A place to legally inject heroin – does this really exist?
Injection drug use presents a special challenge for public health – those who inject drugs become severely addicted, often avoid the health care system, and are at high risk for multiple negative health outcomes, including infection, overdose and death. Some solutions fall under the umbrella of harm reduction, a set of strategies targeted at reducing the negative consequences associated with drug addiction. One harm-reduction approach being considered is called a supervised injection facility (SIF) – a legally sanctioned setting where individuals can inject previously obtained drugs (such as heroin and other opioids) under medical supervision. Individuals utilizing SIFs have access to sterile equipment, receive health care and counseling, and have the opportunity to connect to social services and addiction treatment.
SIFs are far from a new idea. In fact, outside of the U.S. there are nearly 100 operating SIFs throughout Canada, Australia and Europe. Research suggests SIFs may engage marginalized and hard to reach addicted individuals and provide numerous positive health and community benefits including:
- Limiting the spread of HIV/AIDS and Hepatitis C
- Reducing prevalence of bacterial infections
- Increasing access to and utilization of drug treatment services
- Improving community safety by reducing the amount of publicly discarded needles
- Managing overdose and reducing death rates
- Cost savings from reduced disease and emergency medical services
Research supports that SIFs achieve these results while not increasing:
- Community drug use
- Initiation into injection drug use by non-users
- Drug-related crime
And yet, SIFs remain nonexistent and largely taboo in the U.S. Reminiscent of early debates against needle exchange programs, many argue SIFs will do little to help people who inject drugs. Some go further and argue SIFs may enable injection drug users, lessen the likelihood that they will seek treatment, and instead normalize injection drug use.
In addition to the cultural resistance to SIFs, there may be legal barriers to operating them in the U.S. While individual states have the clear legal authority to authorize SIFs, federal law appears to prohibit them, making them vulnerable to prosecution. Section 856 of the Controlled Substances Act prohibits anyone from maintaining or managing a facility for the purpose of unlawfully using a controlled substance, which could apply to SIFs. Additionally, Section 844 of the act prohibits drug possession and would apply to any individuals utilizing SIFs as a safe place to inject drugs. However, the act could also be used by federal law enforcement to target syringe exchange programs, yet these programs now seem to be better tolerated across the U.S.
Politicians and legislators in several states including New York, California, Massachusetts and Washington are advocating for SIFs to confront startling overdose rates and other drug related harms. Forging the way to the first U.S. SIF is Ithaca, NY, where Mayor Svante Myrick has developed a comprehensive strategy alongside treatment specialists, doctors, members of law enforcement and others, titled “The Ithaca Plan.” This 58-page plan includes an outline with services for housing, education, job training, restructuring the criminal justice system and government approved locations for drug users to safely use injection drugs. Linda Rosenthal, chair of the State Assembly committee on Alcoholism and Drug Addiction has thrown support behind SIFs and promised to submit legislation to make them legal in New York, but resistance from government and some community members continues to hinder the progress of establishing the first SIF in the U.S.
With the continuing escalation of the opioid epidemic, it’s time for the U.S. to re-consider its resistance to harm reduction strategies, like SIFs, and to let evidence dictate which interventions are most likely to make an impact. By opposing SIFs in the U.S. we are missing a valuable opportunity to determine if the positive and lifesaving benefits of SIFs seen in other countries around the world can be replicated. Rigorous evaluation should decide if U.S. SIFs can reduce the morbidity and mortality of addiction.
Nicole is a Research Assistant at Center on Addiction