Few would dispute that the United States currently struggles against a growing drug problem. As the New England heroin epidemic rages on, opioid addiction rates continue rising across the country. In addition, law enforcement agencies and addiction treatment centers must now account for new threats such as dangerously potent synthetic drugs. As soon as we begin seeking solutions to one problem, it seems that another soon presents itself. Many fear that our nation may very well lose the war on drugs. Others feel that we have already lost. But some facilities now utilize a particularly controversial method of reducing the threat. They call them safe injection sites.
Safe injection sites go by many names, “shooting galleries” among the most derogatory. As implied by this pejorative, safe injection sites make it possible for heroin addicts to use their drug of choice without fear of infected needles. Providing clean, sterile needles, many supervised injection centers also manage instances of overdose. They focus on harm reduction rather than addiction treatment. Proponents of such sites reason that they cannot stop heroin addicts from abusing drugs, but that they can at least foster a life-saving environment to keep overdose rates from going up.
At the time of writing, you will not find safe injection sites anywhere in the United States. And if you do manage to track one down, you can rest assured that their operation is not legally sanctioned. In fact, Vancouver houses the only legal supervised injection facilities in North America. But some believe that this needs to change. As the opioid crisis continues taking lives while our government struggles to attain better treatment funding, many feel that harm reduction is the only option we have left.
Success at Reducing Harm
When people think of safe injection sites or clean needle exchanges, their primary concern is HIV or AIDS. Certainly, safe injection sites allow heroin users to engage in drug abuse without these concerns. One of Vancouver’s safe injection sites even resides within an AIDS treatment facility. By keeping AIDS patients from injecting drugs on the streets, they feel they can stop the spread of infected needles. Speaking in terms of demographics, there is no telling how many lives such a measure might save. This applies not only to habitual heroin users, but also to initiates who may not think to question the origins of the paraphernalia involved in their drug abuse.
Reactions to overdose depend upon the site in question. In Vancouver, medical professionals remain within close reach in case of overdose. But in some continents, only first responders to medical emergencies retain the right to administer Narcan to overdose victims. This is why an illegal pop-up site in Vancouver claimed overdose as the primary reason for their existence. As a volunteer told CBC News:
“Everybody is going full-tilt and it’s just not enough. People are dying. It’s just really shocking. Really what we are doing is illegal and we didn’t ask, but we are saving lives anyway.”
Proponents of safe injection sites also feel that such facilities may discourage crime. To be clear, most such sites will not allow the purchase or sale of illegal drugs. They only provide the needles and means to use them in a safe environment. But some proponents feel that safe injection sites put a damper on those who sell their drugs alongside paraphernalia. Instead of engaging in discussion with dealers who might sell infected needles, users acquire the drugs from one source before using it safely. Date on this issue tends to leave questions, an issue we intend to cover below.
In Vancouver, it costs approximately $3 million (CAD) per year to run a single injection site. The illegal pop-up site mentioned above estimates their costs at $150 per day. This translates to an estimated cost of $54,750 per year. In other words, illegal sites actually discover more cost-effectiveness in their methods than those approved by their local government. This presents an interesting dilemma, in which breaking the law may save lives more efficiently than following the letter of the law. As one can imagine, this only presents a fraction of the controversy behind safe injection sites.
Controversy and Criticisms
While safe injection sites present a possible solution to the spread of diseases such as HIV by providing clean needle exchanges, critics note that they may fail in presenting one other troublesome disease—the disease of addiction. When Seattle proposed the implementation of two safe injection sites, proponents argued that they could recommend treatment to users. In fact, supervised injection sites across the globe generally provide resources to help addicts stay clean. Nonetheless, critics remain justifiably skeptical that most users would elect to stay clean when provided a facility that allows them to shoot up with impunity.
Of course, the primary goal of supervised injection sites is to reduce overdose deaths. The site in Vancouver appears to have reduced overdose deaths in the surrounding neighborhood by at least 35%. But other sites, such as the Sydney MSIC, appear to yield no noticeable community impact whatsoever. Some research did return evidence of fewer heroin-related medical emergencies during the center’s hours of operation. This evidence remains a source for skepticism, however, it makes no mention of the increased police efforts shortly after the site’s opening. It does make sense that safe injection sites would reduce overdose rates, but claims to this effect currently rely on conflicting data from a relatively small sample size. One therefore cannot say with utmost certainty that such sites will reduce fatalities in the midst of the heroin epidemic. Furthermore, as noted on the blog Legal Insurrection:
“I have mixed feelings about such a location from a public policy perspective. The heroin scourge is real, I’m just not sure normalizing the use helps the problem.”
This public policy argument pertains not only to the points above, but the crime argument as well. The argument is that, concerning possible reductions in crime, safe injection sites present a flawed solution at best. Safe injection sites cannot provide users with drugs, only clean needles and supervised administration. Even if these facilities would allow for legally sanctioned use, the purchase and possession of heroin remains illegal. It does warrant mention that safe injection sites appear to cause no increase in local crime. Nonetheless, those who utilize safe injection sites must still break the law in pursuit of their drug of choice.
Local governments that try to authorize safe injection sites may find themselves on the wrong side of the law as well. One might recall the medical marijuana facilities raided by the federal government, despite being legal in California. Proposed safe injection sites in the United States would run a similar risk. When Mayor Svante Myrick of Ithaca desired to open a supervised injection site, he sought authorization from New York Governor Andrew Cuomo. And when NPR reminded him that he could try to open the site without authorization as long as it was not directly refused, he responded:
“We’ve no interest in putting time and money into something that will get shut down later.”
Safe injection sites already struggle with cost-effectiveness. Government officials in Canada feel that the $3 million used to operate the Vancouver facility should go toward treatment. Meanwhile, the Sydney MSIC in Australia costs enough to potentially fund four hundred treatment centers. Most likely, American sites would face the same struggle. Given that the federal government could simply choose to shut them down at any time, Myrick might be right. Safe injection sites seem like a good idea for many reasons, but the risk might easily outweigh any alleged benefits.
Verdict on Safe Injection Sites
It seems difficult to deny that safe injection sites wield the potential to save lives. Heroin users find in these facilities a place to use their drug of choice without fear of overdose or disease. And many sites will attempt to direct them toward treatment. Considering the potential for lower crime rates as well, one can certainly understand why so many people support these facilities. After all, we should consider every life saved a miracle. Once we stop addiction from taking lives, perhaps battling the disease itself will become easier.
On the other hand, safe injection sites appear to normalize drug use. As opposed to programs such as Operation HOPE, which reward addicts for giving up their drugs entirely, supervised injection facilities reward addicts simply for using drugs less dangerously. They also drain government resources, potentially without merit considering how easily such sites could get shut down. Furthermore, all data suggesting lower rates of crime and overdose seem dubious at best. In short, we really have no idea whether the proposed benefits of safe injection sites truly exist. Legally administering heroin to addicts based on such faulty data does not constitute a solution. It is sheer recklessness.
Considering the slim likelihood that we will ever see safe injection sites in the United States, it might be a moot point either way. In the meantime, we must focus on solutions already on the table. We must focus on increasing funding for treatment centers, as well as local outreach programs such as Operation HOPE. Education, awareness and—most importantly—addiction treatment remain the best solutions we can offer those who struggle with heroin addiction.
Do safe injections sites have something to offer, or are they a disaster waiting to happen? Feel free to share your own thoughts in the comments below.