How Safe Injection Sites are Preventing Death and Overdose

Safe injection centers provide addicts access to clean needles and supervision. It is important to know if these facilities are effective.

By: Rivka Bar-Chaim | rbarcha000@citymail.cuny.edu | Published Nov 19, 2018

 Photo by Cindy Shebley CC BY 2.0

“There’s a big, gaping hole in the family… and everything we do – there’s one missing,” said the father of Teslin Russell, an eighteen-year-old girl who died of drug overdose in 2016. Her family was heartbroken by her completely unexpected death, and so are many others who are affected by the opioid crisis every day (CTV News). The Opioid crisis is a major issue in many countries today. Many people die every day from the crisis, and others fall ill and are at high risk of being hospitalized (Raol).

One option for dealing with the opioid crisis is the establishment of safe injection sites. Safe injection sites are centers that supervise drug injection and provide clean needles for people addicted to opioids. In most safe injection sites, addicts come in with their own drugs and can safely inject the drugs under supervision. Safe injection centers will often connect addicts to other programs such as centers for recovery and rehabilitation (Weiner).

It is important for people to know if these safe injection centers are effective in order to properly decide if they are worth implementing. Voters should stay informed about safe injection sites and decide if they should vote for officials who will closely look at safe injection sites and consider implementing them.  It is important to delve into whether or not these sites effective in preventing the spread of opioid addiction and overdose, to see if they are helping or possibly making the issue worse. People’s lives are at risk and if safe injection sites are indeed a good solution to issues that the opioid crisis brings, implementing these sites is imperative.

 

The Positive Effects of Safe Injection Sites

Safe injection sites reduce high risk behaviors in addicts, offer access to addiction help programs, and prevent death caused by overdose. In 2014, the Harm Reduction Journal found in a study that a Denmark safe injection facility had brought safer injection practices among those who used the center. These included “injecting in a less rushed manner” and “no longer syringe sharing” (Kinnard). When people rush injection, they are more likely to make damaging mistakes. Syringe sharing can cause the spread of catastrophic bloodborne disease such as HIV. Since this safe injection facility decreased these risky behaviors, the facility prevented a lot of damage and possibly saved multiple lives. Although this study is based off a European safe injection facility, it shows that many addicts who use these facilities report that they are useful and help them to decrease in risky behavior.

The main idea behind safe injection facilities is harm reduction. Many people who are addicted to opioids are not able or willing to fight their addiction. In fact, according to the Substance Abuse and Mental Health Services Administration “as many as 90 percent of people” who would benefit from rehabilitation do not get it (“Drug Rehab Success Rates”). Until these people can reach a healthier place, it is best to reduce the harm their addiction can do to themselves, or even others, as much as possible.

As doctor Henry L. Dorkin, a pediatrician at Massachusetts General Hospital, explains, harm reduction is about “meeting patients where they are in their disease to eliminate existing barriers to rehabilitation” (Dorkin). When someone may not yet be ready to recover from their addiction, safe injection sites serve to protect them from serious side effects of addiction, such as the spread of bloodborne disease and infection. This spread of disease is prevented because as previously mentioned, needle sharing and other bad injection practices often lead to the spread of bloodborne disease from one person to another.

In an article called Another Senseless Death — The Case for Supervised Injection Facilities, Sarah E. Wakeman, M.D. reiterates this idea, explaining why the concept that safe injection sites enable addiction is wrong. At this time, the opioid epidemic is past the point of being enabled, and is, according to Wakeman, “soaring unassisted” (Wakeman). This means that the crisis is so devastating that centers such as safe injection sites could not possibly make it worse, and would rather to bring solutions to some of the huge issues that this crisis has brought. Right now, the main goal of governments should be to limit and reduce the harm of opioid addiction, which safe injection sites do effectively by reducing dangerous behaviors associated with injection.

Safe injection sites are effective in preventing harm among addicts because they provide onsite supervision of those injecting drugs. This helps prevent overdose, and more specifically death by opioid overdose. Naloxone is a drug that saves lives of those who overdose on opioids. At safe injection sites, supervisors can be on watch at all times and distribute Naloxone to any addict who may overdose on drugs. A study done by PLoS ONE found that a safe injection site in Vancuver, Canada prevented up to 51 overdoses through the distribution of Naloxone or calling 911 in emergency cases (Milloy). This proves that safe injection sites can be effective not only in preventing risky behaviors among addicts, but in legitimately saving lives.

Despite the many studies backing up the effectiveness of safe injection sites, it can be argued that it could be a waste of government money, specifically if those addicted to opioids would not even be interested in using such facilities. Another study by the  Harm reduction journal in the state of Rhode Island, showed that “more than six in ten” of addicts who participated in the study indicated that they would use a safe injection facility if it was available (Bouvier).

It can be concluded from this study that there is a large interest in safe injection sites among those addicted to opioids and establishing these centers would not be a waste of government funds. Furthermore, if even just ten percent of those who are struggling with opioid related substance abuse in the United States were interested in using safe injection centers, that would be over one hundred thousand people who could be helped by these centers to become less vulnerable to risky behaviors.

Another important factor that governments should look at is that safe injection centers can actually help people struggling and get them on a road toward rehabilitation  (Weiner). Many safe injection centers offer resources for those struggling and being in an environment that encourages health and safety can at the very least make those who are addicted to opioids aware that rehabilitation is an option.

More than anything, safe injection centers are effective in reducing harm caused by opioid addiction. They introduce safe injection practices, by giving people access to clean needles, thereby preventing both the sharing and unsafe disposal of needles. Safe injection centers help to combat the opioid crisis by offering supervision to protect addicts from death by overdose and ensuring their safety while injecting.  Additionally, they give people access to programs and information regarding rehabilitation and safety.

 

Safe Injection Sites from Another Point of View

Many people have issues with the implementation of safe injection sites. In Nothing safe about safe injection sites, Alex Titus discusses some potential issues of  safe injection facilities. His first argument is that there is hardly any evidence that safe injection sites bring people into rehabilitation. This shows a fundamental misunderstanding of what safe injection sites are intended to do. These facilities are not meant to bring people into rehabilitation, rather they are meant to limit harm and risks that come along with addiction to opioids, such as the spread of bloodborne disease and death from overdose (Dorkin).

In fact, there is proof that facilities such as safe injection and needle exchange sites reduce the spread of HIV and other bloodborne disease (“Panel on Needle Exchange”). No one facility is going to be able to completely resolve the opioid crisis, but through the implementation of safe injection sites, the negative impact of the epidemic can be reduced.

Titus also argues that safe injection facilities might cause normalization of opioid use. However, the United States is well passed the stage of normalization. In the past 20 years more than 200,000 people have died from opioid overdose (“Opioid Overdose”). There should no longer be a worry about normalizing addiction since these numbers show that it already is normalized. Right now, the focus needs to be preventing harm caused by addiction to opioids which is something that safe injection sites are proven to do.

Titus does pose some good questions in his article which are necessary to discuss, such as ”If a teenager decides that he wants to experiment with black tar heroin, should the injection site be opened to him?” and “how many overdoses will addicts be permitted per day?” These important questions can be decided by the governments and officials when they implement these necessary institutions. Although posing these questions is important, they don’t negate the importance of safe injection facilities and their potential to create positive change.

Some people argue that safe injection sites add to crime and increase problems in the areas in which they are set up. However, in an article by the Pacific Standard backed up by a 2016 study by the New South Wales Bureau of Crime Statistics and Research, Francie Diep, explains that safe injection sites don’t cause “increases in theft, robbery, narcotics trafficking, or narcotics possession” in the neighborhood of the facility. It is likely stigmas around drug addiction, rather than actual fact that causes people to believe that safe injection centers bring about an increase in crime to their surrounding areas. These centers more likely reduce the amount of people who would be injecting themselves with drugs on the streets with can cause disease to spread to non addicts and regular pedestrians.

According to Rod Rottenstein in a New York Times article, safe injection sites are used by addicts only to get high, “as few as 10 percent of injection site users find their way into treatment,” he says. The fact that 10 percent of the facility users found their way into treatment shows that these facilities are even more effective than they are intended to be. Safe injection sites are made for decreasing harm caused by opioid addiction, if the centers are also helping several hundred people become interested in recovery, that is an extra positive side effect.

 

Struggles Safe Injection Centers Face

It is not easy for everyone to support safe injection centers. In his aforementioned article for Stat News, Doctor Dorkin explains that it is tough for physicians to come out in support of safe injection facilities since they “don’t want to condone, or to be seen as condoning, the use of illicit drugs.” With fewer people in the medical field willing to support safe injection centers, it can be harder for these facilities to get the public support they need in order to be established and funded.

Safe injection sites in North America also face a lot of government backlash, Rod Rottenstein, the current Deputy Attorney General of the United States, clearly has an issue with these centers as do many other government agencies and policy makers. In a report by the Canadian Medical Association Journal, Laura Eggertson discusses the issues with a Canadian anti safe injection facility bill called Bill C-65, which  would require “any organization applying to operate a safe injection site to produce a suite of information that advocates say will make it nearly impossible to get a new site under way.” Eggertson goes on to say that the bill “contends.. doctors who point to evidence that harm-reduction strategies reduce HIV, hepatitis and other infections spread through injection drug use.” This shows that a major issue with this bill is that it ignores the large amount of evidence that shows safe injection sites are effective in reducing harm, and makes it harder for safe injection sites to operate.  

This bill and similar government regulations make it tough for safe injection centers to address issues and help those affected by the opioid crisis. Safe injection centers have been proven to help prevent the multitudes of issues that can come along with addiction, and they additionally save lives in the case of overdose. If governments become more receptive to these facilities, then it could do a lot to deal with the opioid epidemic in many cities across North America.

 

What Needs to be Done

It is clear that safe injection sites are effective in helping people who deal with the opioid crisis. Although the main objective of these centers is harm reduction, they still help people gain access to intervention programs and rehabilitation. Safe injection sites limit disease by providing clean needles and supervision which prevent the spread of bloodborne disease that can come from needle sharing and unsafe disposal.

In order for people affected by the opioid crisis to see more of these centers around them, they will have to vote for officials who will take the positive effects of safe injection sites seriously. That way, more of these centers can be established to help those who are nearly hopelessly addicted to opioids, thereby solving a huge issue of the opioid crisis.

There are still many decisions that need to be made regarding the establishment and upkeep of these centers. These conversations are a crucial part of establishing any sort of government program, especially when it comes to the complex issue of this epidemic. Through these conversations and the establishment of more safe injection centers across North America, there can be a stronger and clearer pathway of the solution to the opioid crisis.

 

Works Cited

Bouvier, Benjamin A., et al. “Willingness to use a supervised injection facility among   
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CTV News. Ottawa Family Shares Story Of Teen’s Overdose Death. 2017, https://www.youtube.com/watch?v=jOeKuoyRs3s. Accessed 18 Nov 2018.

Diep, Francie. “The Department of Justice Is Totally Wrong About Supervised Injection Sites.” Pacific Standard, 29 Aug. 2018, psmag.com/social-justice/the-department-of-justice-is-totally-wrong-about-supervised-injection-sites.

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