What Are Supervised Injection Facilities?
Supervised injection facilities are locations where drug users can safely inject drugs under clinical supervision. The purpose of such facilities is to provide a haven from overdose risk and to also give users counseling that may ultimately lead them to overcome their use.
Also known as safe injection sites, these locations are intended to reduce the health and public disorder issues connected with public injection. Safe injection sites don’t provide the users with the drugs that they will inject. They instead offer a hygienic environment with trained medical personnel who can intervene in the process in various ways.
There are around 100 of these facilities operating in 66 cities in nine countries around the world. In the United States, the idea is now being slowly implemented.
What Is Harm Reduction?
A safe injection site is a type of program that utilizes “harm reduction” policies. Harm reduction policies aim to diminish the negative social and physical consequences connected with certain human behaviors. Harm reduction practices are used in connection with drug use and sexual activity.
Evaluative Research
In the late 1990s, there were several studies done on supervised injection facilities in Germany, Switzerland, and the Netherlands. Reviews concluded that these sites improved public and client health and reduced public nuisances. It was decided that these studies were a good start. However, more research needed to be done.
Researchers in in Australia and Canada took a closer look. The results of this research are rather complex. However, reviewers of the research have claimed that the results of the harm reduction policies have been very positive. The following positive impacts of these supervised injection sites have been noted in the research:
- There has been increased uptake of those into addiction treatment. This is particularly the case among people who distrust the treatment system as these individuals are unlikely to pursue treatment on their own.
- There has been diminished public disorder, reduced public injecting, and heightened public safety.
- The sites have attracted and retained a high-risk population of individuals who inject drugs. They are also at a heightened risk for infectious diseases and overdoses.
- The sites have reduced HIV and hepatitis C risk behavior. This includes needle sharing and unsafe sex.
- There has been a reduction of the prevalence and harms of bacterial infections.
- There has been a reduced cost for medical services needed to treat users.
- There has been better education about safe injecting practices.
- There was no increase in community drug use.
- There was no increase in initiation into injection drug use.
- There was no increase in drug-related crime.
- There was an increase in the delivery of medical and social services.
San Francisco
The city of San Francisco created a task force that would investigate the efficacy of such a program. They found that it would be a good idea, so in February of 2018, the Department of Public Health voted unanimously to support the establishment of safe injection sites. Users will have access to a sanitary location, hygiene supplies, trained staff, and needle disposal boxes. Counseling will also be available.
There are an estimated 22,000 IV drug users in the city. The idea is that more than one center will be opened up to cover the entire territory. City officials want the locations to be readily available to users. According to public health officials, 85 percent of the city’s drug users are expected to use the sites. This could save the city up to $3.5 million in medical costs.
Seattle
In 2016, city officials in Seattle formulated an opioid task force to combat the drug epidemic. One of the recommendations of the task force was to open a safe injection site. Despite the original intentions, there still is no site.
Advocates of the plan in Seattle say that there is a powerful lesson in all this for the city of Philadelphia. The truth is that the number of overdoses continues to rise, and this policy is a possible way of dealing with the situation.
Philadelphia
Officials in Philadelphia decided to implement a similar safe injection site plan in an organized way. They are still not sure of where the exact location will be, but a Center City location might be feasible due to the crime rate there. In addition to Center City, the Kensington neighborhood is another possible location for a safe injection site.
The overdose problem in Philadelphia is rather severe. It was projected that in 2016, overdoses would surpass the murder rate by three to one. The crisis took an estimated 1,200 lives in 2017, which was quadruple the murder rate. This is the highest overdose death rate of any major U.S. city.
The planned sites in Philadelphia will not be operated by the government. Instead, the city will encourage private organizations to assume the role. The city is going to call these sites Comprehensive User Engagement Sites.
City officials spent time researching and debating the idea of supervised injection facilities. They visited a site in Vancouver and sought a report on research gathered in Canada and Europe. The conclusion was that a single site could save 25 to 75 lives a year. Also, millions of dollars in medical costs could be saved. Government officials also anticipate that there will be diminished public injection of drugs and other types of social problems.
What Is the Scope of Harm Reduction Practices?
Safe injection sites are not the only harm reduction practices that are available. Below are some of the other types of practices currently in use.
Needle and Syringe Programs
These programs aim to provide sanitary drug administration equipment to people who use drugs intravenously. They have been strongly proven to prevent and control HIV and other types of infections. There are different kinds of needle and syringe programs. Some sites are fixed, and some are mobile. Some programs work through pharmacies and some through vending machines.
Route-Transition Interventions
These interventions attempt to stop transitions to more dangerous methods of taking drugs. For instance, while still bad, smoking heroin is preferable to injecting it.
Opioid Substitution Therapy
This therapy gives opioid medicines to people struggling with addiction under medical supervision. OST aids the reduction or discontinuation of drug injection. OST also diminishes the risk of contracting illnesses, and it reduces the risk of overdose. Two of the substances used are methadone and buprenorphine. Sometimes, morphine or codeine is used.
Overdose Prevention
Overdose prevention can be facilitated through education and outreach. Some first-aid training often helps. Naloxone is a drug that can be used in case of overdose.
Outreach and Education Programs
Education and outreach programs can help the user acknowledge their problem and gain access to services of various kinds.
Access to Legal Aid
Access to legal aid can also help drug users. This includes getting users access to housing, health, and social services.
Understanding Harm Reduction
To comprehend the deeper philosophy behind the policy of establishing safe injection sites, it’s important to understand the basic principles of harm reduction. Not everyone agrees with this approach.
The basic definition of harm reduction is as follows: Harm reduction is a group of strategies and ideas targeted at diminishing negative consequences associated with drug use. It is also a movement for social justice based upon a belief in the rights of people who use drugs.
Harm reduction utilizes a set of strategies that deal with drug users “where they’re at.” Since harm reduction implements interventions and practices that aim to serve individual and community needs, there is no hard and fast formula for what shape harm reduction will take. However, there are some principles that are central to harm reduction practices:
- Harm reduction accepts that drug use is a fact of life. It is better to deal with its harmful effects rather than ignore or condemn them.
- It conceives of drug use as a multifaceted phenomenon that includes different behaviors that range from severe abuse to abstinence. It considers some ways of using drugs to be safer than others.
- It considers the quality of life to be the aim of successful interventions and practices. Cessation of drug use is not the absolute goal.
- Harm reduction demands that provision of services and resources to people who use drugs be offered without judgment and coercion.
- It demands that drug users are ensured a real voice in the development of programs and policies designed to serve them.
- It makes the drug users themselves the primary agents in diminishing the harm of their drug use.
- It realizes that factors such as poverty, class, racism, and other social inequalities affect people’s ability to deal with their situation.
- Harm reduction does not try to minimize or ignore the damage and danger associated with drug use.
The underlying philosophy of harm reduction focuses both on the problem of the user and their rights as a human to be treated fairly and given control over their life.
The Benefits of Harm Reduction Approaches
Historically, addiction treatment has focused on an abstinence model. In the abstinence model, nothing is acceptable short of abstaining completely from the drug. Twelve-step programs accept this as a basic principle. However, more recently, programs that center on harm reduction have been developed.
It is for good reason that this change is occurring. Many hold that offering approaches to treatment that are not focused on abstinence are good for the community for the following reasons.
1. More People Will Enter Treatment
The stigma of disclosing that you are an addict keeps many people from pursuing treatment at all. By offering an alternative to the 12-step or abstinence-based approach, it is possible that more people will pursue help. Also, therapies such as methadone maintenance offer a user an easier first step to trying to resolve their addiction.
2. Prevention Will Be More Focused
Harm reduction approaches can aid people in moderating their consumption before they become addicted. This may stop new cases of addiction. Also, programs that prevent the spread of disease can create safer communities.
The harm reduction approach, embodied in the policy of creating safe injection sites, shows much promise with respect to helping control the drug epidemic. Cities like Philadelphia are taking the lead on developing this new policy. While it is important to make sure that these programs are implemented carefully, the truth is that people are dying of overdoses every day in cities like Philadelphia. The hope is that all of the details will properly fall into place, and the policy will take hold across the country.
