Over the past five years, deaths from heroin overdose in Maryland have tripled, with 748 deaths in 2015 alone and 2016 on track to be even worse. In response, Baltimore City has rolled out a comprehensive and innovative overdose prevention program, including wide distribution of naloxone, a drug that reverses overdoses. The state has also expanded access to naloxone, as well as increased its substance use disorder treatment funding and authorized the establishment of syringe exchange programs throughout the Maryland.

But we desperately need more evidence-based responses to drug use to stop the crisis — one in particular: Carefully monitored "safer drug consumption" sites would allow us to engage drug users who would otherwise consume in public spaces or unsafe environments and likely wind up in the criminal justice system or fall through the cracks. These spaces, which exist throughout the world, provide clinical supervision and a clean environment, and they allow us to connect the most marginalized members of society to critical health services. Such spaces maintain a strict prohibition on drug sharing or selling. These programs are not condoning illicit behavior; they are meeting people where they are and connecting them with lifesaving resources.


In the span of a year, such spaces have gone from a little known intervention in the U.S. to an innovative approach heralded by public officials in Seattle, San Francisco, New York, Ithaca and many other cities. Even USA Today has endorsed their use. Though relatively new to the U.S., there are already almost 100 SDC sites operating in 66 cities in 10 countries. Numerous studies chronicle the positive impacts on individuals and their communities of these programs, and the lack of negative impacts.

The key to SDC sites is that they serve as access points to substance use disorder treatment and other vital social services for drug users, such as medical care, housing and case management. One study of a Canadian facility found that in a single year more than 2,000 referrals were made, with more than half for addiction counseling, detoxification or other recovery services. We know that many will require repeat contact and engagement to be brought into treatment. Yet we must meet individuals where they are in the moment without judgment in order to establish a meaningful therapeutic alliance.

By providing a safe atmosphere and stable access to services, we can help those struggling with substance use disorder to establish positive relationships with service providers, build trust and begin tackling the challenges in their lives, including substance use. This strategy requires investment, but the reality is it works. In the Canadian facility, clients increased their use of detox services more than 30 percent in just one year.

There is a robust scientific literature to show that SDC spaces are associated with reductions in overdose deaths, HIV, hepatitis B and C, hospital admissions, the need for emergency medical services and public order concerns in surrounding areas, while delivering cost savings and serving as access points to substance use disorder treatment and social services. Each of these benefits comes without increasing community drug use, initiation into injection drug use or drug-related crime.

In 2014, the federal Substance Abuse and Mental Health Services Administration estimated that of the 123,000 Maryland residents who met criteria for a substance use disorder, fewer than 12 percent had received treatment. From 2013 to 2014, heroin-related emergency department visits in Maryland increased 41 percent. The United States has more drug users in prison than in drug treatment, and for far too long we've relied on our emergency medical system to engage those struggling with addiction.

We should remember that Baltimore's 20-year old needle exchange program was once a controversial idea that many did not believe would succeed. Today, the program has dramatically reduced transmission of HIV and hepatitis C and prevented many other harms.

SDC sites are a proven harm reduction strategy implemented across the world. They have saved thousands of lives and helped many start on the path to recovery. It's time they came to Maryland. Without such innovation, we will fail to stop the heroin epidemic.

Dr. Susan G. Sherman (ssherman@jhsph.edu) is a professor at the Johns Hopkins Bloomberg School of Public Health. Dr. Mishka Terplan (Mishka.Terplan@bhsbaltimore.org) is medical director of Behavioral Health System Baltimore. Kaitlyn Boecker (Kboecker@drugpolicy.org) is a policy coordinator at the Drug Policy Alliance. Dr. Nilesh Kalyanaraman, medical director for Healthcare for the Homeless, and Dr. Chris Welsh also contributed to this op-ed.