It’s a radical idea in the fight against drug overdoses: Create facilities where people can go and openly use opioids under the supervision of a doctor or other medical professional.
Great interest has been shown for such facilities in the United States, but the idea has also run up against strong opposition, despite the success of such programs in preventing drug deaths in more than 100 cities in other countries. In Philadelphia, the top federal prosecutor earlier this month halted plans for such a facility, known as a safe injection or overdose prevention site, by suing the non-profit that planned to open one. Last year, then-Gov. Jerry Brown vetoed legislation that would have allowed these spaces in California.
Maryland is the latest state looking at whether to allow such sites as an opioid epidemic that has stumped law enforcement and public health officials continues to kill at a terrifying pace. Del. Joseline Pena-Melnyk and Sen. Brian J. Feldman have introduced legislation to create such facilities on a pilot basis in Maryland, where 1,648 people died from opioid-related overdoses through the first nine months of 2018, a nearly 10 percent jump from the year before. Similar legislation failed last year.
With no end in sight to the epidemic that is now killing more people than firearms and car crashes, we need to start looking at ways to address it. Safe consumption sites are worth trying. Locking up users isn’t solving the problem, and not nearly enough are getting into treatment programs. Meanwhile, the spread of the highly potent synthetic drug fentanyl has radically increased the risk of accidental overdose among those who take street drugs.
To make this intervention work, the federal government, which has warned states that such sites are illegal and has threatened to prosecute, also needs to come on board so clinicians and drug users won’t fear legal repercussions — a major impediment to opening safe use spaces. (This is what led to the lawsuit in Philadephia.)
The legislation does offer local legal protections to staff, drug users and property owners of the buildings where these sites would be located. Doctors couldn’t lose their state licenses, and drug users couldn’t be prosecuted or arrested by local authorities. But it would be better to get the endorsement of law enforcement as well, particularly in Baltimore; if police say they will continue arresting those using marijuana even though the state attorney’s office will no longer prosecute those cases, how would they treat safe injection sites?
Critics of consumption spaces argue that they would just promote more drug use or lead to an increase in crime. They picture open air drug markets where people use freely and carelessly.
But the evidence simply doesn’t show that. We’re not talking about the famed Hamsterdam drug den from The Wire. Various studies looking at the impact of such sites have found no link to crime and, in fact, documented many benefits.The Lankenau Institute for Medical Research found that the sites have helped reduce overdose deaths, blood-borne disease infections such as HIV and hepatitis, and public injections and other drug use where they have opened, according to a fiscal analysis of the legislation.
Just look at the results in Vancouver where 57 percent of people who used drugs at a safe site started treatment and 23 percent stopped using, according to research by the Abell Foundation.
A study by the Johns Hopkins Bloomberg School of Public Health found that one safe consumption space in Baltimore could prevent 5 percent of overdose deaths in a year and save $6 million in costs related to drug deaths.
Safe consumption spaces allow medical professionals to step in and intervene when an apparent overdose is taking place, for instance by administering the overdose reversing drug Narcan. They can take care of medical issues, such as infections. And just as important, doctors, nurses and counselors can connect users to social services, mental health counseling, housing support and other services that might help addicts get their lives together and eventually off of drugs. Now, doctors don’t have a way to reach drug users unless they come for an appointment. This is not a population that frequently makes it to the doctor.
It takes time for substance users to build up the determination to quit. It is not as simple as stopping cold turkey, as many might think. We want to try and stabilize people’s lives and prevent them from overdosing until they come to that point.
Of course, these spaces would need to be carefully monitored. The Maryland legislation calls for some oversight of the facilities, which must collect and report detailed data, including how many people are treated, the number of needles and syringes distributed and details about any overdoses, or overdose reversals.
While sanctioning the use of drugs may seem extreme to some, it reflects the reality that drug abuse is a health issue, not a legal or moral one. Baltimore was a pioneer in harm reduction policies toward drug abuse a generation ago with its needle exchange program to reduce the spread of HIV and other infectious diseases among intravenous drug users. Safe consumption sites are the next step. We urge the General Assembly to allow this life-saving intervention.