Injection Facilities a Bold Remedy for Overdose Deaths

Safety measures help when opioid addicts won't stop.


Needle exchange
Christine Vestal/TNS/Newscom

Addiction to opioids is hazardous to your health. To most people, this may sound like an obvious and inescapable reality. If your chief priority is staying cool, the thinking goes, you don't move to Phoenix. If you really want to stay alive, you don't use heroin.

But humans have created innumerable places in Phoenix where it's possible to minimize personal contact with searing heat. Humans have also created places where it's possible to inject opioids at relatively low risk.

Heroin users have long been susceptible to life-threatening diseases such as AIDS and hepatitis, which are spread through shared syringes. In recent years, those who use heroin or prescription opioids have also faced an increasingly common and more immediate peril: sudden death from overdose.

In 2015, more than 33,000 Americans died of overdoses involving these drugs—nearly triple the number in 2002. That growing epidemic is one reason that life expectancy among whites actually declined last year.

It's not hard to figure out why opioid dependence can lead to the morgue. Users may overdose because their heroin has been adulterated with other, more powerful drugs. They may combine opioids with alcohol or sedatives, aggravating the risk. They often shoot up alone or with other users, meaning they may have no one who can help them if things go wrong.

The best way to reduce the toll is dissuading people from opioid use. But some people are drawn to intoxicating substances, and once they become dependent, they find it hard to abstain even if they would like to—which many don't. So the question becomes how to prevent inveterate users from dying.

Not everyone thinks this objective is commendable. In the 1990s, drug users were contracting and dying of AIDS (and infecting their sexual partners) after shooting up with dirty syringes. But a lot of people, including President Bill Clinton, resisted efforts to expand access to clean needles. Like giving condoms to teens, this was seen as a false solution that would only encourage people to engage in risky behavior.

Wrong. Making sterile needles available, it turned out, averted disease and saved lives without generating more addiction. Let drug users get the means to protect themselves, and many of them will take it. Self-destructiveness is not necessarily their goal.

A comparable approach can avert overdose deaths. One tool is naloxone, a drug that quickly neutralizes the effects of opioids, reversing overdoses. Emergency rooms keep it on hand. Ambulances carry it. Some police departments equip officers with supplies.

Another solution is coming to King County, Washington, which includes Seattle: safe injection facilities where people dependent on drugs can use them in clean conditions, without fear of arrest, under the supervision of health care workers. Those users who are ready to go straight will also get help finding treatment.

Though it's never been done in the United States, it's a well-tested idea. The Drug Policy Alliance says these sites have been opened in some 100 cities around the world.

They have spread because they work. Insite, which operates a venue in Vancouver, just over the Canadian border from Seattle, says 3 million injections have taken place there. Nearly 5,000 overdoses have been reversed, without a single overdose death.

A review in the medical journal Drug and Alcohol Dependence found these facilities have been effective in fostering safer practices and reducing overdoses. Contrary to fears, they have not served to "increase drug injecting, drug trafficking or crime in the surrounding environments."

Aside from the benefits to drug users, there are benefits to everyone else. The safe injection sites succeeded in curtailing public drug use and the presence of syringes left on the street. They save cities money for emergency medical care.

But obstacles abound. Washington state Sen. Mark Miloscia, a Republican who opposes the Seattle initiative, told The Washington Post, "Saving lives is about getting people off heroin and not tolerating it."

Actually, saving the maximum number of lives involves a mix of remedies. One is educating people about the perils of addiction. Another is furnishing treatment to those who want it. Clean living is healthy.

Clean living doesn't appeal to some people, though, and safe injection sites may keep them alive long enough for them to change their ways. Even the most incorrigible opioid users are not beyond help. But dead ones are, and there are more of those every day.

© Copyright 2017 by Creators Syndicate Inc.

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  1. Another is legalizing heroin sales so users can know what they are getting. This would also remove a large portion of overdose deaths.

    1. Availability of enjoyable drugs, especially entheogens, undercuts the market for stupefacients (opiates, barbiturates and alcohol). This was observable in the Summer of Love, before Nixon’s GOP dried up the sources. In fact, the liquor industry has a financial stake in a thriving opiate black market. Evalyn Walsh McLean (as in McLean, Virginia and Hope Diamond), was addicted to Mrs Winslow’s Syrup as a baby. She reported guzzling quarts of distilled spirits to lessen the pain of withdrawal sickness. Small wonder there is again a heroin problem, as there was in 1924. Now, those godless preparations Professor Leary used to cure people of alcoholism and drug addiction, THOSE are the ones the boiling wrath of altruist prohibitionism is directed against with fiercest intensity!

      1. The Controlled Substances Act 1970 was signed into law by Nixon. At the time entheogens were known as psychedelics. LSD, mescaline, THC are in this category as well as alcohol, Yohimbe, Coca(cocaine), Payote. Entheogens was coined in 1979.

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    2. The only way to damage or destroy gangs and cartels is by devaluing the drugs in question. By setting up community clinics, you can administer said substances and medical equipment necessary at no cost. Think of all the ways individuals pay for their habit. Prostitution, theft, cajoling friends and family…and the list goes on. The one caveat, the substance must be used on-site. Nothing can leave the premises.

      Marijuana would be the only exception. I believe that the market system works. Let’s set it free.

  2. Posit a duty to intervene and you will get intervention.

    Kinder gentler statism is not libertarianism.

    1. Bingo. Thenreal solution for the War on Drugs is to do what any rational society would do in the face of a War that hadmcontinued, unabated, for decades without resolution.


      1. A rational society does not use armed prohibitionism to distort markets in the first place. Imagine a monkey holding a fistful of rice through a hole in a coconut… Political freedom isn’t surrender.

        1. Imagine a monkey duck holding a fistful of ricespeaking French through a holewhile it kayaks in a coconut over the rainbow.

          There. FIFY.

      2. And I certainly would not mind if what was going on in King county was some private citizenry setting up some sort of monitored shooting gallery, and all they were asking the government for was good Samaritan protection, or release of liability from the idiots they are trying to keep from killing themselves.

        But we all know it’s not. And once they open the door via any sort of ‘well intentioned’ government attempt to save people from themselves it will rapidly morph into a by any means necessary program attempting to save people from them selves. Up to an including the flash banging of toddlers in their cribs.

        The Chapmans of the world will tell you they are not responsible for such excesses, but the stain upon their hands is permanent.

        1. In the immortal words of Capt. Kirk, “Let them die.” It is not my responsibility to protect you from your own stupidity(children and genuinely mentally disabled ppl excepted). That includes both prohibiting you from it and saving your ass.

          1. This.

          2. Right, so eliminate the police and the courts and save ALL the money!

            1. Yes, that is exactly equivalent in every way to my position.

          3. I only disagree with you in one sense.

            Even if it is your responsibility, that is till not a valid reason to assign the responsibility to government. One because it still might not be others’ responsibility and compelling them to be involved is a gross infliction upon their liberty, and two because if it is your responsibility then you should be the one doing it.

            1. Nearly 5,000 overdoses have been reversed, without a single overdose death.

              You know. If I wanted to kill off (((people))), institutionally, this is probably how I would start. Just keep hyping the number of overdoses reversed while ignoring or even stigmatizing ‘incidental’ deaths outside the lethal injection centers. Make sure no one ever finds out that 5,000 overdoses account for 500 or even 50 people (because privacy!) and that any given center keeps ‘accidental’ overdose deaths below overdose ‘saves’ and let the good times roll. I bet you could get well into the tens of thousands before people started to catch on.

            2. Meh, that’s what comparative advantage is for. It’s my responsibility to secure food to feed myself. That doesn’t mean I need to farm.

              1. Never said you needed to hoe the row. But, in some manner, you personally will need to arrange for that food to appear upon your fork.

                That’s all I meant.

  3. [Citation needed]

    1. ^This^

      The article is shot through with factual errors and sloppy logical thinking that’s readily refutable with even passing knowledge. The only way it could be worse is if it included a justification of violence or a moral imperative to provide these services to illegal immigrants, but only Shikha would write something that dumb.

  4. I disagree with your first sentence. Opioids are used by millions of people for years at a time for chronic pain. Opioids, when taken under a doctors supervision, are perfectly safe. Street opioids, which have varying potency and composition, are incredibly dangerous.

    The problem is no one calls meth “street meth”, or heroin “street heroin”, but they never needed to. Because there is no real acceptable way to casually use these drugs. But fentanyl, percocet, morphine, etc. are all useful drugs that have been safely used for years. But the media say “fentanyl” now to mean both the prescription kind and made-in-a-dirty-basement-lab kind. I highly doubt people are overdosing on their fentanyl prescription; they are overdosing on some crap made overseas cut with industrial cleaner.

    We have a prohibition problem, not a drug problem.

    1. Grace Slick made the contrary claim about “street” drugs, but this was back when Aldous Huxley and bootleg psychedelics were more popular than Billy Graham and diverted pharmaceuticals. I recall a Reason Magazine cover on the Drug ^LAW^ Problem, with a picture of Ronald Ray-gun on the cover. Integrity is a rare thing nowadays.

    2. I think a part of the problem is the feeling that once a law ismpassed (or repealed) the new status is carved in stone, and we must make shift to deal with the consequences.

      What we need to do is repeal all or most drug laws, and then wait ten years and see where we are. We can always prohibit the drugs once more if that isn’t a preferable solution.

    3. “I highly doubt people are overdosing on their fentanyl prescription”

      You’d be highly wrong.

      While it has become very difficult to OD on the reformulated fentanyl patches (compared to the old gel filled ones) people still do. They tend to overdose more on their oxycodone, methadone, and morphine.

      1. I don’t think you are necessarily wrong. But my guess is, if one was to look at the number of people who take oxycodone (for example), with the number of people who die due to OD (or unsafely mixing it with alchohol, or benzos), the ODs would be a very small percentage. But the drug warriors and prudes (on both the left and right) only look at the ODs. Not the millions of people who are able to lead much better lives with chronic (or acute) pain better controlled.

        1. No offense, but I think that is another issue entirely. Since this article is all about free needles, and safe shooting galleries we are mainly dealing with purposeful abuse/misuse.

          But, you are reasonable correct that the percentage of medical users who OD is relatively small. The thing is, given how much chronic opioid use has grown, it’s still a large number of people. Especially when you consider that death is not supposed to be an ordinary risk from routine chronic pain control (it certainly is not an accepted part of any informed consent.)

          And the idea that mixing benzos with opioids is exceedingly dangerous is proving quite accurate, but also fairly new news within the medical community. Because, prior to the last couple years or so it has been an extremely common practice to give chronic pain patients a cocktail of an opiate, a benzo, and a muscle relaxer.

    4. I call street meth street meth, because I’ve used the real thing, and the shit that’s being sold on the streets has about as much resemblance to it as jailhouse hooch has to 50 year-old Scotch. It’s practically a different drug. Meth, for the record, has been around since the beginning to the 20th century. It didn’t become a societal problem until the government made it one. In fact, the majority of Americans had never even heard of it until it became an overnight “epidemic.” I also use the term “street heroin” to describe heroin that’s produced and sold without any government controls on quality and purity, as opposed to heroin that, yes, contrary to the dot gov websites, can absolutely be used safely. That said, your judgement of what’s “acceptable” is incredibly arrogant. I wish I could say that it’s irrelevant as well, but in truth, it’s that attitude that’s killing so many of our young people.

  5. The banning of LSD revived demand for entrenched European and South American drugs once popularized in These States by alcohol prohibition, in much the way banning marijuana caused the Thalidomide crisis. Banning clean needles promptly created hepatitis epidemics centered on the municipalities enacting the bans. After the US became embroiled in more foreign wars and began relying on Mohammedan allies the like of Osama Bin Ladin, AIDS epidemics broke out in Russia, the US–centered on thos same needle-banning cities that had brought on the hepatitis outbreaks. None of those data will make the slightest impression upon mystical fanatics and corrupt political machines. They are too busy gorging on the bribery and asset forfeiture enabled by the pharmaceutical pseudoscience of prohibitionism to be bothered with facts.

  6. You can avoid drugs but you can’t avoid mother nature big difference that said man survived for all of history except for the last centurey with out air conditioning. people used to not work in the middle of the day but for some reason we have created the 9 to 5 work day myth. Also proper clothing is a big thing more loose fitting clothing not less is the real answer

  7. The Post Office in Alaska in Alaska just refused to deliver marijuana tax “drug money” to the state tax office. Does anyone doubt the GO-Pee and Dems have been under Prohibition Party domination since 1928?

  8. You want a truly “bold” remedy to other people’s problems? Stop making them yours. Legalize the damn drugs. Regulate production, not use. Let users use in safety, and when, if, they decide, for themselves (imagine that — letting other people make their own choices in life) that they want to quit, there will be safe, and certainly more effective than what exists today, treatment choices.

  9. Prohibition does nothing to stop addiction. It only compounds the problem with a thriving, criminal black market.

  10. Why is it the state’s job to protect addicts from the idiocy?

  11. I can see these programs prevent deaths the question is do they end up successfully transitioning the addicts to treatment in any significant measure? Otherwise the program just enables addicts to continue. In Seattle there are many outreach programs for addicts which have a very hard time getting people to choose treatment and even then “treatment” is still in the infant phases and doesn’t have a high success rate. On one side it’s nice to save lives but on the other human nature is usually held unchecked when behavior has no consequences. I am torn between the “no judgment” and “total judgment” philosophies. Another question would be: Would the author be all for these safe injection sites if one were located right by his home? What amount should property holders near these sites be compensated due to the negative effects on their property?

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