Safe Injection Sites - What Say You

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   Live to Learnposted 6 years ago

   I listened to a piece on Philadelphia proposing a safe injection site where heroin users can bring their own drugs, have them tested for safety,at no cost, get a free clean needle, have a nurse monitor their vitals during and after the injection; all without the fear of arrest for their behavior, or undue pressure to quit. The proponents point out that there are thousands of these sites, world wide, and America should get with the program.
   
   I'm appalled. But open minded. I don't see an up side. I'd be interested in opinions.

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   PrettyPantherposted 6 years ago

   I would want to know a lot more about how it has been done in other countries and what the results were. If it can be shown that the cost of the program is substantially offset with savings in other areas such as medical costs, law enforcement costs, better outcomes for addicts and their families, etc., then it might be a worthwhile program.

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      Live to Learnposted 6 years agoin reply to this

      Yes, maybe. The person advocating in the program commented that if they wanted help there would be counseling and programs available. The if part offended me. If tax dollars are spent I'd expect those participating to be actively working toward rehabilitation.

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         GA Andersonposted 6 years agoin reply to this

         Hi Live to learn, I hope you are following my exchanges with Wilderness, I think they may offer some thoughts for you to consider in forming your opinion.
         
         Primarily the part about "... those participating to be actively working toward rehabilitation.". My personal experience is that that participation is mostly just lip-service. So a choice must be made: to hell with you if you aren't willing to try to help yourself, or Okay, I know you are going to shoot-up, at least use this clean needle so you don't get Aids and cost us, (our community), more in medical costs.
         
         It's a tough question Live to learn. My gut says I am still struggling to make a decision, but my mind says reality demands another thought.
         
         GA

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            Live to Learnposted 6 years agoin reply to this

            I've been following the exchange. My mind rolls somewhere between yours and wilderness's.
            
            I knew a woman with a nephew hooked on the stuff. His life was ruined. Completely. Until the day he was shot,attempting to purchase another fix. My husband's half brother overdosed, after what I'm told was a truly pitiful life. My brother has a son whose only interaction with family since he found out the boy was his has been theft, begging for money and bringing another life into this world to share his and his girlfriend's pitiful existence.
            
            Although I'm not inclined to attempt to understand what runs through a person's mind when they first pick up a needle, I am not completely unsympathetic. I simply find it difficult to fathom that acceptance and enabling is the answer. But, since I don't know what the answer is, I'm more inclined to listen to those whose opinions don't mirror my own. I may forever disagree, but I'd like to find the logic in their reasoning.

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   Aime Fposted 6 years ago

   This is familiar to me as I lived in Vancouver for nearly 10 years and worked in the Downtown Eastside where a majority of the city’s drug epidemic takes place and the safe injection site is located.
   
   The most obvious upside is that since they’re getting clean needles the potential spread of disease is dramatically reduced. Also if someone overdoses they have immediate medical attention (I looked up a stat that said in one year nearly 500 people overdosed but no one died).
   
   I think it would of course be best used in conjunction with a program that helped try to combat addiction at the same time.
   
   The SIS in Vancouver has been there for almost 15 years now and is still quite controversial but ultimately law enforcement and health authorities both are in favour.

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      Live to Learnposted 6 years agoin reply to this

      They were referencing a program in, I think, New Hampshire. They,too, had had no deaths. I don't mean to sound harsh, but I still don't see that fact as reason enough to encourage and subsidize drug use.

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         Shogunposted 6 years agoin reply to this

         Is this really encouraging drug use? Considering how many users are overdosing because of fentanyl mixed with their heroin, wouldn't it be better to have them get clean needles and have their dope tested?
         
         I know there have been counterarguments offered that having EMTs run around the city reviving, transporting, etc. overdose patients is more problematic than a safe injection site.

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            wildernessposted 6 years agoin reply to this

            If our goal is to save a life until the next time they OD, the SIS would certainly help.  Is that our goal?  To keep them alive in a miserable, rock bottom life so they can prostitute their bodies for another fix or freeze to death under a bridge somewhere?

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               Shogunposted 6 years agoin reply to this

               I think reading through this forum thread is the exact same type of problem that city officials in Philadelphia and others are battling with. I understand that this is a very sensitive subject. People were clearly caught off-guard with how fast opoid addition  grew – especially in the suburbs. Everything should be on the table, as it's clear this problem isn't one we can just run and hide from.
               
               It was just a year ago when Police Commissioner Richard Ross said SIS locations are “completely incredulous” and he was “adamantly opposed” to the idea. Fast forward a year, and city officials have seemingly changed their tune.
               
               Larry Krasner, new Philly DA, won't arrest – or prosecute – the people using SIS facilities, arguing that it's a “form of harm reduction.” The number of opoid overdoses is an epidemic, and drug users are dying at record rates... and younger ages.
               
               Wouldn't it be better to try to reduce the number of open air drug markets, where dealers are slinging dope, and users are just injecting wherever they please. Researchers indicate safe injection locations don't cause spikes in neighborhood crime, and can decrease fatal overdoses.

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                  wildernessposted 6 years agoin reply to this

                  What makes you think that the number of open air drug markets will go down?  Do you expect drug sellers to frequent these SIS places, pushing their product there instead of on the street?  I'll add that nowhere except your post was there any indication that each "fix" would be tested before being used.  That seems nearly impossible to accomplish and I don't see it happening.
                  
                  Wouldn't it be better to try and reduce the number of addicts rather than making it safer or easier to continue the habit?  Resources are never unlimited; wouldn't we be ahead to use those resources to get even one addict cured rather than give 1,000 a safe, comfortable place to shoot up?

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                     Shogunposted 6 years agoin reply to this

                     There is no simple solution here. Even if we want easy answers. I'm sort of thinking that we won't agree on this topic regardless, but nonetheless, I'll share some further information – you can do with it what you wish.
                     
                     "Wouldn't it be better to try and reduce the number of addicts rather than making it safer or easier to continue the habit?"
                     
                     Oh. Of course it would be better to get people into treatment. But trying to convince a full on heroin addict to go to rehab, which requires a hellish detox, isn't going to simply work... even if they've been arrested for possession charges. I'd imagine it'd be more fruitful to have addicts go to a central location with staff present - and they can offer guidance and support, if it's wanted by the user. What people don't seem to realize is that an opioid abuser is going to be an addict forever. That craving or desire doesn't fully disappears, and it's a never ending battle. We cannot be shortsighted about this problem, because users are dying every day in the US.
                     
                     As this very well-written BBC story highlights about the Philadelphia opiod epidemic, where they've been clearing out shooting galleries and trying to get things done. I'll attach a screenshot of the text, instead of just copying and pasting it:
                     
                     
                     
                     Regarding the possibility of “enhancing” or “increasing” drug sales or drug trafficking, per NCBI: “CONCLUSION:
                     SISs have largely fulfilled their initial objectives without enhancing drug use or drug trafficking. Almost all of the studies found in this review were performed in Canada or Australia, whereas the majority of SISs are located in Europe. The implementation of new SISs in places with high rates of injection drug use and associated harms appears to be supported by evidence.”
                     
                     Also, it looks like Vancouver's first attempt has helped fight the tide of overdose deaths: “There is one such site in Canada though, in Vancouver, and statistics suggest it has stemmed the tide of dead bodies there. More than 700 injections take place every day in 13 mirrored booths and no one has died at the facility since it opened in 2003. The clinic estimates that it has prevented 5,000 fatal overdoses.”

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                  Live to Learnposted 6 years agoin reply to this

                  Reduce overdoses?
                  
                  Here's a cold blast of reality. A person not only ruins their own life when they tumble into addiction. Their actions reverberate through their family. For every moment they don't think about the lost opportunity, the danger of their existence, the embarrassment of their actions and the lack of consideration for all around, there are family members and friends who live in fear for that addict's life. Who live with constant mental anguish that they may have, somehow and at sometime, failed that human being.
                  
                  Those lives matter too. Providing safe injection and testing and fancy rooms to crash in while the high kicks in does absolutely nothing to aid those other people. It simply prolongs their angst.
                  
                  We got word that my husband's half brother died of an overdose. I listened as the family created this belief that he did it on purpose. That he was tired of being a theif and an addict. That he was really a great guy fighting some demon not of his own conjuring. It gave them comfort and ended their nightmare. I have to wonder if an injection site would have been a more comforting outcome to this sad and wasted life.

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                     wildernessposted 6 years agoin reply to this

                     "Providing safe injection and testing and fancy rooms to crash in while the high kicks in does absolutely nothing to aid those other people. It simply prolongs their angst."
                     
                     And that is exactly the problem I have with it as well.  We do nothing but prolong the agony - for both addict and secondary victims - instead of providing any real help.

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                        Live to Learnposted 6 years agoin reply to this

                        Agreed. An 'I'm OK, you're OK' philosophy doesn't cut it on this one. It's a picture needing correction, not tacit acceptance.

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                     Shogunposted 6 years agoin reply to this

                     Sadly, that's what makes this discussion so difficult. Finding some research for a different post led me to stumble across this story, where I found ....
                     
                     
                     
                     That quote from the researcher certainly seems even more accurate...

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                        Live to Learnposted 6 years agoin reply to this

                        Decreasing fatal overdoses and no spike in crime doesn't address the core problem of addicts. It enables them. That, to me, is a problem. Should we help them? Certainly. Should we enable them? Is that the right thing to do, or the convenient thing?

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                           GA Andersonposted 6 years agoin reply to this

                           Hi Live to learn, this may sound like a challenge to your perception, but I really ask it just to further the conversation.
                           
                           I would say, that an addict is going to do their fix - no matter what the conditions available. If they have a safe and cozy SIS, all the better, they will do their fix there. But if not, I say they will do it wherever they can; a fast food restaurant bathrroom, a car, or behind the dumpster in a blizzard. One way or another, they will do their fix.
                           
                           I do not think you will disagree with that. Do you?
                           
                           So, if the deed will be done - no matter the circumstances concerning it's "doing," how can an SIS be seen as enabling? Do you think an addict will wait for more convenient and safe circumstances to shoot-up if an SIS or warm bedroom isn't available? Do you think that the demons of their addiction that are demanding their "fix" as soon as possible will subside until safer and more convenient circumstances are available for the actual activity?
                           
                           Remember that we are not talking about casual users. Like the ones that always wait until after work, or when they don't have any complicated commitments, or a dozen other conditions that will cause them to wait awhile before indulging. We are talking about addicts that must do what they need to do, as soon as they can do it.
                           
                           I am slowly but surely getting past my own similar feelings that an SIS is an enabling action. If I could convince myself that an addict has the strength and ability to make the choice of whether or not to take their "fix', now or later, then I would still be struggling, but if I accept the common portrayal of an addict in the throes of needing a "fix," or ignore my own personal experience as a secondary victim, then I might be able to hold onto that "enabling" objection. But neither is the case.
                           
                           Tell me how you disagree with any of the addict assessments I made above, and why you can be certain about your thoughts that an SIS is enabling addicts.
                           
                           GA

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                              Live to Learnposted 6 years agoin reply to this

                              Were I completely certain I would not have opened a thread asking for comment.
                              
                              I think, our desire to find the compassionate route causes us to attempt to understand the SIS proposal. But, it lacks compassion on other fronts and ignores the rightful needs of other citizens.
                              
                              Will the user shoot up wherever and whenever? Certainly. But should there be taxpayer funded 'safe zones' where the illegality is set aside, the damage to society ignored, and the degradation of humanity itself is slightly mitigated by an attempt to ensure the act is medically monitored in order to avoid overdose? We enable the user by creating these surreal environments, giving them a semblance of acceptance.
                              
                              Can the pros outweigh the cons? I'm open to that consideration but I tell you, I've recently moved into a major city and I see many homeless and many appear to be perceptually challenged; so I assume drugs play a role.
                              
                              Is a SIS the answer or a curtain? The jury is still out. Giving them a safe place to shoot up does not address the core question of 'where do they get the money?' It doesn't set what I perceive as a realistic response to the question of 'how do we, as society, want to respond to this type of drug use'. It is not, in my mind, the preferred answer to 'how do we help'.
                              
                              But I also accept that tough love doesn't work because it's perceived by a weak mind as 'no one cares'. Maybe I don't care enough to hand someone a needle in a lawless zone and say 'have at it, I've got your back while you retreat from reality. I don't care if you mugged an old lady to get the money for the fix. I don't care that you live in the streets in a drug induced stupor. Your desires,no matter how much they damage society are important and deserve tax dollars invested in preserving your right to ruin your life.'

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                                 GA Andersonposted 6 years agoin reply to this

                                 Confidence in opinion is proving difficult isn't it Live to learn.
                                 
                                 You thoughts here are the ones that are denying me confidence in my thoughts also. Perhaps I need to go back to a more basic question: "Do I agree with a Needle Exchange program?"
                                 
                                 Based on my understanding that Needle Exchange programs are charity and volunteer based, and considering their primary purpose of controlling things that would certainly be a medical-based cost to our community, (I understand the compassionate secondary purpose of protecting the user), I think I can see the logic of those type of programs.
                                 
                                 But... I also think all of your arguments against an SIS would also apply to  an exchange program. It just seems to be a matter of degrees. Could my agreement with your reasons be set aside to accept a needle exchange program because I view that acceptance to be a small concession to gain the real benefit of those medical/health costs containment, without the thoughts of full-fledged enabling that an SIS is being seen as?
                                 
                                 Damn, this feels like I am thinking that you can be 'just a little bit pregnant'
                                 
                                 GA

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               GA Andersonposted 6 years agoin reply to this

               And that bud, is the question in a nutshell.
               
               GA

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   wildernessposted 6 years ago

   I would be hard pressed to approve of something that not only encourages but also subsidizes an illegal activity, and doubly so for an activity that almost inevitably results in further illegal actions against the community and surrounding people.  Heroin is not cheap, and few addicts can support their habit with legally obtained funds.

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   GA Andersonposted 6 years ago

   Interesting timing for you question Live to learn. A couple weeks ago talk began about a Safe Injection Site, (SIS), in my area. My first reaction was similar to Wilderness', but my second reaction is a bit more moderate.
   
   I am also not familiar with this concept - beyond the scope indicated by your OP. I think part of my problem with understanding this issue is a generational thing. To me, heroin use was the scourge of scourges. I did smoke pot in my younger years, (we won't ask about my "later" years ;-) ), and I snorted some coke, but I would never, ever, even consider touching heroin. A heroin addict was the bottom of the barrel of society. I have a hard time understanding the explosion of heroin use as an acceptable choice of intoxicants these days. I am still working on adjusting that mindset.
   
   I don't think I can agree that a SIS would encourage heroin use. Maybe that is because I still think of it as such n awful choice that I can't imagine anyone willfully making it. The facts of the explosive increase in heroin use proves that thinking wrong, but it is still a hard thought for me to change.
   
   As for his, (Wilderness), thought about the SIS program subsidizing addict's use, I can only guess he is talking about the free needles, and if so, then I disagree. It seems a very small "subsidy" price to pay for the obvious public health benefits achieved.
   
   And... per Aime's comment that her experience indicates both health and law enforcement authorities support the concept, I have to consider the legitimacy of their opinions. They are dealing with the nitty-gritty of the concept on a very basic level. If the cops see benefits in such a program, I have to give a lot of weight to their thoughts.
   
   But still ... I haven't been able to shake the feeling that a SIS is essentially condoning and enabling a horrible practice. I think my thoughts regarding that are not realistic in these current times - so I am still thinking about it.
   
   GA

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      wildernessposted 6 years agoin reply to this

      Buying needles is a subsidy, yes.  So is renting a location, providing 24 hr. nurses, janitors, utilities, management both on site and remote, Hazmat disposal, etc.  I think NIMBY would be a major, major factor as well; I'd fight tooth and toenail to keep one out of my neighborhood!  Needles aren't even worth mentioning compared to the rest of it.
      
      That cops approval rather surprises me, but I guess it would be better than finding OD's all over the city. 
      
      But, GA, I'm not sure at all that your thoughts "are not realistic in these current times".  Ask the family of addicts, the friends, the neighbors if THEY think it is a horrible practice.  Ask the hospitals, the rehab centers.  Ask those that deal with the results of it, even the addicts themselves, if they think it is horrible.  Seems to me that your reaction fits in very well with those that have dealt with it, either as an addict or as one of those "secondary" victims.  I would question more the morality of standing there, telling the addict: "Here; I won't help you in your great time of need...except to hand you a needle and get you to the hospital when you OD".  Is that the best we can do for them ("enabling" seems pertinent here)?  I see this more as a method for society to turn it's back, to somehow clean it up so it's not so visible and obnoxious.  We used to take mentally ill and disabled children out of society, locking them away and out of sight - this seems too much along those same lines.  Clean it up so on the surface it isn't so ugly any more, isn't so "in your face" and we can ignore it.
      
      I'll just add that I keep hearing that the path opioid abusers tend to follow is to hit heroin next.  With the epidemic of opioids, it seems foolish to think we can help heroin addicts continue their addiction without a huge fallout down the line.

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         GA Andersonposted 6 years agoin reply to this

         Buckle up and hang on to your seat Wilderness. Unfortunately I have personal experience in the area of addiction, (no not me! I was one of your secondary victims), and will offer you a perspective that I don't think you are considering.
         
         But first, the only "subsidy" I see in your lead paragraph is the needles, the rest are costs, and do not give the addict anything they wouldn't get if they shot-up or OD'd behind the 7-11. And regarding your thought that Opiod addiction leads to heroin addiction, I have heard testimonials to the opposite. Heroin addicts couldn't get their heroin, or wanted to kick the addiction - but still needed something, turned to opiods. Hmm... probably worth checking if it matters, but I don't have the interest.
         
         Here's the story that I think illustrates why I am uncertain about my "gut first thoughts," and your described perspective.
         
         My wife has a niece who she regards as almost a daughter. This niece is in her thirties. My family - my wife, is the only source of support for this niece's mother. Her father was forced into a "tough love" position. I don't fault him for that. After experiencing what I am describing, I was ready to do the same thing. But I am sure you can understand that a loving mother will never be able to do that to her child.
         
         After a couple years of police calls to go pick her up from where ever, or police calls to come get her from her mother's house, a restraining order meant she had to come live with us.
         
         My wife had two choices, try to help her in any way, or abandon her. Given the conditions, abandonment meant a very real possibility that the next police call would be from the coroner's office.
         
         I will forego the rest of the story, I think you get the idea. Addiction is not a rational choice, and it is not a voluntary choice - although the first choice to use something that leads to addiction was. I do understand the frustration of not understanding why an addict simply isn't strong enough to make the effort to kick the addiction - when every possible effort of support is made. But I have seen just that situation. Those TV versions of an addict having the strength and determination to "go cold turkey" are more fantasy than reality. This niece had a couple loving families trying to help, multiple trips to rehab - multiple types of rehab, but just couldn't, or wouldn't make the effort needed to get clean.
         
         So we arrive at the choice, the answer to your "Is that the best we can offer them?": Abandon them for the weak loser that they are - that's not a derogatory slur, it's a fact. Or hang in there and do what we can to try to keep them alive, (and keep trying for rehab), and mitigate the damage they will do to society - in this case by society I mean my family.
         
         That experience is why I still think my original, and still persisting thoughts - which feel like they should mirror yours, are not consistent with our times.
         
         My apologies. That was much too personal and downbeat to bring into our public forum, but I held, (hold?), the perspective you seem to, and I don't think I am right. I think offering a different perspective might be helpful to both of us.
         
         ps. you better find it helpful, you won't find a post like this from me again. ;-)
         
         GA

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            wildernessposted 6 years agoin reply to this

            Needles is the only subsidy, is it?  You don't count a warm/cool place to be for a while?  You don't count round the clock nursing as a subsidy?  Or that someone else cleans up after them?  Because I sure do.
            
            But I think we're misunderstanding each other somewhere.  I fully get that addiction is not really a choice (except the first few times).  I, too, have watched as a loved one went down the road, as well as other relatives a little further away.  And this SIS thing is, in my mind, the abandoning that you speak of.  We can do better and should.  It will take more than unlimited rehab - it will take additional training (brainwashing if you like) of younger children.  It will take a change in society to make mind altering drugs unacceptable.  It will take massive crackdown on dealers.  All plus lots and lots more rehab.
            
            But unless you're saying you approve of these SIS things, we agree and I still think it's not because we're behind the times.  Anyone that has been a victim, primary or secondary, will, I think, side with not doing this.  It really is abandoning those needing help the most - more than poor, more than homeless, maybe even more than sick or mentally ill - to their own devices.

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               GA Andersonposted 6 years agoin reply to this

               I am stuck Wilderness. My gut says hell no to an SIS, but my real experience says an SIS isn't enabling anything. An addict will do their fix - regardless of where or how. Behind a dumpster, a crack house, or an SIS. With a dirty needle they know is dangerous, or a clean one from an SIS.
               
               So what is the enabling of an SIS? My gut is in conflict with reality. They are going to shoot-up! Is an SIS enabling them by giving them a safer place to shoot-up, or a clean safe needle? I can't answer that enabling question with certainty, can you? I can answer it in principle, but my real life experience says that principle might not reflect reality. So, do I hold the principle, or accept that it needs further consideration?
               
               My experience with the available State rehab and medical assistance, (it was substantial and comprehensive), tells me we are all, state and family, making every reasonable effort to attack and treat the problem, yet no effort will succeed without the addict's commitment - something I think is too often not an option.
               
               So, I think I am leaning towards favoring an SIS. Besides the above logic, the police authority's support is a major point to consider.
               
               GA

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   PrettyPantherposted 6 years ago

   This reminds me of the debate over providing free and easy access to birth control to teenagers. Doing so has,been shown, time and again, to prevent unwanted  pregnancies and lower the abortion rate. These are positive outcomes that most people would support. However, many people cannot get past their" feelings" that teen sex is wrong and that providing free and easy access to birth control is the same as promoting teen sex. They want abstinence programs instead,  even though these programs have consistently been shown to be far less effective in preventing unwanted teen pregnancues and abortions. Moral judgment is getting in the,way of practical, though admittedly imperfect, solutions.

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      wildernessposted 6 years agoin reply to this

      Still seems to me that the major question is "what is our goal" with the SIS.  Is it to prevent "teen pregnancies" (addiction)?  If so, it won't work - we need contraceptives (rehab or better prevention).  If it is to raise the inevitable child (maintain the life of the addict) then it is useful.
      
      (I think I'm getting the metaphor mixed up, but do think that the priority of spending limited resources to prolong a miserable, bottom of the barrel lifestyle rather than using  those resources to change that lifestyle is the wrong way to go.)

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         PrettyPantherposted 6 years agoin reply to this

         Well, I'm not very knowledgeable about the program, but it seems one goal is to prevent deaths from overdoses. That is a worthy goal. To me, anyway.
         
         I empathize with GA's sentiments in this thread. I dont know any heroin addicts, but I do know a meth addict and have first-hsnd experience with alcoholic in-laws. They are all good people who are valued and loved despite their addictions.

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            wildernessposted 6 years agoin reply to this

            It is a goal.  It is just not one I would put ahead of ending addiction.  While I fully understand and sympathize with wanting to save lives, I believe that ending that terrible disease will save more lives than (temporarily) preventing a death from OD.  Without an end to heroin addiction that life is all too likely to end anyway, and with a cause directly attributable to the addiction.
            
            And I'm absolutely positive that ending the addiction will provide a better life for those that accomplish it.

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               PrettyPantherposted 6 years agoin reply to this

               Sure, ending the addiction would be preferable. In the interim, though, keeping the addict alive is also a worthy goal.

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      Live to Learnposted 6 years agoin reply to this

      Wow. Comparing ensuring safe sex for kids experiencing a natural urge to heroin addiction.
      
      I'd laugh, but something tells me you're serious.

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         PrettyPantherposted 6 years agoin reply to this

         Yes, dead serious. Preventing death from heroin addiction is at least as serious as protecting teens from unsafe sex. Addicts are people who are loved--sons, daughters, brothers , sisters, and more--and are human beings worthy of our help.

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