By Dane O’Leary
When it comes to recovery, there’s a common assumption that the only effective way to overcome our nation’s addiction crisis is to encourage drug users to complete a series of clinical rehabilitative treatments. While most experts agree that addiction treatment programs afford the best chances for an individual to achieve lasting sobriety, there are many other types of recovery resources available to help address chemical dependency, from recovery fellowships and support groups to medication-assisted treatment and a slew of options in between. However, the inherent difficulty of offering a variety of options is that, since many of these resources deviate from a more traditional clinical model of recovery, they’re often assumed to be inferior or perhaps even dangerous, which has long been the case for most harm-reduction strategies.
But the times seem to be changing on that front. Rates of addiction and overdose deaths are higher than they’ve ever been, and this has encouraged a number of people to look outside the proverbial box for possible solutions. Of course, we’ve had to make peace with the fact that addressing the opioid crisis is going to take time, so the question becomes whether there are ways to mitigate the collateral damage. Suddenly, harm-reduction strategies are seeming more reasonable and perhaps even viable with new legislation forcing us to consider whether a pilot program for supervised injection sites in Southern California — which would be the first supervised injection sites to ever be offered in the United States — might actually do more good than harm.
What Is Supervised Injection?
Although supervised injection would be new for Americans, it’s not the most novel concept in Europe. The first professionally-staffed injection site was opened in the Netherlands in the 1970s. Since then, it has spread to a number of other countries, including Australia, Spain, Germany and Switzerland.1 What separates supervised injection from other recovery resources is that these aren’t actually programs that help individuals get sober. Rather, supervised injection sites provide intravenous drug users with a clean, safe environment in which to administer their drugs, providing assistance to minimize the chances of injury as well as clean supplies and syringes to mitigate the transmission of illnesses between drug users.
Does It Actually Work?
On the surface, supervised injection might seem counterproductive. Wouldn’t providing a safe environment and fresh supplies to intravenous drug users encourage them to continue using drugs? While it might appear that way, research has shown that’s not always the case.
For one thing, individuals who intend to administer intravenous drugs are likely to do so whether there are supervised injection sites available to them or not. But if supervised injection sites are available, there will be significantly lower chances of accidents, including overdoses, transmission of diseases and personal injuries. In Toronto, Canada, there has been a 35-percent decrease in overdose deaths since the opening of Insite, currently the only supervised injection site in North America (although the Canadian government has plans to open other locations due to the success of the program).2 Moreover, with between 600 and 900 individuals visiting the facility each day, there has been a significant decrease in disease transmission in Toronto, amounting to savings of roughly $6 million due to there being less need for medical care for diseases like HIV and AIDS.
Another issue that supervised injection addresses is the increasing frequency with which heroin is found to have dangerous and even fatal additives.3 For drug users who are unsure about the quality or contents of the drug they’ve bought on the street, visiting a supervised injection site can offer peace of mind since there’s staff members available to intervene in the event that the individual overdoses.
Assembly Bill 186
There have been rumblings regarding possible legislation that would bring supervised injection to California for a number of months, but it’s only recently become a reality. The bill — known as Assembly Bill 186, or AB-186 for short — is sponsored by the Drug Policy Alliance as well as numerous other organizations and AIDS prevention groups. If passed, the bill would facilitate a pilot supervised injection program with locations allowed in a limited number of cities and counties, including Los Angeles, San Francisco, Fresno and Santa Cruz.4 These locations would be supported and sanctioned by the California government, allowing individuals aged 18 or older to administer drugs in the confines of the facilities without fear of prosecution for possession of illicit substances or paraphernalia.
Regarding the possible legislation, those who are against it have a number of valid concerns. They often see the opening supervised injection sites as being tantamount to endorsing “opium dens” or legalizing “shooting galleries.”5 There’s also the view that this harm-reduction strategy would be like waving a white flag and admitting defeat to the opioid crisis. Further, in spite of what research has shown, there’s worry that these sites would provide no real benefit to the surrounding communities. As well, there’s concern that supervised injection sites will require a reallocation of government funding that could’ve been put toward other rehabilitation efforts.
In addition to the practical benefits of supervised injection, one of the most arresting arguments in support of the bill is that, with drug overdose being the leading cause of preventable death, clinical treatment programs are no longer enough to mitigate the effects of the opioid crisis. Between 2014 and 2015, overdose deaths increased by 16 percent.6 To supporters of AB-186, this shows that we cannot continue to rely solely on rehabilitation to solve the opioid epidemic and reduce the annual overdose death rate.
California legislators will put the bill to a vote this summer, but is it likely to pass? At this point, it’s difficult to say. There have been numerous attempts to bring supervised injection to the U.S. in the past and each of them failed, so there’s precedent for the current bill to fail. On the other hand, with opioids currently creating the worse drug crisis we have ever faced, there’s potential for California lawmakers to consider this alternative approach, especially since the bill would only allow a number of test sites in a limited number of counties that are experiencing some of the highest overdose rates in the region.
Aside from decreasing the risk of overdose and transmission of diseases, supervised injection sites can also offer placement services to individuals who are ready to seek help for their drug addictions. In other words, if this landmark bill is approved, these supervised injection sites could double as recovery access points.
1 “Supervised Injection Facilities.” Drug Policy Alliance.
2 Marshall, Brandon D.L., Milloy, M.J., Wood, Evan, Montaner, Julio M.G., & Kerr, Thomas. “Reduction in overdose mortality after the opening of North America’s first medically supervised safer injection facility: a retrospective population-based study.” The Lancet.
3 Folley, Katherine E. “Drug dealers are lacing heroin with elephant tranquilizers over 5,000 times stronger than morphine.” Quartz.
4 “AB-186 Controlled substances: safer drug consumption program.” California Legislative Information.
5 “Safe injection centers are not opium dens.” The Los Angeles Times.
6 Rudd, Rose. A., Seth, Puja, David, Felicita, Scholl, Lawrence. “Increases in Drug and Opioid-Involved Overdose Deaths —United States, 2010-2015.” Centers for Disease Control and Prevention.