HARM REDUCTION

Shooting Up Under a Doctor's Care: Do Injection Facilities Save or Enable Heroin Addicts?

Ithaca, New York’s mayor wants to open a facility where heroin addicts can use under medical care, without risk of arrest.

In an attempt to curb opiate overdose fatalities, Svante Myrick, the 28-year-old mayor of Ithaca, New York, proposed opening a supervised injection facility (SIF), making it possible for heroin users to inject drugs under the care of medical staff. Experts and laypeople alike quickly took sides, holding strong opinions both for and against.

The polarized reaction places drug use and policy at a complex intersection of competing values. On one hand, drug use, especially by way of injection, is a concern of the criminal justice system. On the other, it is a public health crisis in need of studied, public health responses.

In one view, drug users are troublesome offenders; in the other, they are sick people in need of compassion and care. And one cannot forget the dominant ideology in America, which further complicates the field: that abstaining from drugs entirely should always be the goal.

A Patch.com poll recently asked the question: Are you in favor of supervised injection facilities in New York? A total of 2,603 people responded and the answer was a resounding no. Only 14 percent voted in favor. Sifting through the comments, a clear theme emerged for why people are opposed: It enables or even encourages drug use.

“This belief is based on a complete misunderstanding of heroin addiction,” Dr. Sam Snodgrass, a board member of Broken No More, a support group for grieving families who have lost loved ones to drug overdose, told The Daily Beast. “Science has shown that it is not a choice. That it is not a matter of willpower. It is a physical, medical condition.”

Snodgrass continued, “It doesn’t matter if we have a safe facility to use in or not, we can’t stop. We’ll use under bridges, in parks, in the bathroom at McDonald’s, and we will become sick, and we will die of overdose. This facility will not ‘enable’ us, it will save us.”

Ithaca’s young mayor makes a similar argument. “Treatment is the goal,” said Myrick. “We want everyone to get better, but when someone dies from a heroin overdose, the 125 people who will die today from a heroin overdose, will never get better, will never get that treatment. If treatment is our goal, we have to keep people alive until we can get them the medicated treatment, detox, rehab, [and] the counseling they need to actually get healthy.”

The oft-cited phrase in the harm reduction community is: dead people cannot recover.

“If they’re shooting up in gas station bathrooms,” the mayor continued, “if they’re shooting up on the streets, if they’re huddled behind dumpsters, they’re never going to get those resources because they’re never going to have access to medical professionals.”

Others in the field fundamentally disagree with the arguments put forth by Myrick and experts like Dr. Snodgrass. “It’s really a matter of coming to a decision, of what you think is a good use of taxpayer money. I think it’s a terrible use of it myself,” Dr. Robert DuPont, former director at the National Institute on Drug Abuse (NIDA) and current president of the Institute of Behavior and Health, told The Daily Beast.

When I cited several studies to Dr. DuPont emphasizing declines in disease and overdose mortality, he said that wasn’t one of his concerns. Rather, “it perpetuates the addiction,” he said. “Show me the people who have gone through this program and are now drug-free. What these [harm-reduction] programs do is make it safer, more comfortable, and easier to use heroin,” he said. “A good question would be, what happens to these people. Do they get better?”

It depends how one defines “better.”

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At baseline, the argument for harm reductionists is that no matter who you are, staying alive is always better. Even then, empirical studies demonstrate that people who otherwise wouldn’t seek treatment do so because of supervised injection facilities. InSite, the first ever North American supervised injection site, “was associated independently with a 30 percent increase in detoxification service use, and this behavior was associated with increased rates of long-term addiction treatment initiation and reduced injecting at the SIF,” according to one study.

Law enforcement is another major entity against these facilities, for an obvious reason: Heroin use is illegal. “The reason I oppose is because I have taken an oath to uphold the law and I will not condone the use of heroin, which is an illegal substance, whether it’s supervised or not. I just won’t do it,” said Ithaca Police Chief John Barber.

Given that the use of heroin is illegal in the United States, how can a city knowingly supervise its use? InSite, located in Vancouver, where heroin is illegal, faced this very same problem. “You have to get the exemption from federal drug laws,” said Anna Marie D’Angelo, senior media relations officer at Vancouver Coastal Health, who operates InSite. “The higher level police in Vancouver are very supportive [of InSite] and the police on the beat in that area [Downtown Eastside] are very supportive as well,” she told The Daily Beast.

Police in Ithaca are not showing the same support, saying they “will not turn a blind eye to drug users.” However, Gwen Wilkinson, Tompkins County District Attorney in Ithaca, wrote a piece for the Huffington Post, the headline of which was: “Why I, as District Attorney, Am Behind Ithaca’s Groundbreaking Plan to End the War on Drugs.”

“As a career prosecutor who has spent 25 years working in very close proximity to the ‘war on drugs,’ I am all too familiar with the strategy for dealing with drug possession and trafficking: criminalization, prosecution, and incarceration,” Wilkinson wrote. “I also know that this strategy has failed.” Wilkinson believes it’s time to try something new, like a supervised injection site.

“For some people it’s a black and white issue,” said D’Angelo, speaking to Dr. DuPont’s stance. “But it’s a harm-reduction model and most people are used to the abstinence model, the ‘Just Say No’ culture. Harm reduction is research supported, it’s scientific, and [it] does work.”

Dr. Snodgrass wants people who oppose the facility to “look into the eyes of a mother who has lost a child to overdose. And when they do so, I want them to tell that mother that they had the chance to support a facility that might, just might, have saved her child’s life. And they didn’t do it.”