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Safe Use Sites: Helping or Hurting?

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Safe Use Sites: Helping or Hurting?

 

Safe use sites are the subject of an ongoing debate in the United States right now, with passionate people on both sides. These are places where people can go to more safely use drugs with monitoring from health care professionals.

There are benefits of safe use sites, but some genuine downsides have to be considered when discussing this controversial topic.

 

What is a Safe Use Site?

Safe use sites, also known as supervised injection facilities, are something that medical experts, and some lawmakers, have considered to save lives by reducing overdoses. The opioid epidemic has overdose rates of deaths in the hundreds of thousands.

When someone takes opioids, it slows down their central nervous system function. The central nervous system controls critical bodily functions, including breathing.

If a dose is taken that’s more than the brain and body can handle, a person’s breathing can slow to a level that’s dangerous or ultimately deadly.

At these safe consumption sites, people injecting drugs, like heroin, are under the supervision of professional staff. Those staff members are trained specifically to help reduce the public health issues associated with drug consumption.

Creating a safer experience for the drug user may also help the public. These facilities take people off the streets, where they might otherwise get involved with public injection.

The staff members of injection sites don’t handle the drugs that clients bring, nor do they directly help someone inject drugs. However, they do provide sterile supplies for safer injection, answer questions, watch for overdoses, and give first aid if needed. These facilities also offer referrals to medical treatment services and other social support programs.

In ten countries, there are currently legally sanctioned safe use sites. Some of the countries where these facilities presently include:

stethoscope on a map

  • Australia
  • Canada
  • Denmark
  • France
  • Germany
  • Spain
  • Switzerland

Theoretically, safe injection sites are a harm reduction strategy and not a replacement for preventing and treating substance misuse.

In North America, there currently aren’t any legally operating facilities like this. The federal government blocked a recent effort to open a facility in Philadelphia. The judge, in that case, ruled that federal law prevents the operation of these sites. In the specific case of the Philadelphia proposed injection site, the federal government said that it violates a part of the Controlled Substances Act.

There are state and federal laws in the United States that make having a property where drugs are consumed illegally.

Along with legal barriers, there are also societal barriers to safe injection sites. Many people in these communities voice their opposition, fearing it will increase crime and drug use.

 

Harm Reduction Principles

The idea of safe sites for drug use falls into a larger category called harm reduction. Harm reduction is an approach to reduce the negative consequences that come with drug use. The goal is to create customized interventions that genuinely reflect the needs of individuals and communities.

Some of theelements of harm reduction philosophies include:

  • The acceptance that drug use is part of the world, rather than condemning individuals for ignoring that reality, is working to minimize harmful effects 
  • The understanding of drug use as being complex 
  • The idea that well-being and quality of life can be used as criteria for success in interventions rather than a complete cessation of drug use 
  • The provision of non-judgmental services and resources may increase drug treatment consideration.

 

What Are the Benefits of a Safe Injection Site?

Some proponents of injection argue that the facilities are beneficial for individuals and entire communities. Here are some of the points they make:

  • Narcan and other overdose reversal drugs can be kept on-site and used accordingly. Seventy-one thousand people died of a drug overdose in 2019 alone, and there’s the possibility Narcan could have helped them. In some of the countries with supervised injection sites, there have been declines in overdose deaths. 
  • If someone does overdose, paramedics can administer a reversal drug and CPR if needed. 
  • Clean needle exchange reduces the sharing of needles, which can prevent the spread of HIV infection or other diseases. 
  • Facilities can provide healthcare when people visit. 
  • Public illicit drug use could be reduced, as could the number of needles in public. 
  • Fewer people may become involved in the criminal justice system due to drug use or possession, reducing the prison population. Minorities are also disproportionately affected by drug laws in many cases. 
  • The use of these sites could help reduce the financial burden on taxpayers, including the cost of emergency services and hospitalizations.

benefits of safe use sites statistics infographic

What Are the Risks of These Sites?

While there are upsides and some genuine benefits to these facilities, it’s impossible not to look at the risks and downsides.

  • Opponents of safe use sites say that the facilities normalize drug use; drug use can severely affect a person’s physical and mental well-being. They believe that someone with a substance use disorder may continue to inflict that harm on themselves by normalizing drug use. 
  • There’s a concern that some people could be less motivated to stop using substances. When you create a comfortable and safe environment for drug use, and you remove some of the negative consequences, it can reduce motivation to seek drug treatment. In many cases, someone has to feel the consequences of their substance misuse entirely to seek drug treatment. 
  • Some people do end up seeking treatment and being successful in doing so because of legal problems. For example, courts can and do order people into treatment for some drug charges, and injection sites might reduce the number of people who get treatment for that reason. 
  • It is also possible that these sites could bring more crime to the areas where they’re located. Drugs aren’t provided, so these sites could attract drug dealers targeting the visitors, and violence as a result. It could also potentially be risky for the staff. 
  • There’s limited research available right now on how well these facilities work or what the problems could be.

 

What’s the Takeaway?

While many argue that safe injection sites are not the answer to drug use and overdoses, there are compelling benefits to these facilities. Even though there are legal and logistical barriers to opening these facilities in the United States, perhaps people can use some of the harm reduction principles in other ways.

Many people agree that it’s essential to stop looking at addiction through the criminal lens and instead look at it as a public health issue.

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