A Refuge, and a Way Home, for Heroin Users: Supervised Injection Facilities

There is a hot topic trending in the debate over the war on drugs:  should there be safe places for intravenous drug users to inject illegal drugs such as heroin?  A panel of experts from around the world recently convened a symposium in NYC to share their experiences in starting and running so-called “supervised injection facilities.”  The panelists and their sponsor, VOCAL NY, called for establishing one here in New York, and a new coalition of agencies and advocates (sifnyc.org) has formed to advance the idea.

There are an estimated 100 supervised injection facilities worldwide and advocates credit them with reducing both overdose deaths and the spread of infectious diseases such as HIV and hepatitis C (HCV.)  These facilities offer clean needles, a sterile environment, and emergency services in the case of an overdose.  They can also provide education on safe practices, access to social services, and referrals to treatment programs, medical doctors, and mental health care.  Without such a refuge, addicts resort to “whatever it takes” to get high and the resulting health problems resonate throughout society through the spread of infectious diseases and the unnecessary deaths of loved ones.  There are no licensed supervised injection facilities anywhere in the U.S. though some unofficial programs apparently exist.  Changes in state law would be required to allow licensed clinics to open because operating one would violate existing drug trafficking laws.

The rise in heroin, the primary drug used via injection, is well documented and New York City is no exception.  Many heroin users begin by taking prescription painkillers that are chemically similar to heroin, and after becoming addicted find that heroin is cheaper and easier to obtain.  Staten Island is the borough hardest hit by the heroin epidemic and 74 people there died of an overdose in 2014.  Mayor DeBlasio traveled to Staten Island in December (2015) to announce measures addressing the heroin crisis there.  He has made naloxone, an overdose antidote, available in pharmacies without a prescription, and promised to increase the availability of substance abuse treatment by licensing more physicians to prescribe maintenance drugs that dull the cravings for heroin.  Why then might we need the supervised injection facilities?

Firstly, naloxone does not prevent overdoses which can occur from the improvised situations that users often find themselves in; naloxone merely treats an overdose, if it is administered in time.  Supervised injection facilities prevent overdoses by providing an environment that is cleaner and less chaotic than, say, a gas station rest room—a typical place for a user to inject.  Secondly, the spread of infectious disease through unsanitary conditions and instruments represents an even deadlier and widespread threat than overdose, because infected users spread diseases such as HIV and HCV to unsuspecting loved ones through, for example, sexual intercourse.  The sterile conditions of a supervised injection facility will slow the growth of such lethal problems among unsuspecting persons who have nothing to do with illegal drugs.  As for expanding treatment options, that is a good idea but coaxing people into treatment requires engaging the users in a meaningful way; arresting them and threatening them with jail is obviously not working and never has.

A recent editorial in the Staten Island Advance excoriated the idea of opening a supervised injection facility in that borough, using the tired argument that doing so would encourage more drug use.  However, it is the plain fact that many thousands of people on Staten Island, without any encouragement, are seeking out heroin.  Supervised injection facilities do not encourage more drug use; they encourage safe drug use.  One of the thorniest problems in combating illegal drugs is the fact that they are . . . illegal!  Like anyone else, illegal drug users do not want to be arrested and imprisoned.  Because intravenous drug users are punished, deplored, and shamed for their disease, they live in a shadow world apart from mainstream society.  Supervised facilities provide a place where they are not judged.  Staff, often recovered addicts who understand the dire situation facing users, can offer them a path out of their misery by providing access to care and education on infectious diseases and methods of prevention.

Supervised injection facilities are one example of the “harm reduction strategy” towards substance abuse.  Needle exchanges are another example; they accept the fact that users will utilize infected needles if that is their only choice, but respects that users are intelligent and will prefer clean needles over dirty ones if they are available.  The immediate result of needle exchanges is that fewer persons get infected with HIV and hepatitis C, thus the harm of addiction is reduced.  Needle exchanges are proliferating in such unlikely places as Indiana and other rust belt locales where overdoses and HIV are rampant.  NYC has 15 needle exchanges but only one on Staten Island and, sad to say, no one is asking for more.

The harm reduction strategy is the polar opposite of the 50 year “war on drugs” which was lost long ago but no one will admit it.  Millions of Americans want to use drugs, for any number of reasons; there are as many reasons as there are users but making these people criminals exacerbates rather than cures the problem.  And for some users, stopping, even when the thrill is gone, is much harder than just saying no.

Throughout the world, opinion is shifting towards decriminalizing all drugs.  In Latin America, the real front lines of the war on drugs, where narco-terrorists threaten virtually every facet of society, leaders are moving towards raising the white flag of surrender.  A recent draft United Nations report recommended decriminalizing drugs and Portugal did so about ten years ago with no discernible detriment to civil society, and no apparent increase in substance abuse.  On Staten Island, and throughout NYC, it is time to tear down the walls that separate us, bring users in from the cold, and offer them whatever help we can.


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