Opioids

DOJ Promises 'Aggressive' Response to Lifesaving Supervised Injection Facilities

Deputy Attorney General Rod Rosenstein condemns "havens" for drug users, notwithstanding their proven benefits.

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Leah Millis / Reuters / Newscom

For anyone who was wondering how the Trump administration might respond to plans for supervised injection facilities (SIFs), which aim to reduce drug-related disease and death by offering a safe, sanitary, and medically monitored environment where people can inject illegal substances, Deputy Attorney General Rod Rosenstein makes it clear in a recent New York Times op-ed piece that the Justice Department is firmly opposed to the idea. What's not clear is why.

Rosenstein complains that local governments plan to "subsidize" SIFs, which he describes as "taxpayer-sponsored haven[s]" for drug users. Given the billions of dollars that the government routinely squanders on anti-drug efforts that are not just ineffective but counterproductive, a strong argument can be made that harm reduction programs like SIFs are a far more efficient use of taxpayer money. But they need not involve any public expenditure. The SIFs under consideration in New York City, for instance, would be funded and run by nonprofit organizations. With that sort of arrangement, government's role is limited to getting out of the way.

Rosenstein says SIFs "are very dangerous and would only make the opioid crisis worse." Yet research has found that SIFs, which operate legally in 66 cities and 11 countries but are prohibited in the United States, help prevent fatal overdoses, control the spread of HIV and hepatitis C, reduce skin and soft tissue infections, and encourage enrollment in drug treatment.

A 2010 study estimated that Insite, a Vancouver SIF that opened in 2003, saves five times as much money as it costs. According to a 2016 cost-benefit analysis, a SIF in San Francisco would save $2.33 for every dollar spent on it. A 2017 summary by the Penn Wharton Public Policy Initiative concluded that "the effectiveness of SIFs is clear," which helps explain why the American Medical Association supports their legalization.

Instead of evidence, Rosenstein offers bluster and non sequiturs. "Proponents of injection sites say they make drug use safer," he writes, "but they actually create serious public safety risks." Such as?

"Many people addicted to opioids use illicit fentanyl or one of its analogues, which can be up to 5,000 times more powerful than heroin," Rosenstein notes. "Users often have no idea what they are actually buying from criminal drug dealers." And whose fault is that? Rosenstein, who supports a prohibition policy that results in life-threatening uncertainty about drug potency, is complaining about programs that aim to reduce the casualties from that government-created hazard.

Rosentein claims "injection sites destroy the surrounding community," citing the account of a Redmond, Washington, city council member who visited Vancouver. Yet as the Penn Wharton summary notes, "Studies have found that the opening of Insite in Vancouver led to no visible effect on drug trafficking, assaults, or robbery." In fact, "breaking and entering of vehicles and vehicle theft diminished in its surrounding neighborhood." Research in Australia "found similar results." Studies of Insite indicate that SIFs reduce public injection and drug-related litter such as used syringes.

Ultimately Rosenstein falls back on the argument that SIFs should not be tolerated because they are illegal, which is not exactly a rousing defense of current policy. "It is a federal felony to maintain any location for the purpose of facilitating illicit drug use," he notes. "Violations are punishable by up to 20 years in prison, hefty fines and forfeiture of the property used in the criminal activity. The law also authorizes the federal government to obtain civil injunctions against violators. Because federal law clearly prohibits injection sites, cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action."

The federal drug paraphernalia statute makes an exception for locally approved needle exchange programs, and Congress could add a similar accommodation for SIFs to the so-called crackhouse statute cited by Rosenstein. But even without such a change, Rosenstein's aggressive posture is not required by law, since the Justice Department has a great deal of discretion in deciding how to allocate its resources. Shutting down SIFs, which do not distribute drugs but merely provide a safer place to use them, should not be a high priority for any U.S. attorney who wants to reduce drug-related harm.

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  1. …government’s role is limited to getting out of the way.

    A role at which government excels.

    1. That is still way too much to ask of the government.

    2. If government had a dick, it would constantly be tripping over it.

      1. And sticking it into anthills.

        1. Or beehives. 🙂

  2. First there are safe injection sites, then come sanctuary cities, the next thing you know people are killing babies just because . . . . . . . .

    Or, just maybe, the government could get out of people’s lives.

    Of course, first we have to elect the unicorns who will vote that way.

  3. Rosenstein doesn’t realize that the mood on the ground has changed in just the last few years. Parents want safe injection sites for their addict kids. The desire to criminalize has evaporated. Also Trump won because he was the ‘last chance’ of the oxy electorate. They don’t want to end up in prison on top of all their other disappointments.

  4. The SIFs under consideration in New York City, for instance, would be funded and run by nonprofit organizations. With that sort of arrangement, government’s role is limited to getting out of the way.

    I hate this bullshit from Reason. Politicians say the word ‘nonprofit’ and Reason just opens their mouth and begins sucking.

    You mean the City will get out of their way the way they stay out of nonprofit hospitals’ way? The same way they use nonprofit hospitals for land use regulations, regulatory capture, and crowd out private and for-profit services? Libertarian AF.

    1. We find that each dollar spent on a SIF would generate US$2.33 in savings, for total annual net savings of US$3.5 million for a single 13-booth SIF.

      Without physical plans for a SIF facility in San Francisco, we consider our facility cost estimate
      to be a conservative “back-of-the-envelope” calculation.

      Of considerable note from your citation, the overwhelming cost savings from the program is expected to come from preventing HIV/HCV and Soft-tissue infections rather than overdose deaths.

      1. Using those figures, we should invest all tax revenue in SIF. We could make a fortune and start paying down debt.

      2. Overdose deaths are hard to quantify and attribute. One study finds changed behavior of SIF users changes their habits even when injecting outside the SIF, the other didn’t study it. They concluded there was not enough evidence to count it.

        That doesn’t mean the benefits weren’t there, they were just hard to quantify.

    2. “I hate this bullshit from Reason.”

      Agreed. But I see another problem as well. It is the stated premise vs the implied premise. Why even mention ‘nonprofit’ at all? How in any way does that equate to the government’s role being minimized? Accepting that premise means that ‘for profit’ equates to ‘deserving of greater government scrutiny.’

      Which is hardly libertarian. But quite progressive.

  5. for any U.S. attorney who wants to reduce drug-related harm.

    Well, there’s your answer. If your only tool is SWAT, “reducing harm” isn’t going to be a solution.

  6. “Many people addicted to opioids use illicit fentanyl or one of its analogues, which can be up to 5,000 times more powerful than heroin,” he notes. “Users often have no idea what they are actually buying from criminal drug dealers.” And whose fault is that? Rosenstein, who supports a prohibition policy that results in life-threatening uncertainty about drug potency, is complaining about programs that aim to reduce the casualties from that government-created hazard.

    Maybe that’s the whole point. Drug warriors like Rosentein have to gone to a lot of trouble to make drug use as dangerous as possible, and now these programs come along and threaten to at least partially undo their hard work.

    Shutting down SIFs, which do not distribute drugs but merely provide a safer place to use them, should not be a high priority for any U.S. attorney who wants to reduce drug-related harm.

    But it makes perfect sense for any U.S. attorney who doesn’t want to reduce drug-related harm.

  7. “It is a federal felony to maintain any location for the purpose of facilitating illicit drug use,” he notes.

    “Locations like the entire state of Colorado!”

  8. Sometimes you have no choice but to laugh. On the one hand, we hear about this opiod crisis and how supposedly so many people are dying of overdoses. On the other hand, you get this kind of ardent assholery.

    It’s amazing that any intelligent person over the age of 18 or so is still an ardent statist at this point. How much evidence of abject failure and astounding idiocy must there be before people realize that the problems are systemic because government is simply not the right tool to apply to so many different things?

    1. I suspect the Peter principle can be more broadly stated as: static systems continue to the point of catastrophic failure.

      That’s what all this looks like, anyhow.

    2. It’s amazing that any intelligent person over the age of 18 or so is still an ardent statist at this point.

      Yeah, you tell me.

      As a libertarian, I fully support your right to inject drugs on your own private property. I also expect you to deal with the consequences of your drug use yourself.

      As a libertarian, I object to the government providing “safe injection facilities” to drug users.

      1. I think people should be able to inject drugs on public property and private property open to the public so long ass they are discrete about it.

    3. Can you point me to any studies that show these sites prevent death long term, or is it just short term? Do addicts exclusively use these sites? What’s the effective rate on overdoses per user and not just use attempt?

  9. The SIFs under consideration in New York City, for instance, would be funded and run by nonprofit organizations.

    Which probably get mot of their funding from governments. I bet.

  10. Putting a leash on the drug warriors, and compelling a bunch of substandard people to try to find decent livelihoods, seems likely to be the next great accomplishment of America’s mainstream liberal-libertarian alliance.

    Conservatives will oppose freedom in the service of paltry ostensible morals, then mutter bitterly and inconsequentially about the progress that occurs despite their efforts, as has become customary.

    1. You’re becoming less and less coherent. Stop competing with hihn.

  11. Putting a leash on the drug warriors, and compelling a bunch of substandard people to try to find decent livelihoods, seems likely to be the next great accomplishment of America’s mainstream liberal-libertarian alliance.

    Conservatives will oppose freedom in the service of paltry ostensible morals, then mutter bitterly and inconsequentially about the progress that occurs despite their efforts, as has become customary.

    1. Conservatives will oppose freedom in the service of paltry ostensible morals

      How is government putting a public facility for drug users into someone’s neighborhood a sign of “freedom” or limited government?

      1. I was referring to right-wingers’ general stale thinking and authoritarianism with respect to doobies, cocaine, and the like, which substandard thinking and conduct makes drug usage more dangerous.

        I also would prefer government spending on safety with respect to drug usage to government spending with respect to criminalization and prohibition. I blame libertarianism, decency, and lack of respect for conservatism.

        1. Hate to break up your ignorance rev… But drug warrior mentality start in deep blue urban centers under democrats.

  12. The SIFs under consideration in New York City, for instance, would be funded and run by nonprofit organizations. With that sort of arrangement, government’s role is limited to getting out of the way.

    While technically “true”, it’ll be funded by ‘nonprofits’, those nonprofits almost assuredly receive their funding from New York City. Almost 100% of the nonprofits in my city are exclusively city funded.

  13. As a libertarian, I fully support your ability to turn your house into a “safe injection facility”, provided it’s not anywhere near my house.

    I certainly do not support the government putting such a facility into anybody’s neighborhood against their will.

    1. A “libertarian for zoning”?

  14. As an engineer I recognize that first an objective is required, then there can be a best plan for success as people work toward a common goal.

    What is the social objective concerning drug use that will dictate the best plan?

    Is it prevention or normalization? Or is it endless hand wringing without any objective as the drugs get more deadly.

    Government isn’t equipped to take a stand because they’re politicians trying to appease all conflicting groups at the same time.

    That’s why politicians are lousy engineers.

  15. From one of the most liberal news sources:

    vox dot com /science-and-health /2018/8/22/17683364 /safe-injection-sites-study

    Safe injection sites were thought to reduce drug overdoses. The research isn’t so clear.
    A new meta-analysis reviewed the evidence on safe injection sites. There’s bad news.

    cbc dot ca /news2/interactives /portugal-heroin-decriminalization/

    How Europe’s heroin capital solved its overdose crisis
    What Canada can learn from Portugal about opioid addiction, rehab and recovery

    —No “safe” injection sites
    —Drugs decriminalized as in personal possession is now a civil violation
    —Growing, pushing, selling, trafficking of drugs is still penalized harshly
    —Mandatory drug rehab treating as an illness and health problem

  16. Let everyone do what drugs they will and deal with the consequences. If Joe Blow wants to open up a shop and charge people to inject safely and give them some narcan when they accidentally OD, more power to him. But we shouldn’t be putting these people in jail OR providing them injection centers on my tax dollar.

    Though I have a sweet business idea now…those hydration stations and O2 bars can eat my dust.

  17. Yes, Rosenstein is nominally a member of the Trump administration. But to lead off with the notion that this is some sort of flunky doing Trump’s bidding is a joke.

    Heaven forefend we give the more accurate impression that Rosenstein is largely independent of his ostensible ‘boss’ and is merely doing what the Department of Justice – a grossly statist apparatus – tends to do to anyone who does not toe the statist line.

    The worst part about these efforts by Sullum is his abject refusal to place the blame where it belongs – on the Legislature that controls the law that the Executive is expected to enforce.

    Because, since when is demanding selective and politicized enforcement a libertarian thing?

    1. Or, put another way, if Sullum expects Trump to order Rosenstein to ignore certain sorts of illegal activity, who exactly is it to say what other sorts of illegal activities could Trump direct him to forget about?

      You sure you want to go that route Jacob?

  18. If you want to shoot up, go for it, I won’t try to stop you, but you deal with the consequences… don’t make me pay for your needles, or your get high safe zone, or your medical bills when you OD.

  19. Wouldn’t want to live near the SIF. It may be that they do not increase crime in the surrounding area. But I would expect that it does lead to loitering of people I would not want loitering around my house, namely drug addicted homeless people. Same reason I wouldn’t want to live near a Union Gospel Mission.

    That said, my remedy is to either buy up the surrounding property or move. Wouldn’t be happy about it, but not unhappy enough to change my views on property.

  20. Anyone working for the DOJ should “aggressively” stuff themselves into a wood chipper.

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