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Safe consumption sites save lives

State Del. Dan K. Morhaim, a Baltimore County Democrat, has championed safe injection sites in Maryland.
State Del. Dan K. Morhaim, a Baltimore County Democrat, has championed safe injection sites in Maryland. (Steve Ruark / Baltimore Sun Media Group)

In the last decade, deaths from opioids have quadrupled in Maryland. We now have the fifth highest rate of overdose deaths in America. And despite a State of Emergency declared in early 2017, that year is among the worst on record for intoxication deaths.These facts were presented again and again during House and Senate hearings on bills that would bring a tested solution to Maryland — allowing sites where people could use drugs under medical supervision. The logic for this model is simple: If someone overdoses, they can be immediately treated. Having seen the impact of supervised consumption sites first-hand as a physician in Canada, home of the first such sites in North America, I testified as well.

There was wide support for these bills. The House version had 31 sponsors — that's a fifth of all delegates. By my count, 17 people testified in support during the House hearing, 14 during the Senate hearing. There was no opposition that I'm aware of.

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Those who testified were proud to know that we had been heard; the bill was voted favorably in the Senate Finance committee, putting it on path to be debated on the Senate floor. However, a week later we were left confused when a private "reconsideration" vote was held, reversing the decision and effectively killing both bills without any public justification for doing so.

Johns Hopkins Bloomberg School of Public Health researchers have recommended that Baltimore open two facilities that provide people a safe place to do drugs and help prevent fatal overdoses. In a report published and commissioned by the non-profit Abell Foundation, the researchers suggest opening one facility on the east side of the city and the other on the west.

It's obvious to me why the original vote was favorable. Supervised consumption sites have been shown not only to save lives but also to reduce the spread of HIV and hepatitis and increase referrals to treatment, and to be cost-effective by decreasing health care costs. A single site in Baltimore is predicted, every year, to save six people, prevent four HIV and 21 hepatitis C infections, bring 121 people into treatment and generate $7.8 million in savings.

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The bills did not force the creation of these sites and did not request government funding. They only authorized a process for community-based organizations to apply and establish such a site. Applications would be intensely vetted by the Maryland Department of Health and local health departments.

As for the reconsideration vote, I can only speculate as to why this occurred and why some senators changed their votes so the final tally went from six out of 11 senators voting the bill favorable to nine voting it unfavorable. No minutes are accessible, and a request to the committee for information was ignored.

Maryland drug legislation to be introduced Friday would provide treatment on demand in emergency rooms; create drug-use facilities, allow doctors to use pharmaceutical grade opioids, including heroin, to treat a small group of users and decriminalizes the possession and use of very small quantities of drugs.

Likely the discomfort with the idea of "allowing" people to use drugs played a part. To be honest, I was skeptical at first as well, as most people are after being fed "tough on crime" and "just say no" rhetoric for years. Spending time at Canada's sites and with the clients taught me three things that completely changed my mind.

First, people don't start using drugs because they have access to a supervised consumption site. That would be like saying people only start driving because they have access to seatbelts. People will do both of these actions regardless, but we can provide measures to keep them safer while doing so. It's those who have suffered so much from their addiction that they have no choice but to inject in an alley that end up using the supervised sites.

Second, people aren't going to supervised consumption sites to party; they go to treat their withdrawal, in a monitored setting. A heroin user once told me that he doesn't use to "get high" anymore, but to "get normal." The longer one suffers from an addiction, the less they use the drug for the good effects and instead to eliminate the bad. Life becomes a struggle against withdrawal.

Supervised Injection Facilities (SIFs), like those proposed in a bill sponsored by Del. Dan Morhaim, must be considered by Maryland. 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.

Third, it takes time for anyone with an addiction to be ready to quit — just ask any smoker. Except in this case, people will die before they are ready, and you can't go to treatment if you're dead. Supervised consumption sites not only keep people alive but also provide a link to treatment. For example, in Vancouver, 443 people who used the consumption site also accessed an adjacent detox program during fiscal year 2017- 2018.

With the retirement of Del. Dan Morhaim, who brought this bill forward three years in a row in the House, we'll need a new champion. I hope that will be Senate bill sponsor Brian Feldman. In the meantime, Baltimore will lag behind Seattle, San Francisco and Philadelphia where supervised consumption sites are being finalized.

Dr. Mike Benusic (mbenusic@gmail.com) is a physician and public health graduate student at Johns Hopkins.

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