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 there shows they are very effective. This may not seem like an obvious way to fight an abuse epidemic, but there are few other options. While in the U.S., many cities’ efforts to establish such sites have stalled, Philadelphia is now poised to open the country’s first officially sanctioned safe injection site.
The 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. The number of dead is continuing to climb as people overdose on heroin laced with fentanyl, a synthetic opioid that makes heroin much more potent—and thus more deadly.
That’s where safe injection sites would come in. At more than 90 such locations in Europe and elsewhere, if someone overdoses at one of these sites, a health worker or other first responder quickly administers an antidote. The injection facilities also have proved they can reduce the transmission of blood-borne infections, partly through needle-exchange programs. They can also save money: in San Francisco, for example, one analysis concluded that for every dollar spent on such 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, a safe-injection site in Vancouver, for example, 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 individuals who shot up in unsupervised places. And Insite helped get people clean. Of the 6,532 people who visited the facility in 2015, 464 were referred to addiction treatment, and more than half of them completed it.
Critics argue, correctly, that safe injection sites are not a perfect solution on their own. Our country 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. San Francisco and Denver are among the jurisdictions that have 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 providing slightly more legal distance than if they were to finance and manage it themselves. Still, the U.S. Department of Justice may choose to prosecute the city for supporting the move. (The Mayor’s office told Scientific American in a statement that “We’re aware of federal concerns but given the depth of the problem and the number of lives impacted, we need to be bold in our approach.”)
But the stakes are high. If this site does get off the ground, it could finally 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 reverse.