The opioid epidemic in America is no longer a hidden epidemic. Overdose deaths linked to prescription opioids were five times higher in 2016 than in 1999, according to the Centers for Disease Control and Prevention, with more than 100 people dying every day, per the U.S. Department of Health and Human Services.
To combat this, various cities in the U.S. are working toward opening Safe Injection Sites, also called Safe Injection Facilities, or SIFs. These SIFs would provide drug users a safe place to inject illegal drugs and have been proven to reduce transmission of HIV, Hepatitis C, and deaths from overdose.
“It’s a place where people who inject can go and they can inject in a clean, medically supervised setting with sterile injection equipment and with the potential that somebody will reverse an overdose if an overdose should occur,” Don Des Jarlais, Ph.D., of Mount Sinai Health System and NYU’s Center for Drug Use and HIV/HCV Research, told The Daily Beast. “And a critical component is that it can provide referrals and assisted referrals to get into drug treatment and receive other health and social services.”
The plans are rife with controversy, with critics saying SIFs promote drug use by making it acceptable and could make neighborhoods where SIFs open unsafe with dealers and various crime. The Washington state Senate issued a proposed ban on SIFs in 2017, and the Vermont U.S. Attorney’s Office issued a statement in 2017 against SIFs, highlighting common arguments against them while raising issues that SIFs would violate federal law. “It is a crime, not only to use illicit narcotics, but to manage and maintain sites on which such drugs are used and distributed,” the statement said.
In May, the U.S Surgeon General Jerome Adams was misquoted as supporting SIFs, prompting a response from the Trump administration refuting the reporting, saying “the Administration and Surgeon General do not support so called ‘safe’ injection sites… there is no evidence to demonstrate that these illegal sites reduce drug use or significantly improve health outcomes for those with opioid use disorder.”
But research—and experts—say otherwise.
The American Medical Association voiced support in 2017, and research shows that SIFs can help reduce drug use, not encourage it. A study out of Canada, where SIFs have been operating since 2003, found that SIFs are associated with lower overdose mortality, 67 percent fewer ambulance calls for treating overdoses, and a decrease in HIV infections.
Danielle Ompad, an epidemiologist at NYU who focuses on public health and drug use, told The Daily Beast that SIFs are part of what’s called harm reduction, where drug users are provided safe ways to use drugs that can help prevent infectious diseases or death. Needle Exchange Programs, which are legal in the U.S., fall into this category. They were first introduced in the 1980s in Europe, amid the HIV crisis, and eventually came to the U.S. nearly a decade later.
Ompad has been working in harm reduction since that time and believes that programs like SIFs or Needle Exchange Programs are akin to safe sex programs when it comes to preventing disease.
“We give people condoms because if they want to have sex, we want them to have sex in a way that will prevent them from having HIV and this is kind of the same thing,” she said.
Joshua Lee, a doctor who specializes in addiction at NYU said that the lack of harm reduction programs can lead to outbreaks and have. Scott County, Indiana, which is north of Indianapolis, had an HIV outbreak in 2015.
Scott County's public health nurse told an ABC Affiliate at the time: "Since needles were not available at all at that point, everybody shared with everybody. It was insane what people would do."
“In Scott County, Indiana, there’s no access or control of unsafe injection processes and the Scott County story is a clear example of how what happens in parts of the country that have opiates but don’t have modern, contemporary harm reduction,” he told The Daily Beast.
Lee said that the U.S. is behind when it comes to the epidemic and that Canada’s success with harm reduction is promising. Vancouver opened Insite in 2003 and has supervised more 3.6 million clients. In 2017, the Insite intervened 2,151 overdoses, and the SIF has never had a death.
Shaun Hopkins, manager of the Works, a SIF in Toronto, told The Daily Beast that the site had a soft opening in August of 2017, and has since seen about 9,000 visits, averaging between 85 and 100 visits every day.
“Every day people say things to staff that they feel they feel like they can come here and be who they are, that they can tell us what they’re doing and we’ll help them develop a safety plan for themselves,” she said. “We hear from clients, ‘If it wasn’t for you guys, I don’t think I’d be here today.’”
Ompad said her work in the field has introduced her to drug users who are not treated with respect. Even when drug users are at hospitals, she said, medical professionals are dubious of their intent, assuming they’ve come in for medication, not help.
“[SIFs] are often spaces where they’re treated like humans, where the staff is so dedicated to making sure their clients are served, that it helps them get other things they might need, like drug treatment, referrals to shelters, referrals to clothing or food. A lot of these spaces do HIV or hepatitis testing or referrals for treatment,” she said. “I think people focus on the fact that you’re observing people using drugs but I don’t think people realize it can be an opportunity to help them have better health outcomes.”
It’s unclear when the U.S. will get its first SIF, with various states working toward them, and many looking to New York as the potential inaugural site. But Des Jarlais says opening SIFs is just one step in the right direction in eradicating the opioid crisis.
“We’ll have to do much more to prevent people from starting to use opioids,” he said. “That’s something that has not been seriously tried in New York or in the U.S. as a whole.”