA does literally nothing to stop this but, you know, planes are safe as long as you aren’t standing in line at a TSA checkpoint out in front of the airport.

      1. How many US planes were blown up by terrorists here prior to 9/11? Zero. And even those weren’t blown up, they were crashed into the buildings and used as bombs. The closest would be Flight 103 en route to the US that was blown up over Lockerbie in ’88. I don’t think there has ever been a US plane blown up over US territory.

        There was a spate of hijackings of US planes back around the 70’s, which were generally either Palestinians or Cubans and the point wasn’t to blow up the planes but to use them as bargaining chips or to make a political display. The count dropped way off to next to nothing when the world started treating them as simple criminal acts and agreed not to give in to demands.

        I think the number of mass murders would drop off the same way if they were reported the same way – just as criminal acts whose motivations were unimportant.

        1. Nope, not even close. In these attacks there are NO DEMANDS. The act is of itself the reward. Also, the democrats have been trying to do what you’re saying for years now. Like when Loretta Lynch said we may never know why that radicalized Muslim shot up that gay nightclub in Florida.

  8. A serious junkie buys their stuff and gets a dose in themselves ASAP–usually within minutes of buying. Seconds if possible.

    These are a lot of the deaths we’re seeing. Because you can get kinda rushed getting that first dose.

    Someone using one of these muni shooting galleries has already gotten past that.

    1. Yep Some junkie bitch showed up to toss the place of a recently deceased fellow in my neighborhood who was known to deal hard drugs. Apparently she hit the jackpot. She didn’t even bother to drive away before she shot up. Neighbors saw her passed out in the driver’s seat for,forty minutes, while the engine was running. When she didn’t respond to knocks on the car window 911 was called.

      The EMT’s arrived quickly and decided to summon the police so they could get inside the vehicle. After gaining entry, it was determined the woman was not in any danger. However, the cops ended up,searching the car and found multiple bags of heroin and several dozen fresh needles. So they hauled her off to jail.

      Had she just managed to go home first, she would likely not have been arrested.

  9. Sanctuary cities again? Just a different federal crime being ignored.
    Either enforce the law, or repeal it. Hint: repeal is cheaper and more in line with individual freedom; you know, America.

  10. If our government wanted to keep drug users alive, they’d legalize drugs.

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