There is an epidemic of opioid abuse and opioid overdose deaths, especially in the United States but also in Europe. So far the US and the United Kingdom are resisting one of the safest and most cost-effective ways other nations have found to stop the latter and maybe the former: fix rooms.
Also known as safe (or supervised) injection sites (SIS), fix rooms are a peculiar sort of harm reduction, in some ways related to and an outgrowth of needle and syringe exchange programs (NSPs). While the primary goal of NSPs is to prevent the spread of HIV and hepatitis C through the sharing of dirty needles, the primary goal of fix rooms is to prevent the death by overdose of opioid addicts by giving them a safe place to shoot up, with a nurse or doctor on hand to provide the anti-overdose drug naloxone or other medical assistance if needed.
Some also can first test the drug to make sure it is uncontaminated and contains the drug intended. Many dealers substitute fentanyl, an opioid that is far cheaper, stronger, and more easily available on the black market for things such as heroin. The possibly accidental consumption of fentanyl was responsible for the overdose deaths of the musicians Prince and Tom Petty. Skin contact with pure fentanyl has resulted in overdoses.
Save Money, Save Lives
Fix rooms now operate in 66 countries, according to a 2017 article in the American Journal of Preventive Medicine, including Canada, Australia and in some countries of Europe, but not the US or UK, at least not legally. Reportedly there has been at least one such underground site somewhere in the US since September 2014.
The reason for this reticence is not that authorities do not believe that fix rooms would save money or lives. According to one analysis in San Francisco, for every dollar spent on an SIS, the city would save $2.33 in law enforcement and emergency medical services, or $3.5m annually. Another proposed for Baltimore would save $6m. And a proposed fix room in Glasgow was rejected by the UK government despite an acknowledgement that it would save lives.
It is not just hypothetical. According to a 2011 study in The Lancet, overdose deaths in the vicinity of InSite, an SIS in Vancouver, declined by 35%, compared to 9% overall. In 2016, InSite probably saved more lives when it found its clients’ heroin was laced with fentanyl more than 150 times.
Susan Sherman – a professor at Johns Hopkins Bloomberg School of Public Health and one of the authors of a report on SIS – claims that since the first safe injection facility opened in Switzerland in 1986, not one person there has died from an overdose.
SIS was not even among the recommendations of The President’s Commission on Combating Drug Addiction and the Opioid Crisis. The problem is that many of the officials and politicians fear that permitting fix rooms amounts to approval. As with US President Donald Trump’s Attorney General Jeff Sessions, opposition to all drug abuse is more a matter of dogma than facts. UK politicians seem to have a similar puritanical attitude.
In reaction to plans for two pilot SIS sites in Washington state, one state senator opined that it was necessary to stigmatise heroin addicts to push them into drug rehab and save their lives. That has not worked out so far.
In fact, fix rooms are more likely to lead people into drug rehab. Sherman said, if you give them a safe place to use, you give them some stability, and they are more likely to seek the treatment offered.
Fix rooms do have their limitations and drawbacks, however. For one thing, even if they save money in the long run, they are expensive to start. One such site opened in France in 2016 but was expected to cost the state $1.3m.
Another problem is they may not be popular with the voters and taxpayers. Even if they approve of them in principle, when it comes to practice they cry NIMBY (Not In My Back Yard) and oppose the establishment of fix rooms near their homes.
Like marijuana legalisation, safe injection sites or fix rooms seem to be a no-brainer. The potential harm and cost of enforcing existing drug laws seem enormously higher than adopting new laws or adapting old ones.
In rejecting Glasgow’s fix room, the Lord Advocate said that the UK government would first have to amend the Misuse of Drugs Act. That doing so might be unpopular or difficult is no excuse not to try.
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