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Supervised Injection Facilities Save Lives

The Justice Department’s opposition to such harm-reducing programs is irrational, unscientific, and inhumane.

Last week California's legislature approved a bill that would authorize "overdose prevention programs" in San Francisco where people can inject their own drugs in a safe, sanitary, and supervised environment. The next day, Deputy Attorney General Rod Rosenstein published a New York Times op-ed piece in which he promised "swift and aggressive action" against such programs.

The fight over supervised injection facilities (SIFs), which operate legally in 66 cities around the world but are prohibited in the United States, is the latest round of a long-running debate. On one side are advocates of "harm reduction," who seek to save lives by making drug use less dangerous; on the other are hard-line prohibitionists like Rosenstein, who seek to deter drug use by keeping it as dangerous as possible.

In the 1990s, needle exchange programs, which reduce the spread of blood-borne diseases such as AIDS and hepatitis C by making clean syringes more readily available, were just as controversial as SIFs are today. Two decades later, they are not only legally tolerated but federally subsidized, and even social conservatives such as Vice President Mike Pence have come to recognize their lifesaving value.

Naloxone, an opioid antagonist that reverses overdoses, posed a similar challenge to drug warriors. In 2016 Maine Gov. Paul LePage, a Republican, vetoed a bill allowing pharmacists to dispense naloxone without a prescription, saying he did not want to create "a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction." But Maine legislators overrode LePage's veto, and wide distribution of naloxone has become a consensus policy endorsed by the Trump administration.

SIFs combine syringe exchange and naloxone kits in a space where drug users needn't worry about overdosing with no one around to help or about being arrested, assaulted, or robbed. Survey data suggest that environment encourages more cautious dosing and safer injection practices.

Rosenstein claims SIFs "would only make the opioid crisis worse." Yet research has found that SIFs 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.

Rosentein says "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," and research in Australia "found similar results."

Studies of Insite indicate that SIFs reduce public injection and drug-related litter such as used syringes. In a survey of drug users at an underground American SIF, more than 90 percent "reported that, if not for the site, they would have been injecting in a public restroom, street, park, or parking lot."

Rosenstein also complains that local governments plan to "subsidize" SIFs, which he describes as "taxpayer-sponsored haven[s]" for drug users. But SIFs 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 cites the so-called crackhouse statute, which makes it a felony, punishable by up to 20 years in prison, large fines, and property forfeiture, to "maintain any place…for the purpose of…using any controlled substance." But the Justice Department has wide discretion in deciding how to allocate its resources, and shutting down SIFs should not be a high priority for federal prosecutors who sincerely want to reduce the harm caused by drug use.

© Copyright 2018 by Creators Syndicate Inc.

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  • loveconstitution1789||

    Its like prostitution spots that nobody wants near their house.

    Drugs should be legal and prostitution too. Until they are expect the drug warriors and sex warriors to up their war tactics.

  • JoeBlow123||

    Surefire way to make the locals happy and increase home values: put a Batman signal out to the homeless drug addicts calling them all to these drug facilities.

  • John's broseph||

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

    If you knew anything about non-profits in 2018 you would know that a significant number of them survive not off donations but from government grants. It's welfare for white women.

  • Jerryskids||

    shutting down SIFs should not be a high priority for federal prosecutors who sincerely want to reduce the harm caused by drug use.

    This is why the War on Drug Users isn't "irrational, unscientific, and inhumane" as the subhed claims, it's perfectly logical if you assume the Drug Warriors think drug users are sub-humans who deserve to die. Cf: the government spiking alcohol during prohibition, knowing many people were going to drink the poison anyways. Not much different than the Bible-thumpers who think AIDS is God's punishment for sodomites. They're just doing God's work here, making sure sinners are punished for their sins.

  • Cyronic||

    I'd say there's a difference between seeking to punish wrong-doers and refusing to protect them from the consequences of their actions. Even if that means death.

    Several (or all) drugs should be legalized and punishments should stop, yes, but if drug users are going to continue risky behavior that gets themselves killed, I'm not eager to protect them from their poor choices. I'm certainly not going to support subsidizing that risky behavior; that will only encourage more risks, like with any product consumption.

  • ||

    Several (or all) drugs should be legalized and punishments should stop, yes, but if drug users are going to continue risky behavior that gets themselves killed, I'm not eager to protect them from their poor choices. I'm certainly not going to support subsidizing that risky behavior; that will only encourage more risks, like with any product consumption.

    Agreed. Intervening to stop them from ODing (or dying because of it) and/or contracting HIV/HCV is little different than intervening because you think drugs are bad. Arguably worse as the previous generation of drug warriors had to pretend or talk in terms of metaphorical lives saved while the new generation of drug warrior will have the righteousness of actual lives saved at their back.

    There's a romanticism that everyone saved goes on to live a happy life. In reality, plenty (not all) of the lives saved are more zombie-like slaves to the chemicals they use and even the one's who do recover and go on to the pink house with the white picket fence will tell you that it's not easy, always preferable, or for everyone.

  • BestUsedCarSales||

    Two decades later, they are not only legally tolerated but federally subsidized

    The latter is my only real concern about this topic.

  • H. Farnham||

    Agreed. Especially with statistics like this floating out there: "a Vancouver SIF that opened in 2003, saves five times as much money as it costs".

    I'm curious who exactly is bearing the cost and who is reaping the savings (too lazy to read the linked article). I would imagine its a collectivized cost/benefit analysis, of which I'm always skeptical.

  • ||

    The latter is my only real concern about this topic.

    There should be several latters. First, the ROI study Sullum quotes flatly admits that not site has been chosen in SF and that that alone could completely obliterate all estimates. Second, the program uses the usual layers-deep funny money math to arrive at savings not in actual dollars, but in dollars spent by other government programs. If you look at their estimates, the spending/savings on actual overdose deaths is $1/$0.38. The overwhelming majority of the 'savings' (assuming the site doesn't blow any/all budgets) comes from preventing HIV and HCV infections that the state would have to treat anyway. Lastly, it's the underpinnings of the same not-for-profit bullshit that currently grips hospitals. Whereby centers open to the public will enjoy land tax free (lest they blow the $1/$2.33 projection) and can even leverage it to build more centers as long as they provide services the state tells them to provide and whom it tells them to provide it. If you think the SIF's are going to operate at a $2.33 margin (assuming property costs don't tip the balance) and that we'll all see a spending cut or tax refund, you're a moron.

  • Cynical Asshole||

    ...shutting down SIFs should not be a high priority for federal prosecutors who sincerely want to reduce the harm caused by drug use.

    But since there are no such federal prosecutors...

  • DonHonda||

    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

  • GeoffB1972||

    What this world needs is more non-profits dedicated to providing a way for people to act out unhealthy behaviors legal and illegal. Maybe next we can create cutting centers with fresh razor blades and sanitary wipes and a nurse down the hall to stitch you up after your session.

    If these people can get on drugs and maintain a normal life, that's fine. But if they can't maintain a druggie lifestyle on their own, they need treatment to get out of it.

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