Should supervised drug-consumption spaces be used to address the opioid/heroin epidemic?
We in public health are in the business of looking at the data to inform policy and practice and, as an intervention, there is significant evidence that this is an effective component of a comprehensive approach to drug use. Safe drug-consumption spaces are associated with a reduction in overdose deaths, an uptake in drug treatment and a reduction in HIV and HIV risk behaviors. On the continuum of people’s drug use, the safe space serves as an access point to substance use disorder treatment.
They should be part of a comprehensive drug treatment and health promotion program. A key component would be linking them to supportive treatment facilities. Having settings where the chances of arrest are reduced would also probably facilitate safer injection. Key questions are how significant are the barriers to use of safe-injection facilities and are there larger interventions that could have more of a public health impact, such as empowering and organizing drug users.
It is too early to disseminate or expand the supervised injection approach, which in my view remains unconventional, unproven and problematic. I worry that it sends a message of therapeutic pessimism and discrimination, that some individuals with addiction are hopeless and do not deserve our full rehabilitative efforts. I believe there are productive and ethical ways to conduct the necessary randomized controlled trials, without which this is not the right next step for the current opioid epidemic.
Solving complex problems like substance use requires a multifaceted approach with a continuum of services. Safe drug-consumption spaces have been proven to help the people who use the programs and to increase safety in the neighborhoods where they are implemented. Our own research has shown that implementing just one of these spaces in a U.S. city would garner savings of $3.5 million per year.
Alex Kral, PhD, is director of the Behavioral and Urban Health Program at RTI International.
As an epidemiologist who worked on the scientific evaluation of Insite [the first supervised drug injection site in North America], the conclusion was that exposure to Insite was associated with reductions in rates of used-syringe sharing and the risk of fatal overdose, and a 30-plus percent increase in people going to detox to initiate methadone treatment. The evidence shows us that facilities like Insite need to be central parts of a public health response to this grave crisis.
M.J. Milloy, PhD, is an assistant professor of Medicine at the University of British Columbia.