Marlys McConnell spends every Sunday roaming the streets in Seattle, Washington. She carries with her needles, a tea candle to use as a cooker, cotton balls to act as filters, and a band to function as a tourniquet.
Marlys McConnell does not use heroin. However, her son Andrew did. The two were supposed to see a movie on the day he overdosed alone in a bathroom. McConnell spends every Sunday on the streets in Seattle, Washington distributing supplies to help reduce harm to people dealing with addiction.
A safe injection site (SIS) is a government-approved facility where individuals can safely inject themselves with opioids. They have been productive in other countries around the globe. The first government-approved SIS was founded in Berne, Switzerland in 1986.
Subsequently, the first set of safe injection facilities initiated in Europe in the 1990s were studied extensively and produced enough favorable results to justify their continuation. A notable conclusion of one major study from the European Monitoring Centre for Drugs and Drug Addiction was that safe injection sites “contributed to improved public and client health and reductions in public nuisance.” Thus, safe injection sites not only help their users but the public at large.
Closer to home and more similar in culture, safe injection sites are beginning to be approved in Canada. In 2013, a needs assessment concluded that Toronto needed three to five supervised injection facilities.
Injections are monitored by both a nurse and a harm reduction volunteer who has experience using drugs and medically important knowledge about the drugs people use and the language used to describe the narcotics.
The aforementioned medical professionals are able to help save the lives of those who might otherwise overdose on opioids. Around 42,249 Americans died from opioids in 2016, making overdose the leading cause of accidental death in the United States.
At Insite, a safe injection site in Vancouver, Canada, the drug Naloxone has been implemented to reverse over 6,000 overdoses, thus saving that many lives. This equates to 88 fewer overdose deaths per 100,000 people per year.
Additionally, 6 to 57 HIV infections, a disease which will eventually kill its carriers without treatment, per year were prevented by the safe injection sites in Vancouver.
Fewer ambulance calls for treating overdoses are also made due to safe injection sites. Approximately 67 percent fewer ambulance calls for opioid overdoses were made in one area that has a safe injection site. In an area near another SIS, average monthly ambulance calls with naloxone treatment for suspected opioid overdose decreased from 27 to 9.
Aside from the positive health associations, having fewer ambulance calls is more cost effective and saves lives, provides less of a strain on already limited resources, and allows ambulance services to be used in a more equitable way.
Safe injection sites also help save lives of individuals who otherwise may not be able to help themselves. According to Bernadette Pauly, an associate professor at the University of Victoria school of nursing, “Addiction is not a life choice. Addiction is a health issue. Supervised injection is among the most researched public health interventions, and the evidence is overwhelming: it reduces infection rates and prevents overdoses and engages people in health care.”
Justice Ian Pitfield, of the Supreme Court of British Columbia, determined that peer-reviewed data in studies of Insite support the “incontrovertible” conclusions that “drug addiction is an illness.” He also concluded that “the risk of morbidity and mortality associated with addiction and injection is ameliorated by injection in the presence of qualified health professionals.” Without implementing safe injection sites, we leave people to battle addiction alone.
While the evidence for legalizing safe injection sites is overwhelming, there are still critics. The argument is sometimes made that safe injection sites don’t encourage cessation of opioid use. Massachusetts governor Charlie Baker even went as far as claiming there is “virtually no evidence that [safe injection sites] lead people into treatment.” This, however, is simply not the case.
One study found that over two years, with approximately 900 participants, 23% experienced an incidence of cessation and 60% entered treatment. Another study found that Insite users are 30-35% more likely to access detoxification than individuals who do not visit an SIS.
Another argument that is often made is that safe injection sites are not economically friendly. But, that is not true. A study found that in San Francisco, for each dollar spent on an SIS, $2.33 will be saved. This results in a net savings of $3.5 million each year per SIS.
Another report documented that the cost per HIV infection averted in Toronto due to having a safe injection site was $323,496 and $66,358 in Ottawa. The cost averted per Hepatitis C infection was $47,489 in Toronto and $18,591 in Ottawa. We must also decide, however, if cost should even be considered when it comes to saving lives. How much is a life worth, and who gets to determine this?
In summary, safe injection sites provide critical care and a safe environment for individuals who are addicted to opioids. They have been effectively implemented elsewhere in the world and have saved lives. They are cost-effective and provide an opportunity for treatment. It is now the time to afford this opportunity to every individual struggling with addiction by legalizing safe-injection sites in the United States.