Unprecedented Media Coverage and Support for Supervised Injection Facilities (SIFs)

Submission Date: January, 11, 2016
Attributing Author: Stephen Gutwillig 
Source: Boston Globe,New York Daily News &Associated Press 

USA Requires Supervised Injection Facilities (SIFs).

Over the last month, there has been unprecedented media coverage and support for supervised injection facilities (SIFs).

SIFs are controlled health care settings where people can more safely inject drugs under clinical supervision and receive health care, counseling and referrals to health and social services, including drug treatment. There is strong evidence that SIFs are effective in reducing new HIV infections, overdose deaths and public disorder – and that they do not increase drug use or criminal activity. Given the continued rise in overdose deaths, new tools to reduce overdose need serious consideration. Just last month the New York City Department of Health and Mental Hygiene released data showing that rates of unintentional drug overdose deaths increased by 42% for the period 2010 to 2014 in NYC.

There are SIFs in 68 cities around the world, but none in the U.S. – yet.

Below is a major editorial in the Boston Globe, a powerful op-ed in the New York Daily News and an Associated Press story making the case for initiating SIFs in the U.S. as soon as possible!

NY Daily News

Safe, clean spaces for heroin injection

BY Dr. Julie Holland

January 9, 2016


When I first moved to New York City as a medical resident at Mount Sinai Hospital, I volunteered for a needle exchange program on the Lower East Side. We would walk around the streets, a group of clinicians, social workers, harm reductionists, offering to safely dispose of addicts’ dirty needles while providing sterile ones as well as alcohol swabs, virus-killing bleach and condoms. Most importantly, we provided humane, compassionate, nonjudgmental medical assistance.

As an expert in psychopharmacology and former attending psychiatrist in the Psychiatric ER at Bellevue Hospital in New York, I have seen first-hand just how entrenched, paralyzing, and deadly addiction can be. We cannot turn our backs on these patients, because they are our mothers and sons. They are us.

More Americans are using opiates than ever before, and they are dying more than ever, topping car accidents as the number-one cause of accidental death. The rate of opioid overdose deaths has doubled in New York City over the past four years, with prescription opiates more often the cause of death than heroin.

Prescription opiates often end up being a gateway drug to heroin; when the pills become harder to obtain, many discover a cheaper alternative. They are then more likely to begin injecting, putting themselves and our community at risk for hepatitis or HIV. These and other medical issues can be easily avoided, but we will have to move outside of our comfort zone to bushwhack an innovative path.

There is a proven effective strategy: a harm-reduction intervention called supervised injection facilities. They’ve been operating for thirty years in 68 cities worldwide, and they work.

Legally sanctioned sites where IV drug users can inject their pre-obtained drugs under medical supervision, SIFs create a safe, clean place for individuals to inject rather than on the street, which means fewer dirty needles in our parks, alleyways, and public bathrooms.

For people who cannot or are not ready to stop injecting drugs, SIFs are lifesaving, reducing overdose deaths, rates of transmission of HIV and Hepatitis C, and instances of other infections as well.

Most importantly, having a communal site, not buried in shame, allows us to build a bridge to help those struggling with their circumstances. It is a crucial point of entry for a needy population.

And lest you think this is a problem specific to people of color, I have some news for you: the rate of ODs involving heroin are highest among white New Yorkers.

I understand there’s strong resistance to the concept in a city that’s still just getting used to decriminalizing possession of small amounts of marijuana. Some think that providing a safe place for people to inject themselves is a tacit endorsement of heroin use.

But given the crisis we now find ourselves in, and the continued loss of life, people will need to take SIFs seriously. A slow learning curve — like the one we had for syringe exchanges — will mean more needless deaths.

As medical professionals, we vow to help all those who come before us. All lives are worth saving, all bodies worth healing. Whether someone is suffering because he failed to wear a bike helmet, made bad dietary choices or became addicted to opioids, our duty is to ease pain and suffering.

We conduct new research and advance new ideas to find the best practices and cutting-edge ways to continue helping our patients, no matter what circumstances bring them to us.

When it comes to treating those with addiction, we need every possible tool, even those that may make us uncomfortable. It is time for our country to get serious about helping the thousands of people struggling with heroin addiction. The U.S. should open supervised injection facilities. And start here in New York.

Holland, MD, is an New York City psychiatrist and former attending at Bellevue Hospital Comprehensive Psychiatric Emergency Program.

Boston Globe Editorial

Massachusetts needs safe injection sites

December 27, 2015


Four people will die today from an opioid overdose in Massachusetts. Tomorrow, if the average from 2015 remains unchanged, another four souls — who may at this very moment be reading this article — will also lose their lives with the push of a plunger.

For the new year to look any different from the last, it has become clear that uncomfortable measures will need to be taken in order to end the overdose crisis. Gloucester Police Chief Leonard Campanello has shown a willingness to do just that by taking on Big Pharma and offering treatment instead of jail time, as has Governor Charlie Baker in his willingness to go up against the medical establishment to curb the over prescription of opioids.

The governor’s opioid bill, however, concentrates on prevention and treatment of drug addiction. Much more pragmatic tools are needed immediately. A good start would be a dramatic increase in spending for the harm-reduction approaches that are shown to work but can be politically polarizing: making the anti-overdose drug Narcan more widely available; improving access to substitution treatments such as methadone and buprenorphine; and bolstering needle exchange programs. In fact, the Legislature should go one step further and be the first in the nation to legalize safe injection sites.

Many overdoses happen because people are taking drugs alone, out of stigma or fear of law enforcement. Public health officials in eight other countries have addressed this by establishing nearly 100 facilities worldwide where users can shoot drugs under the watch of health care providers. Doctors or nurses are available to intervene in the event of medical emergency, but staff also distribute clean syringes and other supplies and direct addicts to drug treatment.

Right now Vancouver, British Columbia, operates the only supervised injection facility in North America. That program, called Insite, opened in 2003. More than 30 peer-reviewed studies have found that Insite saves lives every day, thousands of lives altogether. It also saves millions of dollars in both health care and public safety costs, reduces transmission of diseases such as HIV and hepatitis C, and promotes entry into treatment. There is no evidence it promotes drug use or drug-related crime.

The legal hurdles for Massachusetts to follow in Insite’s footsteps are daunting. Organizations that want to open a supervised injection site would risk federal prosecution and 20 years in prison under what are known as “crack house statutes,” which make it a crime to “knowingly open, lease, rent, use, or maintain any place . . . for the purpose of manufacturing, distributing, or using any controlled substances.” State lawmakers would have to craft a carve-out, similar to Good Samaritan laws already enacted for Narcan distribution, to shield safe injection site operators from scrutiny by local and state law enforcement — and hope the feds choose not to interfere, which seems possible, considering the precedent set by the Obama administration’s hands-off stance on state marijuana laws. Given the current public health emergency, legal experts suggest the timing for such a gamble has never been better.

Two obvious locations for the Commonwealth’s first safe injection site would be Cambridge’s Central Square or the intersection of Massachusetts Avenue and Albany Street in Boston. Both are, in different ways, ground zero of the opioid crisis, but the latter, sometimes referred to as “Methadone Mile,” is already home to the venerable Boston Health Care for the Homeless Program. One doctor there reports now often being unable to walk from the parking lot to the clinic’s front door without encountering someone in the early stages of overdose.

In November, Dr. Jessie Gaeta, the program’s chief medical officer, suggested that it may open a “safe space” where people could come when they’re high on heroin. No actual drug use would take place, Gaeta told WBUR, but the program would instead offer “a safe place to be that’s not a street corner.”

Mayor Marty Walsh reacted positively to the idea. “I’m up for trying anything when it comes to addiction and active using,” he said at the time. “If we can help some folks, homeless folks in particular, we should try anything.”

If we take the mayor at his word, empowering Gaeta and her colleagues to open a true supervised injection site would have exponentially greater impact.

Experience teaches that breaking past stigma and fear on public health matters has wide-reaching consequences. In the 1980s, clean-syringe programs were also seen as political nonstarters, but HIV contraction among drug users has fallen by more than 90 percent in the state since exchanges were introduced. In 2001, there were only two official Narcan-distribution programs nationwide. Last year, first responders administered 11,000 doses of Narcan to people overdosing in Massachusetts alone. A safe injection site is today’s equivalent to those initiatives, a life-saving public health service to all those in the Commonwealth who need it.

Fatal opioid overdoses are preventable. In 2016, that should be the goal for Massachusetts’ political leadership. Anything else needlessly risks lives.

Associated Press

Groups pushing for supervised heroin sites

December 9, 2015


ALBANY, N.Y. (AP) — A coalition of public health groups and supporters of less punitive approaches to illegal drug use says New York should consider allowing heroin users to inject themselves in supervised settings to prevent overdoses.

The group includes advocates from the Drug Policy Alliance, the New York Academy of Medicine and VOCAL New York. In a statement Tuesday the coalition says supervised injection sites would place users under the watchful eyes of health workers who could intervene in case of an overdose.

They want health officials in New York City and at the state level to create such sites, which they say have been successful in curbing drug deaths elsewhere in the world.

Critics say supervised injection sites can be unsafe and send mixed messages about illegal drug use.

“This isn’t something you can just go out and use and all of a sudden wake up and you’re fine,” said Alan Rozansky, the Erie County Sheriff’s Office’s Chief of Narcotics. “The necessity of the heroin and monies it takes to keep using heroin will lead people to continue doing what they don’t normally do.”

“The solution is to try to curb this epidemic,” said Avi Israel, an advocate for addiction awareness. “Not to tell somebody you can come here and use and don’t worry about it.”