For over a half century we have tried to punish and interdict our way out of this crisis of drug deaths and yet the death rate and costs just keep going up. We capture only a tiny percentage of the drugs entering this country, exacerbated by fentanyl and its analogues, which are so potent that miniscule quantities that can kill many more people are easily hidden in transport. We incarcerate hundreds of thousands yearly, largely for simple possession and mostly for marijuana, stigmatizing them and ruining their ability to get a job in the future; and the problem continues to grow. But what if there were a proven way to lower deaths and save some of the monetary and social cost of all those overdoses?
The Institute for Clinical and Economic Review (ICER) released its report in January 2021 regarding supervised injection sites (harm reduction centers). These facilities have been present in Canada, Australia and many European countries for many years. New York City has opened two. In these sites persons who use illicit drugs bring their own drugs in and use them under supervised conditions. Medical personnel, naloxone, oxygen and other equipment for resuscitation in case of overdose are available. Usual additional services are medical treatment, needle/syringe exchange, counseling and referral for drug treatment. The ICER did an exhaustive review of the data looking at death rates, societal effects and economic effects at these sites. They found that they prevent overdose deaths and differentially benefit communities that are historically disadvantaged and underserved. Also safe injection sites have resulted in overall cost savings when taking into account ambulance calls, ER and hospital care. Additionally there was no link to rates of various crimes in the area and public use of drugs actually decreased.
While this approach may sound radical, it is widely used in the rest of the world and successful. Many of us either have or will have family or friends affected. Experience shows that people initially fear these sites will bring drugs to their community; but the drugs are already there. Instead they bring drug safety to their communities. They generally reduce crime in their communities and ultimately are well accepted. It’s not the whole answer but it is a good start. Why not here?
Wilbur Brooks is a retired family physician who has seen first-hand the devastation of drugs in patients and in family.
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