The June 29 Redmond Reporter opinion piece by David Carson, “’Safe injection sites’ are not the answer to our heroin problem,” contains a number of inaccuracies. We would like to set the record straight about these sites and their role in addressing the heroin and opioid drug epidemic that is taking the life of a King County resident every 36 hours.
Last March, the King County Heroin and Prescription Opiate Addiction Task Force, recommended expansion of low-barrier access to medication-assisted treatment for addiction as the main strategy to address the opioid epidemic. They also recommended piloting and evaluating two safe injection sites, also known as Community Health Engagement Locations (CHELS). The two sites are estimated to represent 1-2 percent of resources available for the overall strategy.
CHEL sites are a public health service that provide a safe space for drug use under the supervision of a health care professional trained in overdose response. The facilities do not provide drugs and no selling or exchange of drugs is allowed on or near the premises.
The task force recommended CHELs because opioid and heroin addiction is a chronic medical condition — a disorder of brain chemistry — and not a moral failure any more than alcoholism or tobacco addiction or chronic diseases like diabetes or high blood pressure are. As such, opioid addiction must be treated like other medical conditions, with the best available medical evidence. And, as with alcoholism and tobacco addiction, we all know that there are people who are not ready or able to enter treatment on any given day, but who should have every opportunity to stay alive and enter treatment when they are ready to do so.
The problems Mr. Carson attributes to the Insite facility in the downtown Eastside neighborhood of Vancouver, BC, including poverty, homelessness and public drug use, were present before Insite. The evidence does not show that these sites increase the frequency, or initiation, of opiate injection. In fact, globally, similar facilities are purposely located in areas where these issues are problematic.
The increased number of overdoses in Vancouver, BC, is due to a dramatic increase in the use of illicit fentanyl in that community, not the presence of the Insite facility. Insite opened in 2003, the overdose death rate began increasing a decade later and dramatic increases in the past two years are clearly due to fentanyl. Fentanyl is a synthetic opioid that is 50 to 100 times more potent than heroin and is highly lethal. In response, Vancouver and other areas in Canada are expanding the use of supervised injection sites as one tool to address the growing numbers of overdoses. At this time, King County does not have a high level of illicit fentanyl, but piloting CHELs to help reverse overdoses and connect people to treatment will be even more important if we do experience an increase in fentanyl use in our community.
Supervised injection facilities have been endorsed by a variety of medical and public health professional associations, including the American Medical Association (AMA). The AMA found that studies from other countries have shown supervised injection facilities reduce the number of overdose deaths, reduce transmission rates of infectious disease, and increase the number of individuals initiating treatment without increasing drug trafficking or crime in the areas where the facilities are located.
As health care and treatment providers, researchers, and long time community members who work with people struggling with addiction, we see the urgency for our community to come together to test models that have worked elsewhere, because the unfortunate reality is that we already have injection sites—injection sites in parks, alleyways and public places. By providing an option for those struggling with addiction to come indoors, we can limit hazards from needles on our streets and keep people alive until they are able and ready to access treatment.
The following authors of this letter are members of the Heroin and Prescription Opiate Addiction Task Force:
Darcy Jaffe, MN, ARNP, Chief Nurse and Patient Care Administrator, Harborview Medical Center
Molly Carney, PhD, MBA, Executive Director, Evergreen Treatment Services
Caleb Banta-Green, PhD, Principal Research Scientist, Alcohol and Drug Abuse Institute, University of Washington.
Brad Finegood, MA, LMHC, Assistant Division Director, King County Behavioral Health and Recovery Division
Jeffrey Duchin, MD, Health Officer, Public Health – Seattle & King County