Pubdate: Sat, 24 Jun 2017
Source: Los Angeles Times (CA)
Copyright: 2017 Los Angeles Times
Author: Rick Rycroft


Government-sanctioned and supported "supervised injection centers,"
where addicts can bring their illicitly obtained drugs and shoot up
with little fear of arrest or a fatal overdose, have been in service
in Europe for decades.

There's only one in all of North America, though. It's in Canada -- a
Vancouver, Canada, center called Insite. Research found that after the
center opened in 2003 fatal drug overdoses decreased by 35% in the
nearby community. Earlier this month Canadian officials authorized
injection centers in Montreal, Toronto and other cities.

Unsurprisingly, this is an extremely controversial idea south of the
border, where some people dismiss them as legalized shooting
galleries. Just this month, Boston city officials rejected a proposal
supported by the Massachusetts Medical Society and others to develop a
pilot injection center program in the city's "Methadone Mile."
Government, critics say, shouldn't sanction the use of dangerous
drugs.The opioid addiction crisis ravaging communities from coast to
coast calls not only for immediate action, but for new approaches as

But with drug overdose now the leading cause of accidental death in
Americans under 50, it may be time to reconsider that position. The
opioid addiction crisis ravaging communities from coast to coast calls
not only for immediate action, but for new approaches as well. Yes,
the U.S. needs to fund addiction prevention and treatment programs.
But it also needs to think about what are called "harm-reduction"
strategies that can help keep people who do use drugs. This is the
idea behind needle exchange programs and the effort to equip police
and other authorities with naloxone, a drug that reverses opioid
overdoses in just minutes. It is also the idea behind safe injection

A bill in Sacramento would allow eight selected counties, including
Los Angeles, to try the idea out. Not only is the philosophy of safe
injection centers consistent with California's efforts to treat
addiction as a disease not a crime, but a pilot project would gather
invaluable data. The proposal by Assemblywoman Susan Eggman
(D-Stockton) comes up for a crucial vote in a state Senate committee
hearing in early July.

The bill is sponsored by the Drug Policy Alliance and supported by a
wide array of addiction and AIDS prevention groups. Nevertheless, it
faces an uncertain future because of strong opposition by law
enforcement groups that view these centers as "government-sanctioned
drug dens" (as one Republican lawmaker put it recently). Some critics
also wonder whether such sites would leave local governments liable in
the case of an overdose. These seem like solvable concerns that should
be addressed and fixed before the legislation passes.

It's counterintuitive to fight addiction by facilitating drug use. But
injection sites, also known as fix rooms, are not opium dens of yore.
In fact, they look exactly like health facilities. There's a nurse on
site to administer anti-overdose medication if needed. Last year,
1,781 overdoses were stopped at Vancouver's Insite -- overdoses that
might have proved fatal had they occurred elsewhere. No one has died
from an overdose at the facility.

Sterilized needles and cooking implements are available so that users
don't risk contracting HIV and other blood-borne viruses or infections
from dirty needles. Staff members at the injection centers are trained
to make referrals for counseling and addiction treatment. In addition
to saving lives, injection centers are often the first step for many
on the road to sobriety, according to the Canadian program. Indeed, of
the 6,532 people who fixed at Insite in 2015, 464 were referred to a
related detox facility. More than half completed the program. Though
the centers make clear that treatment is available, they don't make it
a condition of using the site for fear of scaring off people coming to
the centers for safety reasons.

Detractors are correct that injection centers alone can't solve the
opioid crisis -- but harm reduction should certainly be part of the
solution. Last year 59,000 people died from drug overdoses in the
U.S., the majority of which involved opioids such as heroin and
fentanyl. This year is shaping up to be even worse.

Boston notwithstanding, attitudes about injection centers appear to be
changing. Earlier this month, the American Medical Assn. decided to
support safe injection facilities. Washington, among the states
hardest hit by drug deaths, is opening the nation's first supervised
injection center. These are hopeful signs. The United States is in the
grip of a crisis and must care for people at all stages of addiction.
That includes keeping alive those who are still using.
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