Are safe injection rooms the key to stemming America's heroin problem?
It’s not exactly fresh news that America has seen an opiate problem. Since 2007, it has been estimated that heroin use alone has risen by 145 per cent and at present an average of 91 people are dying every day as a result of drug overdoses, two thirds of which now involve opiates. To put that in perspective, in the last two years, more Americans have died because of opiate use than died in the whole of the Vietnam war, and it is now the leading cause of death in Americans under the age of 50.
Behind this epidemic is believed to be the widespread over-prescription of highly addictive opiate-based painkiller medicines. When these prescriptions were eventually cracked down on, users moved on to cheaper, but more potent street heroin to feed their habits. In turn, deaths related to heroin increased threefold between 2010 and 2015. Deaths from synthetic opiates, including the even more lethal fentanyl, also increased dramatically during this time.
Now affecting every segment of society, from high school kids to educated professionals, the problem is estimated to be costing the US economy well over $50 billion every year, once factors such as lost productivity, health care and law enforcement are included. While education programmes have been enacted and wider access to rehab made available, these are often brief and inherently unsuitable to tackle the root causes of addiction. But could safe injection facilities, where addicts can go inject in a controlled environment, be another way to help combat this issue? If the success of schemes in other countries is to be listened to, it might just be.
Put simply, safe injections sites are facilities where users of heroin and other drugs can go to take their drugs in an environment that is designed to be safer than residential properties or public places. Equipped with professionally trained staff that can intervene if things do go wrong, they also provide free, clean needles, and aim to reduce instances of illnesses associated with intravenous drug use such as HIV and hepatitis.
Although primarily designed with intravenous drugs in mind, many safe injection sites will also accept users of other substances. Despite the open-minded approach that they may be associated with, in most safe sites around the world there are strict control surrounding behaviour. Although each works slightly differently, generally individuals are not permitted to buy or sell drugs on site, may not take needles away, and only individual drug users are permitted to handle their drugs.
There are currently no officially sanctioned safe injection rooms in the US, but they do exist in 66 cities in 10 countries across the world, including Germany, Canada, the Netherlands and Australia. The first site in the UK - where drug related deaths are among the highest in Europe - is scheduled open in Glasgow in early 2018, and there are currently multiple locations across America looking into the possibility of introducing safe injection sites, including Philadelphia, Seattle and Washington.
It seems that so far, the supervised injection sites in other countries are making an impact. In Australia, which has one centre, as of 2015, over 960,000 injections had been supervised and staff were able to intervene in 5,925 overdoses, without a single death. According to the country’s Alcohol and Drug Foundation, since its 2001 opening, the number of publicly discarded syringes and needles has more than halved. This success appears to have also been replicated in Canada - which is struggling with its own opiate addiction issues - so much so that Health Canada is now in the process of opening more sites across the country.
Vancouver’s safe injection site, InSite, which opened in 2003, has so far witnessed over three million injections; a study into its cost-effectiveness found that over the course of 10 years, its existence resulted in a net saving of $18 million and 1175 life-years gained. Unsurprisingly then, Vancouver’s Mayor, Gregor Robertson, is among the most outspoken advocates of safe injection rooms as an answer to drug abuse: "Addiction is a health issue, not a criminal issue. Research, and now the law, confirms our position that safe injection sites such as InSite perform an important health-care role in the lives of people living with chronic addiction-related problems."
The centres have also won the support of a range of other individuals, including former addicts who believe that the centres have the potential to not only save lives, but turn them around: “I was on this floor, right here, lying right here,” said Guy Felicella, who visited the centre in Vancouver "thousands" of times, “And a nurse, through her interventions, brought me back to life. And it was after that, that I made the decision to seek treatment options and change my life. When I was ready, they were here to help me.”
Despite being widely accepted as a beneficial move by medical professionals, the centres do provoke controversy from critics who argue that they may encourage drug use, create a "honey trap" of crime and public disorder. It is for this reason, and particularly the reaction of politicians and the public, that the US has been slower than other developed countries to implement this idea; in 2017, a bill to create the country’s first centre in California was defeated by the state Senate, with one Republican member arguing that it would "create sanctioned shooting galleries for street heroin."
While much has been made of the scale and extent of the problem, America is still lacking in its response to it, other than portraying heroin as an unstoppable beast. But with no sign of this worrying increase abating, it’s clear that something more must be done, rapidly. The worries and lack of appetite from some sectors of society is perhaps understandable, but the harsh reality is that drug use and abuse is always going to exist - and no one sets out to be an addict - so to refuse people safety on the basis that it might “empower” addiction is a bit like saying you shouldn’t take the contraceptive pill because it might “encourage” unprotected sex. It doesn't work. And after all, if it was your son, your sister or your best friend injecting, isn’t their safety all you’d ask for?
Featured illustration by Egarcigu