On nearly every line, green-colored signs embellish New York City train cars, each urging the public to “Save a life. Carry naloxone.” Other signs offer well-intentioned advice, such as “Avoid using alone!” and “The best way to prevent an overdose is to not use drugs”.
Each of these public service announcements is aimed towards combating a steady rise in the use of opioids. Opioid use disorder has grown astronomically in the past decade within the United States and developed countries and around the world.
The death toll from accidental opioid overdose reached 70,000 in 2017 out of the nearly 1.7 million Americans suffering from heroin use disorder or addiction to prescription opiates. This upward trend has led government officials and healthcare professionals to deem the opioid crisis a public health crisis.
The origin of this epidemic is difficult to pinpoint. Many look to economic shifts that lead to a subsequent feeling of hopelessness within the working middle class, while others point to the role pharmaceutical companies had in encouraging prescription opioids to doctors. Availability of legal prescription opioids, such as oxycodone, are typically used for chronic pain relief. Although abuse of this form of opioid is problematic, it is legal, and its production is regulated.
Heroin is the most common street opioid: it is unregulated, self-administered, and has been increasingly mixed with other synthetic narcotics.
Supervised injection sites (SIS) for people with opioid use disorder would ameliorate the unpredictability of street opioids, reduce overdose deaths, and provide struggling individuals with effective case management to properly wean off substance dependence.
Benefits of SIS
Supervised injection sites can rectify many biological complications of the opioid crisis. Intravenous drug use introduces a myriad of hazards, such as blood-borne pathogens. Bacterial infections of tissue can also occur as a result of dirty needles and unsanitary wound care at the site of infection.
From an economic perspective, the lifelong treatments needed for chronic illnesses contracted from needles likely outweighs the cost of launching and maintaining SIS clinics. A theoretical proposal for a single SIS facility in Seattle projected health benefits alone to result in approximately $534,453 in savings. SIS would aid in providing free, clean instruments while reducing the effects of inappropriately discarded sharps.
Moreover, heroin has been increasingly mixed with more powerful sedatives and synthetic narcotics. Users are often unaware that these substances are present and suffer unintended consequences.
Fentanyl is a pervasive additive that is 50 to 100 times more potent than heroin and is responsible for 28,400 deaths in 2017. At SIS locations, users would be able to test their products for purity to ensure that they are not inadvertently taking other psychoactive drugs. Providing additional naloxone administration training will prepare individuals for situations beyond the reach of the clinic as well.
Oppositions
The idea of SIS is naturally an uncomfortable one: most healthy people would find it absurd to provide a government-funded space that seemingly encourages opioid use.
However, these criticisms are often rooted in the white upper-middle-class with limited exposure to the underserved’s hardships. Similarly, the panic insinuated by politicians and media coverage of the “crack epidemic” distracted the public’s attention away from the structural and societal problems from which the epidemic originated, citing individuals’ choices and moral character instead. In the case of the opioid crisis, deceptive and regulatory mistakes by the FDA have been overlooked in favor of scapegoating individual users.
Opponents of SIS believe that these clinics would create a permissive attitude towards drug usage, but multiple other countries have already introduced similar successful initiatives.
One study looked at a supervised injection site in Vancouver, Canada, and found that the use of a supervised injection facility was not associated with recent incarceration. The data suggested that similar harm reduction programs do not require tradeoffs between public health and public order. The priority of SIS is not to keep users on a steady opiate diet.
A Safer and Affordable Way
The criminal justice economic burden totals nearly $5.1 billion, covering correctional facilities and police costs. This only constitutes ~9% of the total US societal costs from opioid abuse. The introduction of SIS in major cities would already demonstrate a massive cut in the federal expense on incarceration due to opioid abuse.
Ultimately, SIS clinics are a deeply beneficial investment that would help reverse the opioid epidemic if implemented on a federal level. These clinics have the potential to reduce overdoses, infections, and fentanyl-related complications while creating an economic benefit for many communities.
SIS would lower drug-related incarceration and surrounding costs. Most importantly, supervised injection sites would help many Americans suffering from opioid-use disorder get back on track to a happy, healthy, and meaningful life.
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