Researchers at Johns Hopkins Bloomberg School of Public Health recommend that Baltimore turn to an unorthodox way of dealing with its heroin epidemic by opening two facilities that provide people a safe place to do drugs.
In a report published and commissioned by the nonprofit Abell Foundation, the researchers suggest opening one facility each on the city's east and west sides. They say such facilities would prevent overdose deaths and other harms that addicts face.
While the idea of so-called "safe-drug consumption spaces" is just starting to gain traction in the United States, the researchers said such facilities have helped stop deaths in other countries. There are 97 safe spaces in 66 cities and 11 countries, according to the report.
The report comes as the nation faces a growing opioid epidemic that shows little sign of easing. In Baltimore city alone, an estimated 19,000 people inject drugs, and there were 481 fatal overdose deaths during the first nine months of 2016, a 65 percent increase over the same period the year before.
"It is a public health emergency and we need every single evidence-based tool that is at our disposal," said Susan Sherman, a professor in the Bloomberg School's Department of Health Behavior and Society and the report's lead author.
But Sherman acknowledged there are legal hurdles and critics blasted the idea. One said the government should focus its efforts on opening more treatment facilities.
"The government should be spending our resources on helping people get off drugs, not helping them get high," said Mike Gimbel, former director of the Baltimore County Office of Substance Abuse and now a private consultant.
The facilities would be akin to allowing legal drug dealing, Gimble said. He said addicts likely wouldn't use the centers because they like to get high several times a day and it would be inconvenient to travel to a center. They also might fear the police are watching, he said.
There are also questions about the legality of allowing people to use illegal drugs.
It is illegal under federal law and the Maryland criminal code to possess controlled substances, so anybody that used the safe spaces to use illegal drugs could be arrested. People who work and run the facilities could be open to criminal charges too.
Breaking federal law also could endanger any federal funding the city receives, said Baltimore Health Commissioner Leana Wen.
While Wen said that the safe space is a model the city could explore, she doesn't think the idea could move forward without the blessing of the federal government.
"As I understand, it depends on interpretation of federal law," Wen said. "We have a new presidential administration that has yet to weigh in on a safe injection facility."
Legislation pending in the General Assembly would allow for the creation of such sites, but it is unclear if it will pass this legislative session. Sherman said a state law could provide some legal protection.
"If there is no state protection, people are a lot more exposed," she said.
In the meantime, a coalition of groups that includes the Abell Foundation and Open Society Institute-Baltimore already have been studying and discussing the idea of opening safe drug consumption spaces.
The Drug Policy Alliance and Open Society have provided Sherman funding to hire a community organizer to build support toward the idea of opening such centers in the city. The foundation that owns the nonprofit also has provided funding to safe space facilities in other countries, including Europe and Australia. They also have been involved with a site in Vancouver, British Columbia.
"One of the questions is are we in a moment where we can move on this? I believe that we can," said Scott Nolen, director of drug addiction treatment programs at Open Society Institute-Baltimore. "We have blown epidemic out of the water; we are now in unchartered territory the way people are overdosing."
Several cities are actively looking at opening safe spaces, according to the Abell Foundation report, including New York; Ithaca, N.Y.; Seattle and San Francisco. Last month the King County Board of Health voted to open two facilities — one in Seattle and another in a surrounding county.
The safe spaces are a form of treatment called harm prevention. The priority is not necessarily to get people into treatment, but prevent them from dying or getting HIV from using dirty needles or abscesses from too many injections. They also keep people from walking around the streets high, which can put them in dangerous situations.
The report found that Vancouver saw a 35 percent reduction in overdose events around one of its safe consumption spaces compared with the city as a whole. Sydney, Australia, saw a 68 percent reduction in ambulance calls in the vicinity of its safe space.
The facilities also would provide other services such as counseling and access to drug treatment. Over time use of the safe space can lead people to seek treatment, the report found. In Vancouver, 57 percent of people who inject drugs at one safe site started addiction treatment, and 23 percent stopped injecting drugs altogether.
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The safe spaces can also be cost-effective, Sherman said. A recent study of the Institute Safe Center in Vancouver showed it generated an annual benefit to society exceeding $6 million. Baltimore likely would see similar savings, through reduced overdose deaths and averted cases of HIV and other infections, the report found.
Rep. Andy Harris, a Maryland Republican, said such facilities would only make the underlying problem worse.
"Instead of concentrating on methods to provide adequate drug rehab programs, especially supporting and expanding access to faith-based programs that work for those afflicted with the scourge of illegal drug addiction, this study suggests that essentially legalizing heroin dens and crack houses in Baltimore is the answer," Harris said in a statement.
"The real answer lies in improving our education system, providing job opportunities in a growing economy, and, most importantly, making sure that we have adequate treatment programs to accommodate the growing number of addicts, and bringing these addicts into those programs through the justice system if necessary," he said.
This story has been updated to correct the spelling of Scott Nolen's name.