Pubdate: Mon, 09 May 2016
Source: Appeal-Democrat (Marysville, CA)
Copyright: 2016 Associated Press


Across the United States, heroin users have died in alleys behind 
convenience stores, on city sidewalks and in the bathrooms of 
fast-food joints - because no one was around to save them when they overdosed.

An alarming 47,000 American overdose deaths in 2014 - 60 percent from 
heroin and related painkillers like fentanyl - has pushed elected 
leaders from coast to coast to consider what was once unthinkable: 
government-sanctioned sites where users can shoot up under the 
supervision of a doctor or nurse who can administer an antidote if necessary.

"Things are getting out of control. We have to find things we can do 
for people who are addicted now," said New York state Assemblywoman 
Linda Rosenthal, who is working on legislation to allow supervised 
injection sites that would also include space for treatment services. 
"The idea shouldn't be dismissed out of hand. I don't see anyone else 
coming up with anything new and innovative."

Critics of the war on drugs have long talked about the need for a new 
approach to addiction, but the idea of allowing supervised injection 
sites is now coming from state lawmakers in New York, Maryland and 
California, along with city officials in Seattle, San Francisco and 
Ithaca, N.Y., who note syringe exchanges were once controversial but 
now operate in 33 states.

While such sites have operated for years in places such as Canada, 
the Netherlands and Australia, they face significant legal and 
political challenges in the U.S., including criticism that they are 
tantamount to waving a white flag at an epidemic that should be 
fought with prevention and treatment.

"It's a dangerous idea," said John Walters, drug czar under President 
George W. Bush. "It's advocated by people who seem to think that the 
way we should help sick people is by keeping them sick, but comfortably sick."

But proponents argue such sites are not so radical outside the U.S., 
pointing to examples where they offer not only a place to shoot up, 
but also health care, counseling and even treatment beds. In many 
cases, the users are there to shoot up heroin or dangerous opioids 
like fentanyl, though some take painkillers in pill form.

At Sydney's Medically Supervised Injecting Centre, more than 5,900 
people have overdosed since it opened in 2001. No one has died. It's 
the same at Insite in Vancouver, British Columbia. About 20 overdoses 
happen there every week, but the facility, which is jointly operated 
by a local nonprofit and the Vancouver Coastal Health Authority, has 
yet to record a death.

"A big fat zero," said Insite site coordinator Darwin Fisher.

Sydney's facility is tucked between a hostel and a Chinese restaurant 
in Kings Cross, the city's red-light district. Aside from the 
security guard posted just inside the front door, it looks like a 
typical health clinic.

At least two staffers, including a registered nurse, monitor the 
injection room. They are not allowed to administer drugs, though 
sterile needles are provided. If a patient overdoses, the nurse 
delivers the antidote Narcan, which quickly reverses the overdose.

After users get their fix, they head to a second room with a 
decidedly warmer feel. Colored Christmas lights hang from the 
ceiling; books and magazines line the shelves. Clients can relax with 
a cup of coffee or tea or talk to staff. Some stay for 15 minutes; 
others spend hours. They exit through a back door to protect their privacy.

Advocates in the U.S. have long discussed the potential benefits of 
injection sites - but they point to the tripling of heroin and opioid 
overdose deaths since 2000 as one reason why the suggestion is 
starting to get serious consideration.

U.S. federal law effectively prohibits injection facilities, but 
supporters say that if a state or city were to authorize one, 
Washington officials could adopt a hands-off approach similar to the 
federal response to state medical marijuana programs.

California Assemblyman Tom Lackey, who served on the California 
Highway Patrol for 28 years, said he understands that supporters are 
looking for a new approach. But he has deep reservations about 
legislation in his state, which would create clinics where users 
could use heroin, crack or other drugs.

"These facilities send a message that there is a safe use, and I 
don't think there is any safe use of heroin," he said.
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MAP posted-by: Jay Bergstrom