Maryland has made many important strides in the fight against opioid addiction, but with 887 people dead in 2014 because of overdose or poisoning and a shocking increase in crime and violence related to drug addiction last year, we need more than a just steps in the right direction. We need to take a leap.
That's why supervised injection facilities (SIFs), like those proposed in a bill sponsored by Del. Dan Morhaim, must be considered. SIFs are places where adult, long-time injection drug users are supervised by clinically trained staff while they consume. While this may sound radical to some, it is actually quite logical. Persons with substance abuse disorders typically take their drugs where there is no help — in back alleys and bathrooms — and are often alone or with friends who are also intoxicated. SIFs, on the other hand, provide trained medical personnel who can immediately administer rescue medications at the first signs of an overdose and ensure hygienic injection practices. SIFs are also non-judgmental, safe spaces that can help drug users obtain needed treatment, be it short term or long term.
The first SIF in North America, Insite, opened in Vancouver, British Columbia in 2003. This program is one of the best researched of its kind and literally has been found to be life-saving. A 2010 modeling study published in the International Journal of Drug Policy found that each year Insite prevents three overdose deaths and 35 new cases of HIV. Even more convincing, facilities such as Insite have been found to help the most marginalized of drug users: young men in their 30s. This is important in Maryland, where young men are at high risk of being uninsured when they come to our hospitals seeking care.
Beyond helping people with addictions, SIFs act as a harm reduction measure, protecting the rest of society from the dangers of substance use. SIFs have not been found to increase drug use (even among those trying to quit), drug trafficking or crime, as some critics might claim. They actually lead to lower rates of public drug injection and used needles found in the streets.
SIFs provide opportunities for drug users to build a trusting relationship with health care providers, and hence they lead to increases in the uptake of addictions counseling, detox and treatment. I am a family physician who works primarily with street involved drug users, and so I know the power of a strong, therapeutic relationship. Every day, in addition to seeing scheduled patients, our nurses visit community drop-in centers to provide clean drug use equipment and chat with users — similar to what a nurse would do at a SIF. Here's how this worked for one of my most challenging patients, whom I will call "Mr. Z."
If it wasn't for the gradual relationship that developed between my nurse and Mr. Z while she handed him safe equipment, he would have never agreed to a first appointment with me. But slowly over time, our nursing staff earned the trust of this 35 year old man, who had a traumatic brain injury and used alcohol and multiple drugs, and he eventually agreed to see the "doctor upstairs." I quickly learned that Mr. Z's multiple unsuccessful attempts at detoxing were because of his brain injury, which made him unable to control his impulses. After my fifth appointment with him, he is now on track to seeing a neurologist and is taking medication treatment for his heroin addiction. His anti-social behavior has decreased, and he has not had any brushes with the law since his involvement with us.
Mr. Z is only a success story because he lived to see his fifth appointment. Unfortunately, many drug users will die of an overdose before they can ever be connected to the right health services. Supervised injection facilities are critical because they give the Mr. Zs of Maryland — who may be our friends, family members and neighbors — a fighting chance to stay alive long enough to engage in treatment. This is treatment that staff at an SIF would be ready, waiting to offer, and it's why this innovative program should be part of our approach to the rampant drug abuse that has become all too commonplace in Maryland.
Fareen Karachiwalla is a family doctor from Canada who recently completed her master's in public health at Johns Hopkins University in Baltimore. Her email is firstname.lastname@example.org.