Pubdate: Wed, 23 Mar 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company
Author: Lisa W. Foderaro


ITHACA, N.Y. - Even Svante L. Myrick, the mayor of this city, thought 
the proposal sounded a little crazy, though it was put forth by a 
committee he had appointed. The plan called for establishing a site 
where people could legally shoot heroin - something that does not 
exist anywhere in the United States.

"Heroin is bad, and injecting heroin is bad, so how could supervised 
heroin injection be a good thing?" Mr. Myrick, a Democrat, said.

But he also knew he had to do something drastic to confront the 
scourge of heroin in his city in central New York. So he was willing 
to take a chance and embrace the radical notion, knowing well that it 
would provoke a backlash.

And it has.

Ever since Mr. Myrick, 29, unveiled a plan last month for what he 
called a "supervised injection facility," critics have pounced on it 
as a harebrained idea that would just enable more drug abuse. A 
Republican state legislator, Tom O'Mara, called it "preposterous" and 
"asinine," and a Cornell law professor, William A. Jacobson, said it 
would be a "government-run heroin shooting gallery."

But others, including workers on the front lines of the heroin 
epidemic and some law enforcement officials, view the proposal as an 
important tool in the battle against addiction and overdoses, a way 
to keep users alive long enough to connect them to treatment. In the 
plan, users would be under medical supervision and could inject only 
a small amount of heroin.

The plan would need state approval, and it faces a steep climb in the 
arena of public opinion. But the unorthodox idea has drawn attention 
at a time of intense concern about the growing toll of heroin abuse, 
which, along with prescription opioid painkillers, kills 78 people a 
day, according to the federal Centers for Disease Control and 
Prevention. Many of them are overdosing not in squalid rooms but in 
public places.

Since announcing the plan on Feb. 24, Mr. Myrick has taken pains to 
explain to the public that a supervised injection center is only one 
pillar of a four-part plan that also addresses prevention, treatment 
and law enforcement.

Mr. Myrick said his father battled crack cocaine addiction, which 
helped inspire him to create the committee to confront the heroin problem.

Though unheard-of in the United States, supervised injection sites 
have existed in Europe for years - one of the first was in 
Switzerland, 30 years ago - and in Vancouver, British Columbia, the 
only city in North America where the practice is allowed. They have 
been linked to a reduction in harm from heroin abuse: In Vancouver, 
fatal overdoses dropped 35 percent in the community surrounding its 
main injection site in the two years after it opened in 2003 and fell 
9 percent citywide.

Here in Ithaca, a city of 30,000 in the Finger Lakes region, there 
were more than a dozen heroin overdoses, three of them fatal, in a 
span of a week and a half in 2014, shortly after Mr. Myrick appointed 
the committee that proposed the injection center. The Tompkins County 
Health Department does not break out overdoses by municipality, but 
in 2014, the most recent year for which data is available, there were 
14 fatal overdoses in the county, where Ithaca is the only city.

The proposal for an injection facility, part of "The Ithaca Plan: A 
Public Health and Safety Approach to Drugs and Drug Policy," would 
require changes to a number of state and federal laws, according to 
state health officials.

Gov. Andrew M. Cuomo, a Democrat who has mounted a forceful response 
to the heroin epidemic, told reporters at an unrelated news 
conference recently that he was unfamiliar with the details of the 
Ithaca plan and would not offer his opinion.

Much of the Ithaca drug plan has been embraced by a cross section of 
the community. The plan calls for more drug education, both for 
children and adults; improved mental health screening; a 
detoxification center; and a methadone clinic. But the supervised 
injection program has divided local law enforcement officials.

Ithaca's police chief, John R. Barber, said he could not support the 
proposal because "right now, heroin is considered an illegal 
substance under the law." But Gwen Wilkinson, the district attorney 
for Tompkins County who helped lead the committee that formulated the 
plan, said after its release that she was "prouder than ever to be an Ithacan."

And Assemblywoman Linda B. Rosenthal, a Democrat who leads the 
Committee on Alcoholism and Drug Abuse, has endorsed the proposal for 
the injection facility, saying she would work on legislation to allow it.

Mr. Myrick, a 2009 graduate of Cornell who was elected mayor at 24, 
said the injection site would address three problem areas, by slowing 
the transmission of blood-borne diseases like hepatitis and H.I.V.; 
reducing the public nature of heroin addiction, with people 
increasingly using the drug in parks and public bathrooms; and 
creating "pathways" to treatment.

Addicts would be allowed to carry small amounts of heroin into the 
injection center where a nurse would explain treatment options. They 
would also have access to general health care, an important 
component, Mr. Myrick said, since addicts sometimes forgo medical 
treatment because of the all-consuming need for heroin.

"They will have just had their fix, so that won't be their first 
priority, and they might say to the doctor there, 'Actually my tooth 
has been hurting and I have a puncture wound that has gone bad,'" Mr. 
Myrick said. "You can begin to treat the other physical things and 
get them prepared for their moment of clarity."

In Vancouver, the injection facility stirred controversy when it was 
first proposed as part of a comprehensive drug plan in 2001. 
According to Donald MacPherson, director of the Canadian Drug Policy 
Coalition, the addicts who have availed themselves of the program are 
30 percent more likely to get treatment and other health services 
than those who do not.

Mr. MacPherson, who was an informal adviser to the Ithaca committee, 
served as Vancouver's drug policy coordinator from 2000 to 2009. The 
impetus for the program, he said, was about 1,000 fatal overdoses 
that occurred over six years in the 1990s. Medical staff at the 
city's two injection sites use both oxygen and the medication Narcan 
to reverse an overdose.

"There are lots of people who have gotten much better," he said, 
referring to addicts who used the injection facilities. "They've 
gotten onto methadone and into housing. It's a place of empowerment."

In Ithaca, Herebeorht Howland-Bolton, a 26-year-old self-described 
heroin addict with a shock of auburn hair, said he would welcome a 
place to use heroin under the watchful eyes of medical staff. He 
started using heroin when he was 14, has been in and out of jail 16 
times and through rehab twice. In mid-February, he overdosed on 
heroin and wound up in a hospital.

"It's common sense," he said, after visiting a needle exchange 
program here. "You give somebody the option to save their life. My 
last three roommates have died from overdoses."

Mr. Myrick said he was gratified that the proposal had ignited a 
discussion. The idea to devise a citywide drug plan was prompted, in 
part, by his own experience. His father was a crack addict when Mr. 
Myrick was born, robbing him of a critical role model. His father now 
lives in Florida, and while Mr. Myrick has occasionally heard from 
him in the past few years - after 15 years of "radio silence" - he 
has not set eyes on his father since he was 6.

"I learned at a very young age that this was a disease and that it 
was a powerful one," he said. "I'm just glad people are talking about 
it. This has been a quiet epidemic for far too long."
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