If there’s one thing we’ve learned over the past 35 years, it’s that housing is health care. But until our nation reinvests in affordable housing, the daily realities of homelessness remain devastating to health.
People without homes are far likelier than their housed counterparts to die prematurely. Their deaths result from increased exposure to violence and the elements along with a variety of health conditions, including addiction. The opioid epidemic is all too real for many people served by Health Care for the Homeless.
This year, Maryland has an opportunity to save lives by adopting a proven strategy to reduce overdose deaths and promote access to treatment: overdose prevention sites. Bills proposed in the Maryland General Assembly (H.B. 464/S.B. 990) would establish these indoor spaces where people could use their own drugs while finding immediate access to life-saving interventions, medical and mental health treatment, emotional support and non-judgmental therapeutic relationships.
One of our patients, Mark, was admitted to a Health Care for the Homeless recuperative care program with multiple abscesses on both arms — limbs so swollen they resembled tree trunks. Over decades, he had tried both inpatient and outpatient rehabilitation to stop using heroin and had been brought back on countless occasions from the brink of death. By the time one of our nurses met him, Mark was in his fifties, newly diagnosed with HIV, completely hopeless and full of regret. Fearful of being judged for his addiction, he told the nurse he wished there was a place he could have gone to use safely until he felt ready to stop.
When people are afraid of stigma and criminalization, they don’t seek help. The consequences play out across news headlines, including 2,406 overdose deaths in Maryland in 2018 alone.
Despite our collective work to increase access to treatment and overdose reversal medication like naloxone, thousands of Marylanders with the disease of addiction will die without additional intervention. What if Mark’s wish came true? What if there were medically-supervised and stigma-free places in Maryland — centers of humanity and compassion — where people with the disease of addiction could safely consume drugs and follow a path toward treatment and recovery?
Overdose prevention sites work. The legislation is inspired by more than 120 programs already established across the globe. No one has died from an overdose in any overdose prevention site in the over 10 countries and more than 60 cities where they exist. And following recent decisions by U.S. courts, the first overdose prevention site in the country plans to open in Pennsylvania this year. Maryland should also explore what the rest of the world already knows to be effective.
A Canadian facility found that overdose mortality dropped 35% in the surrounding community soon after it opened. In Barcelona, Spain, overdose deaths have decreased by 60% since prevention sites opened almost 30 years ago. Overdose prevention sites are associated with a 69% reduction of syringe sharing and an increase in condom use dramatically reducing the spread of infectious diseases like HIV and hepatitis C. This is particularly important for Maryland, where hepatitis C is among the most deadly infectious diseases in the state.
At Health Care for the Homeless, we believe in treating addiction as a public health issue, not as a criminal matter. Meeting people where they are and working side-by-side with them are cornerstones of our successful work. We can’t force people to recover from addiction, just as we can’t force recovery from hypertension, diabetes or any chronic disease. But we can offer programs that meet people who use drugs with the compassion that any of us need to battle a serious illness.
The most successful interventions to longstanding problems are initially met with skepticism or outright opposition — but are later embraced when the outcomes are too promising to ignore. When they were first introduced, free syringe exchange and naloxone were revolutionary and controversial concepts. People argued that they would increase drug use, but instead they have saved lives.
Will overdose prevention sites entirely end overdose deaths in Maryland? Of course not. Will they end homelessness? Only housing can do that. But these important measures under consideration in Annapolis would provide additional evidence-based tools to reduce premature death and promote access to treatment for our neighbors with addiction — housed and homeless. Maryland should adopt them in pursuit of stronger communities in which we all can live.
Kevin Lindamood (firstname.lastname@example.org) is president and CEO of Health Care for the Homeless.