Still Not Sold on Overdose Prevention Sites? Read This
A injection kit is seen inside the newly opened Fraser Health supervised consumption site is pictured in Surrey, B.C., Canada. Photo credit: THE CANADIAN PRESS/Jonathan Hayward
I lost a friend to a heroin overdose when I was in college. We met at the student newspaper, and he was a brilliant writer. We all figured he would go on to great things in journalism and probably literature. Instead, he died alone in an abandoned house in Detroit with a needle in his arm.
I grieve for my friend, but I know someone who loses five to ten friends each year to overdose and health issues stemming from drug use. Five to ten a year. When I heard that, I was rattled to the core.
It’s not easy to get someone with an addiction to stop using drugs. But there is a way to help reduce harm and prevent deaths: Overdose prevention sites.
Formerly known as “safe injection sites” (let’s applaud the more politically palatable change), OPS are centers for using drugs in a safe, supervised environment. They’re proven to reduce overdose deaths and the spread of diseases like HIV and Hepatitis C, and offer ways to find help with detox and drug treatment.
The catch? They’re illegal.
An overdose prevention site in Germany. Photo credit: HealthRIGHT 360.
The federal government is staunchly opposed to OPS in any form, and Gov. Jerry Brown vetoed legislation last year that would allow them in San Francisco because it didn’t include language to require treatment.
However, Assemblywoman Susan Eggman, D-Stockton, and Sen. Scott Wiener, D-San Francisco, authored a new, similar bill together this year (AB362, which will be heard in the California Assembly Health Committee on March 12), and Gov. Newsom has said he’s “very, very open” to the idea. It appears San Franciscans, true to their progressive nature, are in favor as well, according to a Chamber of Commerce poll showing 67 percent of city residents support them.
These sites already operate successfully in 10 nations. For a glimpse at one, check out the details about the Vancouver Coastal Health program called Insite.
But what about the people who still have a knee-jerk reaction to OPS without having any facts? I’d like to outline some arguments here.
My friend referenced earlier is a formerly homeless IV drug user who’s been sober eight years now. And even he said he was against OPS before he got educated about them, so there are still a lot of misconceptions.
He asked me to use a pseudonym in this article not because he feels any stigma, but due to the public nature of his job, so I’ll call him Scott Campbell. Let’s tackle the first line most people throw out there: “We shouldn’t enable or encourage people to use drugs.”
An overdose prevention site in Montreal, Canada. Photo credit: HealthRIGHT 360.
“People that are actively using drugs are going to use them whether they have somewhere to use them or not,” Campbell said. The San Francisco Safe Injection Services Task Force in 2017 published a report that estimated about 22,500 people in the city inject drugs each year, and more than 100 of them die annually from an overdose. “It’s happening whether we want it to happen or not,” he said of IV drug use.
Addiction is often misunderstood, said Lauren Kahn, spokesperson for HealthRIGHT 360, a nonjudgmental provider of health care to anyone who needs it. Some people perceive that drug users are making a choice, she said, “when in fact, addiction rewires your brain chemistry, and you are much more often trying to continue to use drugs to prevent getting sick as opposed to enjoying a high.” Kahn also said people often start using drugs after incidents of trauma or because of untreated mental illness.
For people who are addicted, OPS not only provide a safe space for using drugs—”safe” meaning cutting back on overdoses and the spread of illness and disease—they’re also instrumental in building trust so that when someone is ready for treatment, they can easily get it.
Campbell said when he was using, his physical and mental health suffered, and for a long time, he wasn’t familiar with any programs or services that could help if he decided he wanted it. Setting up OPS would “connect folks to harm reduction programs, treatment programs, detox, that otherwise wouldn’t be offered to them using on the streets in some of the dark corners of the city,” he said.
In addition, many IV drug users are homeless or become homeless due to circumstances stemming from their addiction. And more than 70,000 people nationwide died last year from drug overdoses. Not one person has ever died in an OPS. These sites have existed since the 1980s in other places, from Australia to Spain, but here, Kahn said, they still seem novel.
“You don’t have to be an expert in harm reduction or addiction to know that what we’re currently doing is not resolving the problem,” she said.
A mobile overdose prevention site. Photo credit: HealthRIGHT 360.
But wait: What if you’re a cold-hearted conservative who doesn’t care about helping addicts? You don’t want to fund harm reduction or overdose prevention because you don’t care if they get sick or OD. You don’t see them as human beings, like Campbell, with a loving mother, a doting husband and friends who care about him.
Let’s move on to our next argument: “It’ll harm our communities to have sites where people can freely use drugs.”
Anyone who’s been to the 16th Street and Mission BART station, among many others, or walked down Ellis Street in the Tenderloin knows that IV drug users who openly use already are damaging our neighborhoods. The amount we pay indirectly in hospital visits and other health care alone is enormous, let alone funding for Public Works to clean up needles in streets and parks. A study in Harm Reduction Journal showed a predicted cost-benefit ratio of $4.35 saved for every dollar spent on OPS.
Kahn said, “One of the things that comes up all the time are accidental needle sticks. There’s a public safety issue for everybody involved in people using drugs in an unsafe location.” Also, Campbell said where OPS exist worldwide, studies show the surrounding area is actually safer.
And as we all know, businesses tend to lock their bathrooms so no one will shoot up in them. That leads to people—even those who aren’t using drugs—using the streets and parks as toilets.
Finally, there’s perception. Even though San Francisco isn’t the only place with open drug use, it seems to bear the brunt of media attention—likely because of its density, which makes the problem more visible to locals and tourists alike. But it’s also true it’s become more prevalent.
An overdose prevention site in Germany. Photo credit: HealthRIGHT 360.
This CNN article mentions discarded drug needle complaints increased from 132 in 2008 to more than 7,500 from January to October 2018. Hearteningly, the article notes Mayor Breed’s support for OPS as one possible approach for mitigating open drug use.
Still, there’s pushback. “Addiction is terribly stigmatized in our country,” Kahn said, “and it’s hard to imagine [OPS].”
If OPS were opened in San Francisco, Kahn said, they’d likely be in the Tenderloin, Civic Center and Inner Mission, where the majority of open drug use already occurs. People won’t walk 10 or 15 minutes to a site, she said: “This is about taking people who are currently using outside and bringing them inside.”
“I think there’s no question it seems weird if you know nothing about drug use; if you know nothing about health care,” Kahn said. “The reality is, there’s only an up side to opening overdose prevention sites.”
