Annual opioid fatalities have now surpassed the yearly number of deaths from AIDS at the height of that epidemic in the mid-1990s. In 2016 drug overdose deaths numbered 63,000, more than the U.S. death toll from the entire Vietnam War. The trend is terrifying: the problem is getting worse each year.
Cities and states reeling from opioid deaths need to give serious consideration to setting up safe injection rooms, which could significantly reduce fatalities. These are places where a drug user can go to consume illegal drugs under the supervision of health workers. They have been used in Europe, Canada and Australia for decades, and evidence and experience have shown that they are very effective. This may not seem like an obvious way to fight an abuse epidemic, but few other options exist. In the U.S., many cities' efforts to establish such sites have stalled, but now multiple cities have plans to open the country's first officially sanctioned injection sites. Philadelphia expects to do so in 2019. San Francisco, too, hopes to overcome legal and siting obstacles and open its first facilities this year. New York City's mayor has also endorsed setting up multiple sites at current needle-exchange programs.
Misuse of prescription opioids such as OxyContin is inextricably linked with that of street drugs such as heroin. Nearly half of young people who inject heroin started by abusing prescription drugs. Then they turned to the cheaper, more readily available alternative. The path from pills to needles has meant that U.S. deaths from heroin have increased by a factor of five since 2010, topping 15,000 people in 2016. And the toll is continuing to climb as people overdose on heroin laced with fentanyl, a synthetic opioid that makes heroin much more potent—and much deadlier.
That is where safe injection sites come in. If someone overdoses at one of more than 90 such locations in Europe and elsewhere, a health worker or other first responder quickly administers an antidote. The facilities have also proved they can reduce the transmission of blood-borne infections, partly through needle exchanges. Moreover, they can save money: in San Francisco, for example, one analysis concluded that for every dollar spent on supervised sites, $2.33 in emergency medical, law enforcement and other costs would be reduced, producing a yearly net savings of $3.5 million.
The evidence for increased safety is compelling. At Insite in Vancouver, B.C., there was a 35 percent reduction in fatal overdoses in the area around the facility, compared with a 9.3 percent reduction in other parts of the city that may have had other interventions. People who used Insite were also much less likely to share needles than those who shot up in unsupervised places. And of the 8,040 people who visited the facility in 2016, 517 were referred to addiction treatment, and more than a third of them completed it.
Critics argue, correctly, that injection sites are not a perfect solution. Our country also needs more drug-treatment beds and counseling options; medication assistance to help with drug withdrawal; and other evidence-based care to alleviate the crisis. Safe sites also work best in places where drug use is centralized, such as in specific urban neighborhoods rather than rural areas. And of course, they are controversial because they require officials to tacitly accept illegal drug use.
That is why no American city has yet cleared the necessary hurdles to proceed with establishing an injection site. In addition to San Francisco and Philadelphia, Denver has considered this option. Seattle, too, has called for two safe consumption rooms and has even set aside funds to support them, but its effort has been mired in legal battles. Federal law currently makes it illegal to use nonprescribed opiates and opioids, so Philadelphia officials have said they would not fund or operate such a facility. They would instead encourage private efforts to open one—which would perhaps provide slightly more legal distance than if they were to finance and manage it themselves. Still, the U.S. Department of Justice could choose to prosecute the city for endorsing the move.
But if a site in Philadelphia, San Francisco or elsewhere does get off the ground, it could at last pave the way for other cities to follow suit, giving communities new hope that the rising death toll from the opioid crisis might finally begin to recede.