Drug Policy

Vermont's U.S. Attorney Says Safe Injection Sites Encourage Illegal Drug Use. The Research Says She's Wrong.

Is U.S. Attorney Christina E. Nolan intimidating Vermont legislators who want to keep their constituents alive?


A nurse at the Insite safe injection clinic in Vancouver, B.C., holds a basket of clean supplies. Credit: Darryl Dyck/ZUMA Press/Newscom

The United States attorney with jurisdiction over Vermont announced this week that a proposal to introduce supervised injection facilities (SIFs) in the state would be illegal under federal law and would "encourage and normalize heroin use."

Vermont legislators are considering supervised injection facilities due to the state's massive increase in opioid overdose deaths. In November, a group of local law enforcement and medical professionals in Chittenden County, Vermont, concluded an eight-month study of SIFs by announcing that the state legislature should legalize them.

Such facilities have operated for years in Canada, Australia, many cities in Europe, and Iran. They allow heroin users a safe place to inject, clean needles, and access to social workers and medical staff.

The list of SIF proponents in Vermont includes Patricia Fisher, a physician at the University of Vermont Medical Center; University of Vermont Police Chief Lianne Tuomey; Chittenden County State's Attorney Sarah George; and Grace Keller, the head of a harm reduction facility called Howard Center.

But others in Vermont's law enforcement community appear unready to lower the death toll. "By permitting SIFs, is Vermont at risk of condoning heroin use and giving illegal drug use the state's stamp of approval?" asked Tom Anderson, the state's commissioner of public safety, in November.

And now a federal prosecutor has waded into what should be a state and local debate. On Wednesday, the office of U.S. Attorney Christina E. Nolan released a statement claiming that SIFs "are counterproductive and dangerous as a matter of policy." Here's more:

[T]he proposed government-sanctioned sites would encourage and normalize heroin use, thereby increasing demand for opiates and, by extension, risk of overdose and overdose deaths. Opiate users, moreover, all-to-often believe they are purchasing heroin when, in fact, they are purchasing its common substitute, fentanyl, ingestion of which gives rise to greatly enhanced dangers of overdose and fatality. Introduction of fentanyl to SIFs would create additional public health risks, not only for the users, but for SIF staff members who might come in contact with that highly potent substance.

What's really interesting about this statement is that not one part of it is true. A 2014 literature review of 75 SIF studies concluded that such facilities are "efficacious in attracting the most marginalized [drug users], promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency." The literature review also found no evidence that SIFs "increase drug injecting, drug trafficking or crime in the surrounding environments."

As to whether it's better to get people off heroin than to let them shoot up safely: That's the wrong question to ask. Of course it's better to not be addicted to heroin. But there's a huge disparity between the availability of evidence-based treatment options and the number of people who want to manage their opioid addiction. Regardless of whether we resolve that asymmetry, basic human decency should compel us to make life less awful for people who risk dying every time they get high.

As Steven Chapman recently put it: "Even the most incorrigible opioid users are not beyond help. But dead ones are, and there are more of those every day."