“When you get into a tight place and everything goes against you, till it seems you could not hang on a minute longer, never give up then, for that is just the place and time that the tide will turn.”
— Harriet Beecher Stowe
Today, I want to pose a question about a controversial topic, “Should we have safe injection sites?”. I have always been on the fence about this question, leaning toward “no, they are not a good idea”. For those of you that are unfamiliar, the typical safe injection site is a place manned by medically trained personnel who give out new syringes and observe while a person injects themselves with the illicit drugs that they brought, typically opiates. The trained personnel try to make sure that the individual does not die from an overdose and they may offer advice, help, social services, and other resources to try to get the individual with a substance use disorder (SUD) into treatment.
This issue has come to the forefront recently as the City of Philadelphia is trying to permit such a facility. A non-profit called Safehouse has requested permission to operate a safe injection site in Philadelphia’s notorious Kensington section. The City is in favor of the proposal, but the federal government has sued to prevent it.
Raising the Issue
I recently attended a seminar about addiction and treatment, and someone asked the speaker his opinion regarding safe injection sites. The speaker stated that he is in favor of such facilities because they save lives and you can’t get someone into rehab if they are dead. That is a pretty straightforward argument that you would be hard pressed to refute. I try to be a reasonable, open-minded person so when someone that I believe has more experience then I takes a position, I give it very serious consideration. We all have our biases but I try to get past that and truly consider what has been said.
Our son was saved with Narcan and we got six months to see the kind of amazing man that he was when his life was not controlled by addiction. I firmly agree that saving lives has to be one of our primary goals because as the speaker said, you can’t get into recovery if you are dead. So therefore, I must agree that safe injection sites are a good idea. Well, maybe it is not that simple.
My Thoughts
As I considered changing my mind, I tried to take inventory of why I initially thought that safe injection sites were not a good idea. Then it hit me;
Suppose I said that I was going to provide my son with new needles and I would monitor him as he used, as long as stayed home so that I could give him Narcan if necessary. I would be considered the worst kind of enabler. I would be severely criticized and rightfully so. Why then is it different if a non-profit or government agency does the exact same thing?
To my way of looking at it, it is not different. It is enabling, facilitating this person’s addiction. This is my answer, but it is kind of a cop-out. I don’t address if the ultimate impact is better or worse, just that it flies in the face of conventional wisdom.
The Facts
Let’s be honest, everyone thinks that they have facts and common-sense on their side but they are mostly just opinions and suppositions. Here are some of the “facts” and how I view them:
- Providing clean needles reduces the incidence of infection, hepatitis, HIV, etc. The data seems to show that this actually is a fact, but it cannot be viewed in a vacuum. Are we trading this advantage for longer-lasting addiction and all that comes with it? There is no valid way to measure that because we cannot know how the individual would respond or if there may be other outside influences.
- Safe injection sites save lives. This is a fact in the short-term because anyone who is saved with Narcan and otherwise would have died, is a life saved. But we cannot know if the safe injection site makes it easier to continue to use, in which case we did not save a life, we just prolong it a little. But isn’t it worth prolonging a life? It certainly was in our case.
- Safe injection sites promote drug use. It seems like this should be true but this is one of those common-sense statements that is not a fact. We have no way of knowing if the overall effect of safe injection sites is to promote drug use or to get more people into recovery by keeping them alive until find recovery.
- Safe injection sites will destroy the neighborhood, attract drug dealers, and make a centralized location for dealers to find buyers. This certainly seems like it would be the case, but it is not a fact. We cannot know if this will happen and is it really that different from the way Kensington is now?
- Our laws do not allow you to have a property where you allow illegal drug use (crack-house laws). This is true but it is a law, not a fact. Just like any other law, if it does not work, change it. That is the job of Congress and we pay them quite handsomely for that job.
- We should not spend time and money to keep people alive that don’t care about themselves. Did your head explode? Mine almost did just writing that sentence. This is the worst kind of ignorance parading as common-sense. People with a SUD do not choose that life. They made a mistake early on and their brain has been overwhelmed. Regardless of how far their life has sunk, they deserve our compassion.
So, it Looks Like I am Back Where I Started.
I do not think that I can in good conscience support a safe injection site because it is enabling addiction on a large scale. On the other hand, I do not think that I could oppose one either because there is a reasonable chance that it will save lives. I would give anything to have my son back. How can I deny something that might save someone else’s son or daughter?
FACT: Safe injection sites are not the answer to our addiction crisis. They may be a reasonable stopgap measure, but they are not a solution.
Do you have thoughts, opinions, or experiences to share? Please comment, let’s work together and help each other to understand this problem.