Pubdate: Fri, 02 Feb 2018
Source: Philadelphia Daily News (PA)
Copyright: 2018 Philadelphia Newspapers Inc.
Author: Beth Ann Swan


A Philly nurse on safe injection sites

"You want me to do what?" "Where's your compassion?" "What a waste of
resources!" "I have an obligation to help people stay healthy."

These are conflicting responses I imagine nurses and health-care
professionals may have when asked to provide care at safe injection
sites, places where people can use drugs under medical supervision.
There aren't any such sites right now. But the City of Philadelphia
announced that it will encourage setting them up. Should health-care
professionals participate? It's a dilemma wrought with ethical, moral,
legal, and regulatory issues and more questions than answers. As a
nurse, I can understand and appreciate both sides.

I have been trying to educate myself on this subject for the last
year, after the teenage son of a family friend died from a heroin
overdose. Would the existence of a safe injection site have prevented
his death? I don't know.

On one side of the issue, these sites address a staggering public
health issue, serve a good purpose, provide a safe space for drug
users, help avoid/lessen overdoses and deaths, reduce transmission of
infectious diseases, offer counseling and help to get off drugs.
Conversely, there is concern that such sites would proliferate
predatory practices of drug dealers selling near the sites. In
addition, there is the law, drug possession and use is illegal, as is
the presence of nurses and health-care professionals when people are
injecting themselves with heroin.

In deciding whether to support or work in safe injection sites, nurses
must consider the code of ethics by which they are bound and the
dilemma posed by the desire to do both - ensure their patient's best
interest while preserving their own professional integrity. How can I
supervise drug injections and live with myself?

According to the code of ethics, nurses must take appropriate action
when they see illegal practices that place the best interests of
patients in jeopardy. However, safe injection sites, even if their
legality is at issue, provide a service that may be in the best
interest of the individual. Nurses must be mindful of competing moral
demands and conflicting values in collaborating for human rights in
complex, extreme, or extraordinary practice settings. How do I take
nursing students to safe injection sites for clinical experience and
also teach them about a culture of health and safety, and the American
Nurses Association Code of Ethics? What happens when a nurse executive
asks a roomful of nurses to supervise heroin injections?

Each individual will need to decide whether to support safe injection
sites on his or her own. There needs to be debate and discourse among
students, faculty, and health professionals, many of whom are likely
to struggle in evaluating this extraordinary situation.

So where do I come down? Yes, safe injection sites shelter an illegal
activity and are not regulated. But, in my view, it would help lessen
senseless overdoses and deaths - and perhaps get people into
treatment. The common denominator for sites is the code of ethics
provision on integrating social justice. It speaks of a shared
responsibility among all nurses and health professionals to shape
health care locally and nationally and take action to influence
leaders, government agencies, legislators, and professional

It's a tough call. But I can live with safe injection sites for one
basic reason: I think they will save lives. And as a nurse, that's
what I'm all about.

Philadelphia's recent decision to encourage such sites to combat the
opioid crisis signifies a watershed moment for health and social
policy and the role of nurses and health professionals in addressing
the city's and nation's opioid crisis. And it offers an option for
drug users and promise to break the cycle for their family and friends.

- ---------------------------------------------------------------------

Beth Ann Swan is a professor at Jefferson College of Nursing and was
dean of the nursing school from 2011 to 2016.
- ---
MAP posted-by: Matt