The Health 202: Some cities want to open supervised injection facilities

By Paulina Firozi, The Washington Post

Several major cities are trying to open "safe injection sites" for drug abusers - even though they are technically illegal.

With recent evidence that these sites can save lives and money, cities including San Francisco, Seattle and Philadelphia are considering opening public health facilities where people who acquired illegal drugs can inject them under the supervision of trained health-care providers.

They would be the first U.S. cities to adopt such an approach to combat the sweeping opioid epidemic, which has recently gained attention from the White House, Congress and policymakers across the country.

"While overdose deaths aren't new, the scale of them is new . . . and that's leading a lot of communities to look for different solutions, to look for something new that hasn't been tried," said Laura Thomas, deputy California state director for the Drug Policy Alliance.

San Francisco's Department of Public Health says it expects to open its first sites as early as this summer, but is still working out the legal issues and location details. In King County in Washington, which includes Seattle, a task force recommended opening sites as part of a 2016 list of recommendations for combating addiction, and the county's Board of Health unanimously voted last year to endorse opening two sites.

And in Philadelphia, city officials announced in January they want the private sector to develop such a facility, and have since hosted community forums to seek public feedback on the plans.

Outside the United States, these sites are gaining tractionas a way to combat drug abuse. There are about 100 sanctioned sites that have opened in 11 countries, according to one expert, mostly in Europe as well as in Australia and Canada.

The facilities don't provide illicit drugs, but provide a space for people to use drugs with sterile instruments and under supervision. Trained health-care workers are also available to administer opioid antidotes if users exhibit signs of an overdose, and can also offer information about long-term treatment.

In the United States, however, the federal government is against the opening of these facilities, and concerns about abuse of the law and community pushback in some cities has stalled them from getting off the ground.

Drug Enforcement Administration spokesman Melvin Patterson said the facilities violate the federal Controlled Substances Act and are "subject to being prosecuted." Patrick Trainor, a special agent with the DEA in Philadelphia, said these facilities are a nonstarter. "I don't think it should come as a real surprise, but no, coming from the DEA perspective, we're not in favor or don't support them," he said.

But experts who have been observing and studying injection sites say they see a lot of positives to supervised drug use.

Alex Kral, an epidemiologist for the nonprofit research group RTI International, said the sites can decrease drug users' risk of infections from HIV and hepatitis, reduce overdose fatalities and connect users with resources such as drug treatment programs or social services. They can also reduce the number of people injecting in public and ensure needles are properly disposed, he said.

What's more, he said, "We don't see a lot of negative aspects" to the sites. "It's surprising. As a researcher I'm interested in both the positive and the negative. And I haven't seen a lot or heard of a lot of negative components."

Kral's research has found supervised injection facilities would save money, too. In a study that looked at the cost effectiveness of opening a facility in San Francisco, he found a single 13-booth facility would lead to $3.5 million in net annual savings for the city.

Henry L. Dorkin, president of the Massachusetts Medical Society, said he was initially skeptical about supporting a facility that enables drug use, but changed his mind after looking at the research.

"The bottom line was these people already had these drugs and they were already going to inject them," Dorkin said. "The only thing that's being facilitated is saving their lives, and at the same time, making available to them rehabilitation facilities and people who wouldn't be available down that proverbial dark alley where they would normally shoot up."

Thomas, from the Drug Policy Alliance,argued drug users "want these programs."

"They don't like having to inject in public; that's very much a last resort for people," she said. "If we could have these programs, it would give people a little bit of safety and belonging and respect, which is often what people need in order to stabilize their lives and make changes in their lives."

But state and local lawmakers are divided over supervised injection sites, given they're a relatively new idea. Some are worried that law enforcement, both at the local and federal level, would come after those involved with the sites. And in some cities, residents have expressed fears that a site might cause trouble in their neighborhood.

"There's still a lot of stigma, there's still a lot of questions about legality of it. And I think that's one of the things people are worried about - potential liability," Kral said.

California State Sen. Scott Wiener said he wants the sites opened "yesterday." Wiener, a Democrat, is working on a bill he hopes would remove some of the obstacles by authorizing certain counties in the state - including San Francisco and Los Angeles - to pilot a program.

"Obviously we can't control federal law, but we can remove state barriers," Wiener said.

He's partnering with Democratic Assemblywoman Susan Eggman, who worked to pass the bill through the state Assembly. But it has stalled in the state Senate, two votes shy of passing. But Wiener feels the state should move forward even without authorization from the legislature.

Read the full story here: https://www.sfgate.com/news/article/The-Health-202-Some-cities-want-to-…