Jan 25, 2018
Philadelphia green lights safe-injection facilities; puts aside moralism and criminalization for something that actually works
by Christina Garcés
Philadelphia officials announced Tuesday that they would support the opening of a safe-injection facility, finally putting evidence-based medicine ahead of moralistic arguments claiming they enable addiction.
Safe-injection facilities (SIFs) are locations where individuals are provided a safe space to inject illicit drugs under the supervision of medical providers. If an overdose occurs, staff are standing-by ready to immediately administer Nalaxone (Narcan), the opioid overdose reversal drug. SIFs also provide supportive services such as wound care, HIV testing, and referrals to substance abuse treatment programs. Countless overdoses have been reversed at these facilities, and of the nearly 100 operating around the world, not a single fatality has been reported.
Numerous studies have been published confirming SIFs as a viable public health intervention, consistently concluding that they stop overdose deaths, get people into treatment, reduce spread of infectious disease, and decrease incidence of public injection and drug-related litter in their surrounding communities.
However, SIFs face staunch resistance in the United States, largely due to cultural and political ideologies deeply rooted in the decades-long war on drugs. Contemporary American understandings of drug-addiction have been inundated by the narratives of the drug war, which have presented drug-use as a radicalized, socially destructive behavior and a punishable crime. Consequently, addiction resulting from drug use has been primarily dealt with by law enforcement, allowing further narrativization of drug-addiction as a criminal issue, rather than a medical one, despite present-day medical understandings that addiction is a disease, and should be treated as one.
Last month, Vermont US Attorney Christina Nolan, threatened to prosecute anyone operating a SIF in her jurisdiction:
“The proposed government-sanctioned sites would encourage and normalize heroin use thereby increasing demand for opiates…It is a crime, not only to use illicit narcotics, but manage and maintain sites … [Thus] exposure to criminal charges would arise for users and safe-injection facility (SIF) workers and overseers.”
Attorney Nolan’s comments are indicative of the absurd and contradicting moralisms spouted by proponents of the drug war; they threaten to punish people who are trying to save lives while hyper-focusing on the false, alarmist claims that health care for people struggling with addiction would “normalize” drug-use to the extent that increased drug-trafficking would result, even though several studies already have proved this not to be the case. But even Philadelphia Police Commissioner Richard Ross, who started vehemently opposed to SIFs, admitted Tuesday to being swayed after hearing the first-hand experiences from law enforcement in Vancouver where Insite, North America’s first SIF, is located.
Nolan proposes that the “normalization” of drug-use would be disastrous, but healthcare providers know the significant role stigma plays in deterring drug-users from seeking help. SIFs don’t normalize drug-use, they de-stigmatize drug-use and in doing so allow individuals struggling with addiction to form trusting relationships with healthcare professionals who can help guide them into recovery. But rather than recognizing evidence, opponents like Nolan consistently fixate their narratives on the depravity of drug-using behavior, alluding to the individual’s failure to do the right thing. This subtle implication reveals what we’ve been taught to accept for so many years: people with drug-addictions deserve punishment more than they deserve care, because their poor behavior is more important than their health, and their crime more real than their disease.
Pennsylvania Attorney General Josh Shapiro recently justified his opposition to SIFs by asserting that “there is no safe way to inject heroin [or] fentanyl.” But there are safe ways to inject drugs: with sterile equipment and supervision in case of an overdose. Shapiro knows this, but he also knows such a statement immediately evokes an image that many will find instinctively repellent: Needles. Drugs. Injection. That is the true purpose of this statement, to prompt and reaffirm the narrative that all drug-use is absolutely deplorable.
It is also intentionally misleading. The suffering associated with the opioid epidemic is not a function of the injection, but the circumstances in which people are doing it. People get abscesses because they inject with dirty syringes; they die because they are injecting alone. In a safe-injection site, neither would happen.
Anti-harm reductionists also contend that opening a SIF would detract focus and funds from treatment and recovery initiatives, but they seem to conveniently forget that in order to enter a treatment program you need to be alive. We must remember that what we have today is not simply an opioid epidemic, but an overdose epidemic. Addiction is complicated, overdose is not. Naloxone and rescue breaths are all it takes to save someone’s life.
Philadelphia has the highest overdose death death rate of any major US city. In 2016 the death toll was 900, but that number has been steadily increasing. 1,200 deaths are projected for 2017- four times the city’s murder rate.
On Tuesday, Philadelphia city officials released a report, suggesting they could no longer justify prohibiting this life saving intervention. Thomas Farley, Philadelphia health commissioner, said,
“We cannot just watch as our children, our parents, our brothers, and our sisters die of drug overdose. We have to use every proven tool we can to save their lives until they recover from the grip of addiction.”
Dr. Farley’s comments signal a long-awaited admission by public officials; harm reduction works, safe-injection sites save lives, and we can’t wait any longer. We’re already thousands too late.
Christina Garcés is a student in the Urban Bioethics program and a medical student at the Lewis Katz School of Medicine at Temple University. She is president of Temple Med’s Prevention Point Board, member of the Latinx Medical Student Association and co-founder of SOL Collective, a harm reductionist group pushing for Safe Injection Facilities in Philadelphia. Her research interests include social justice in health care, particularly in areas concerning harm reduction, safer-injection, sex-workers rights, rights for incarcerated people and people who use drugs (PWUDs). She regularly volunteers at Prevention Point Philadelphia, Catholic Worker Clinic and Sex Workers Outreach Project/SWOP-Behind Bars.
