The City of Boston is beginning a discussion over whether it wants to allow supervised injection facilities (SIFs) to operate within the city. On June 19th, the Boston City Council had its first public meeting on this subject, where medical experts, advocates, and business groups gave testimony supporting and opposing these facilities.
Generally, the battle lines lie between medical professionals and addiction treatment advocates, who typically support the proposal, and individuals and business groups who are afraid that supervised injection sites will normalize addiction and flood the surrounding areas with addicts—in many ways, this divide mimics the one surrounding methadone clinics.
This meeting was only the first step in what promises to be an extremely emotionally charged debate. The City Council has not held a vote on this issue and, even if it did, the state would be required to pass legislation legalizing these facilities before one could start operating.
Currently, such a bill (S.1081 of the 190th legislative session) is being heard in the Joint Committee on Mental Health, Substance Use and Recovery. This process can take a great deal of time, particularly with controversial issues, and it isn’t unusual for bills to require resubmission and get shunted between committees (I interned with the Joint Committee on Public Health shortly after graduating BU and saw this process firsthand).
What are Supervised Injection Facilities?
Supervised Injection Facilities are a very controversial form of harm reduction for opiate drug addicts. These facilities are safe spaces where injection drug addicts are able to access clean and safe “works” (needles, cookers, water, etc.), then inject themselves on-site. Medical personnel are on staff with a supply of Narcan (a drug that reverses overdoses), and addicts are given access to support services if they choose to kick their habit.
The Debate Over Supervised Injections
The reasons to allow supervised injections are numerous:
First, it reduces overdose deaths because drug addicts who overdose in these facilities have immediate medical help and are not reliant on somebody finding them and calling 911. Many overdose deaths are avoidable if only the addict had immediate medical attention, and creating safe spaces for them to inject themselves is a proven method of minimizing the time between an overdose and medical treatment.
Second, it reduces the strain on emergency services caused by addicts by decreasing the number of drug overdose calls that they have to deal with (e.g. in Sydney, Australia these calls decreased by 68%). Addicts who repeatedly overdose and need regular emergency services cost an astonishing amount of money. They can also pull emergency personnel away from other emergency situations (e.g. car crashes, fires, etc.). Reducing the prevalence of these overdoses could save a great deal of money and time.
Third, it reduces the spread of IV drug infections (HIV, Hepatitis, etc.) by providing sterile equipment to addicts. Desperate addicts will use dirty needles and share needles to fulfill their high, leading many states to implement safe needle exchanges. These programs have been extremely successful in reducing outbreaks, and safe injection sites take this model a little further by adding a safe location to inject. These needle exchange/injection site programs also have the added benefit of reducing the number of needles discarded on the street, which pose a massive public safety risk.
Fourth, supervised injection sites can act as a platform for drug treatment referrals. While addicts are on the premises, they are not forced to attend a drug treatment program, but they are given all of the information that they need to begin treatment if they so choose. This non-coercive aspect to drug treatment helps ensures that addicts are willing to use the space.
On the other side of the debate, people who oppose supervised injection sites utilize their own arguments.
First, they claim that supervised injection sites normalize addiction, turn the state into a willing facilitator of drug abuse, and reduce the disincentives for people to become addicts. However, studies from nations that have implemented these programs indicate no evidence that supervised injection sites increase addiction rates. That said, there is some truth to the idea that harm reduction program in general do reduce the stigma of drug addiction, simply because they shift addiction from a criminal paradigm to a medical one (instead of considering addicts simply criminals that need to be punished, they are seen as sick people who need help).
Second, they claim that drug addicts will congregate around injection sites and destroy the neighborhood. This is highly debatable, but the sad fact is that in Boston, addicts are already on the street doing drugs. The real question is, do we want addicts to inject on the street, or do we want to give them a safe place to inject where they are not in danger and pose less of a risk to others?
Third, some have argued that these sites make a mockery of the law and represent the state essentially condoning illegal conduct. This is arguably true, but it neglects the fact that the law exists to protect society and human life. The criminalization and tough on crime approaches have woefully failed at achieving these aims in regard to drug use, and this is one case where the current laws actually produce detrimental outcomes to their stated goals.
The current laws are wrong, and violating or changing them may be necessary to save thousands of lives.
Edited by Taralei Griffin