In response to the increasingly deadly opioid crisis, several cities across the United States are considering implementing legally sanctioned safe injection sites, where people can inject illegal drugs under medical supervision. Lawmakers in cities like Seattle, San Francisco, New York City and Philadelphia are hopeful that these facilities — which are also known as supervised consumption sites, among other things — will help curb the record number of fatal overdoses from injecting heroin, fentanyl and other powerful, and often illegal, drugs. While there is evidence that safe injection sites are effective at saving lives, this week, the Department of Justice vowed to crack down on any city that opens one on grounds that they would be violating federal law.
“I’m not aware of any valid basis for the argument that you can engage in criminal activity as long as you do it in the presence of someone with a medical [license],” U.S. Deputy Attorney General Rod Rosenstein said in an interview with NPR.
According to the CDC, more than 72,000 Americans died from fatal overdoses last year, a third of which were linked to opiates; according to NPR, that’s more than any single year total during the AIDS crisis. Philadelphia Health Commissioner Dr. Thomas Farley said that just as controversial needle-exchange programs proved essential to slowing the spread of HIV, “likewise, now, we know there are a lot of needless death from drug overdoses and we know we can save lives because the evidence is clear that these facilities save lives.”
While the research is still too preliminary to reach solid conclusions, the studies that have been conducted thus far indicate that supervised injection sites help reduce fatal overdoses. The American Medical Association has endorsed launching supervised injection site pilot programs, and advocates have argued that the facilities also help curb the spread of infectious diseases and have been effective at getting people into addiction treatment.
However, Rosenstein believes the facilities do more harm than good. “This is not a disease that gets spread like the flu,” Rosenstein told NPR. “People can only become addicted if they have access to these illegal drugs. And so if we can prevent that access, we can prevent the addiction.”
Rosenstein’s argument ignores how prescription opiates have contributed to the current crisis. According to the CDC, in 2016, nearly half of all overdose deaths were from prescription opiates like Methadone, Oxycodone and Hydrocodone. The massive increase in the use of prescription and non-prescription opioid drugs is complex and multifaceted, but the start of the surge can be traced back to the mid-1990s, when Purdue Pharma debuted a reformulated version of oxycodone called Oxycontin, which had an FDA-approved abuse-resistant label. Purdue Pharma incentivized their salesforce to market the drug to doctors and hospitals as having a 1 percent risk of addiction.
However, OxyContin was easy to abuse, as the drug’s controlled-release formula could be overcome by simply by crushing the tablets into a powder which could then be ingested orally, inhaled or injected — and Purdue Pharma knew it too, as their own private tests in 1995 had shown that 68 percent of the oxycodone in an OxyContin tablet could be extracted when crushed. In 2007, Pursue Pharma pleaded guilty to making false claims about the risk of drug abuse associated with oxycodone, and agreed to pay $600 million in fines. Three years later, they reformulated OxyContin to include polymer, so the tablets were much more difficult to crush or dissolve in water. By then, opiate abuse had become an epidemic.
“If local governments get in the business of facilitating drug use … they’re actually inviting people to bring these illegal drugs into their places of business,” Rosenstein told NPR. “If you start down that road, you’re really going to undermine the deterrent message that I think is so important in order to prevent people from becoming addicted in the future.”
Rosenstein is wrong to suggest that opiate addiction begins with access to illegal drugs like heroin and can be best prevented through a message of deterrence; quite the opposite, in fact, as the National Institute on Drug Abuse has found that 80 percent of heroin addicts initially began by abusing prescription opiates, and then turned to heroin because it’s cheaper and easier to acquire on the black market. To refuse to deal with that reality by vilifying harm-reduction efforts simplistically, erroneously and dangerously treats opiate addiction as a criminal matter rather than a health and public safety crisis.
“Nobody likes the idea of watching someone who is addicted just inject drugs. We want to get all of those people into treatment, but we all have to recognize that, despite all of our efforts, many people are not going to drug treatment,” Farley told NPR. He hopes that the DOJ’s threats of a crackdown don’t deter opiate users from coming to safe injection sites once they open.
“If the message is clear that, if you walk in this facility you’re going to be arrested, people wouldn’t be using that,” Farley said. “But that is not what is happened currently with syringe exchange, and that’s the sort of accommodation we hope we can set up with an overdose prevention site. … In a crisis like thus, with this many people dying as we have, it’s worth a try.”