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.