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      Photo Credit: Vancouver Coastal Health

      Why is the United States ignoring one of the most effective strategies against the Opioid Crisis?          

                 In the 1990s, Syringe Exchange Programs (SEPs) became a hotly debated harm reduction strategy. The practice of providing people who inject drugs with sterile syringes was originally developed in the Netherlands in 1983, and was eventually adopted by many other countries to combat the spread of HIV/AIDS and other infections. For many years, SEPs faced strong criticism in the USA by those claiming it enabled drug use, though the studies examining its impact showed that this was a fallacy. The practice significantly reduces the transmission of disease and infection via shared needles. Today, its efficacy as a harm reduction tool has long been proven though many legal barriers still prevent its application in many U.S. states.
      We are watching history repeat itself along the topic of Safe Injection Facilities (SIFs).

                 A Safe Injection Facility is a clean, safe environment where users can inject their own drugs under the supervision of clinical staff. As we face public health issues in the United States, we often forget that other countries have faced the same problems and in many cases have developed effective strategies to overcome them. In response to an epidemic of opioid abuse in Europe, the concept of SIFs was developed to facilitate low-risk, hygienic drug consumption, and reduce risk of fatal overdose and transmission of HIV and HCV along with other infections. The service also puts users in touch with social services, drug treatment services, and mental health services while reducing public drug use and unsafe needle disposal.
                 Opiate overdose is now the leading cause of death for people under 50 years in America, with a total of 64,000 deaths nationwide in 2016. The CDC reports that there are an average of 115 unintended overdose deaths per day in the US. New York City alone accounts for four of these deaths every day. How many unnecessary deaths until the US joins Canada, Europe, and Australia with the commensurate pragmatic and effective public health policy of Safe Injection Facilities?
                 SIFs vary in the details of their operation, but most follow a similar format: users can inject under clinical supervision with clean equipment. After injection, they usually go to a post-injection room to be treated for any wounds or infections, seek counseling, and receive other services. Palliative care is also available (food, showers, clothes, and laundry), and registered nurses, trained peer workers, and addiction counselors are available as needed. If an emergency occurs, the presence of trained medical staff and a well-equipped facility prevents it from becoming a fatality.
                 Though the first Safe Injection Facilities emerged in central Europe over 30 years ago, the practice continues to face strong resistance in the United States today – despite overwhelming evidence demonstrating its efficacy. Currently, there are nearly 100 SIFs in Canada, Australia, and Europe. None exist in the United States, though some cities are beginning to consider the idea. The “Opioid Epidemic” in our country has become a national issue, but our interest in exploring new approaches to harm reduction remains stubbornly absent. In her article, “How Much Evidence Is Enough?”, Professor Lisa Maher cites the large body of peer reviewed research demonstrating that SIFs reduce overdose fatalities, prevent needle sharing and unsafe syringe disposal, increase participation in treatment programs, and have not caused increases in drug use or crime. Furthermore, they are shown to be well accepted by the communities in which they exist due to the positive effects resulting from their presence. With this information in front of us, it seems unthinkable that SIFs continue to face powerful resistance in the United States.
                 By continuing to threaten people who inject drugs with arrest, we only add new elements of danger and difficulty to their lives. Heroin has been illegal since the passage of the Harrison Act in 1914 and yet continues to be a significant public health problem over 100 years later. This is further evidence that we are in desperate need of a new approach to this area of drug policy. Safe Injection Facilities keep people with addictions out of the criminal justice system and allow them to be treated more humanely by placing an emphasis on their health and well-being.

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