State your case: Should law enforcement endorse safe injection sites?
Since two overdose prevention centers opened in NYC in late 2021, health department officials report they have prevented 59 overdoses
In late 2021, the nation's first safe injection sites, also called overdose prevention centers (OPC), opened in New York City. Drug users can bring their drugs to the sites where trained staff provide clean needles, monitor them during use and can provide naloxone if necessary.
The NYC Health Department reports that, in the first three weeks of operation, staff at the two OPCs averted at least 59 overdoses to prevent injury and death. In the first three weeks of operation, the centers have been used more than 2,000 times.
“These data are promising and show how Overdose Prevention Centers will reduce needless suffering and avoidable death,” said Health Commissioner Dr. Dave A. Chokshi. “The simple truth is that Overdose Prevention Centers save lives – the lives of our neighbors, family and loved ones.”
In December 2021, the Fund for Public Health, a non-profit organization in New York, opened a request for proposals to install public health vending machines that will dispense naloxone and clean needles in an effort to help those who are "disproportionately burdened" by overdoses.
In a recent poll, Police1 asked readers if safe injection sites can help reduce drug overdoses. Here's how you responded.
Read our columnists' take on this issue and share your opinion below.
The ground rules: As in an actual debate, the pro and con sides are assigned randomly as an exercise in critical thinking and analyzing problems from different perspectives.
Our debaters: Jim Dudley, a 32-year veteran of the San Francisco Police Department where he retired as deputy chief of the Patrol Bureau, and Chief Joel Shults, EdD, who retired as chief of police in Colorado.
Jim Dudley: I am steadfastly against the idea of legal supervised drug injection sites anywhere in America. This is the latest example of a social experiment with deadly consequences and a major threat to the rest of those who are not active intravenous drug users.
Harm reduction policies are often created with the knowledge that a harmful or illegal behavior may be adjusted to reduce harm. Safe injection sites seem to be encouraging rather than discouraging the illegal use of intravenous drugs. In this case, it creates a “normalization” of illegal and harmful drug use.
The message of a state-sanctioned “legal supervised drug injection site” is preposterous. We are talking about illegal drugs that are harmful and addictive at the federal level and in most states in America today. We are at a record-breaking pace over the past few years of overdose deaths across the country, with over 700 recorded in San Francisco alone in 2020.
The research so far is inconclusive at best as to whether drug injection sites create positive or negative results. We have seen catastrophic events over the past few years of other social experiments regarding de-funding the police, bail reform and decriminalization of crime statutes.
In the vein of drug use (pun somewhat intended), free needle programs that give out free syringes for drug injections have reduced the widespread diseases associated with the use of shared "dirty needles" among users. But when the details are examined, with so many needles given out (approximately 4.5 million per year) not nearly the same amount are returned, with dirty needles showing up on our nation's streets, in doorways, at parks and other public spaces. As a result, another $1 million in San Francisco's budget for example is reserved for needle pick-ups from public areas. I’m not sure where any sort of “prevention” aspects come from the free supplies given at needle exchanges, where verbiage states:
We provide safer injection supplies like cookers, cotton (small and large), alcohol wipes, sani hands, sterile water, saline, tourniquets (both latex and non-latex), and vitamin C. You can also get safer smoking supplies like aluminum foil, pipe covers and brillo, wound care and medical supplies like gauze, medical tape, hot hands (instant hot compress), Band-Aids, saline and triple antibiotic ointment.”
Joel Shults: Jim, you use the phrase “social experiment” to describe safe injection sites. We’ve been experimenting with a lot of things for over 100 years.
The federal government enacted its first drug regulation with the 1914 Harrison Act, which means we’ve been trying to control drug use for 108 years. In 1875, San Francisco attempted to regulate opium dens. The 1920s saw a brief experiment with banning alcohol. The successes of prohibition are overshadowed by its failure. During the 1950s, federal sentences were increased, including the death penalty for selling heroin to minors. The social upheavals of the 1960s saw debates favoring legalization vs. harsher penalties. The 1970s saw Nixon’s war on drugs declaring drugs “public enemy number one.” His recommended legislation included prevention and treatment, but that part got little attention. The 1980s saw the crack cocaine epidemic associated with the rise in violent crime that had spilled into suburbia from the inner city. The 1990s saw a ramping up of law enforcement and a building boom in prisons. Mandatory minimum sentences and racial disparity in sentencing attracted attention in the new century. In recent years the decriminalization of drugs, particularly marijuana, defied federal law and the Obama administration chose not to fight it.
The point of this little history lesson is to ask what have we accomplished in the 100+ years of trying to keep people drug-free? Can we rely on law enforcement and the courts to accomplish this goal? Maybe a strategy to keep people alive long enough to maintain the hope of recovery isn’t so wild after all.
Jim Dudley: Joel, I agree with the idea of keeping America “drug-free” is an impossibility. However, with respect to the 100 years of social experimenting – except for the horrendous alcohol prohibition policy from 1919-1933 – we have made some policy moves to keep drug abuse issues from going off the rails, as we have seen since the end of the “drug war” where we turned the keys to the car over to public health.
Advocates and proponents of drugs have moved from “compassionate use” to de-criminalization to recreational and now, as we have seen in Oregon, to full on legalization. The normalization of drug use, from marijuana to federal schedule 1 hallucinogens and opiates, has created an explosion of overdose deaths as never seen before. Property crimes may be attributable to the trend to decriminalize as well.
Whenever people talk about legalization, I always ask if we will be giving drugs away for free as well. An unknown number of auto and home burglaries are certainly perpetrated by those with serious drug abuse and addiction issues.
One aspect of the injection sites is that drug testing will be done. An individual walks in with their street drug and has it tested before use. It is unclear what will happen when the drug tests for high amounts of fentanyl or other dangerous substances. Will the sample be destroyed? Be given back with additional naloxone on hand? Will “clean” drugs then be substituted?
There’s also the matter of the target audience who will be using injection sites. They are often homeless, drug-addicted and many suffering from mental illness. Does this cater to their addiction, in hopes of saving their lives, only to continue down their self-destructive path?
I also wonder what effect the city and state-sponsored injection sites (illegal by federal standards) will have on the public and impressionable youth, in particular. The message is a muddy one, to be sure, and a mixed one that says “drugs are bad and harmful, but not to worry, we will make it safe for your consumption.”
In reading studies on the viability and possible consequences of a “legal injection” site in America, the ones I have read are speculative, since there is only one currently in America today. We do not compare with other nations that may have different laws, cultures, resources and attitudes. We have seen the toll on lives and families with the harm reduction attitudes, policies and programs in cities where misery and blight are often accompanying consequences. Let’s not add to the problems.
Joel Shults: I think a good argument for harm reduction is harm reduction for the population at large. A decade of experience in 120 locations across 10 countries can’t be ignored. Their reports show less drug paraphernalia litter in neighborhoods, fewer overdose fatalities, and reduced disturbances related to drug use and sales. The centers provide access to intervention programs, as well as reduce HIV and drug-related sexual encounters.
There’s no question that the concept makes us a little queasy, kind of like hearing a parent give up and let their teenagers drink and party in the basement because “at least we know where they are.” I’m not much more enthusiastic about that than I am about safe injection sites. It smells of giving up. However, it will be the numbers that prove any results.
I hope that data on more than just overdose deaths are measured, such as the use of treatment programs, neighborhood safety and eventual reduction in demand. Might work, might not, but on balance, it’s probably worth trying.
Police1 readers respond
- The question alone is an oxymoron. Misleading at best, propaganda at worst. It’s similar to the claim that naloxone prevents overdoses when in reality overdoses are way up. Naloxone prevents some deaths, but only temporarily. People who have survived overdose with naloxone on average postpone their inevitable death. Injection sites might make some misguided people feel good about themselves, but it just handing an addict a gun with clean new bullets to shoot themselves. As a recovering addict and certified drug counselor, I know addiction better than most, and nobody ever wakes up and gets excited and happy to hustle for money, score dope and shoot up anywhere no matter how safely, just to stop the withdrawals. In fact, we hate being addicted, and all of us want out. Until you have been completely overtaken by addiction you will never understand the hell that is addiction. All this virtue signaling just wastes money on a feel-good stopgap. That money should go toward more treatment centers, detox facilities and increased attention to MAT, using suboxone as a real stop gap on the road to recovery. There need to be thousands more treatment centers and hundreds of thousands of new counselors paid what they deserve, not encouraging addicts to use “ safely.”
- When I read the article I don't see reduced overdoses, I see reduced deaths from the overdoses. I am also unsure how Vancouver could claim to have prevented 35 cases of HIV, this is just conjecture. I see allowing the use of illegal drugs, be it for safety, seems to be more criminal justice. We used to just call it justice, This program is akin to the idea that fewer traffic stops have less opportunity for bad interactions. What if the violators just comply, so we have fewer violent interactions? I am sure that drug possession arrests went way down when they just say, it's OK, I'm on my way to the safe injection site. When I see 940 life years added over 10 years, does that mean that 94 people lived one year longer in each of the ten years? I am with Jim Dudley on this one all the way.
- Yes, dramatically. So many women will wait to do their drugs until they get on-site to avoid being molested or raped. And people who feel less stigmatized are more likely to respect themselves enough to get treatment.
- Coming from Vancouver, I KNOW that safe injection sites reduce overdoses. Besides established safe injection sites, certain subsidized housing buildings supply clean needles and areas where citizens can use drugs in a safer manner than on the streets. Despite this, as I travel to the eastside at least once a week, there are clear signs of overdose and death in plain sight. There is no way to completely remove drugs from the streets but the government has the ability to control its use and to a certain extent, regulate it. Instead of people hiding behind dumpsters in alleys, hiding from the cops and sharing the same needle between a group, having a safe space to take a smaller dose of a drug that has been tested is a positive alternative. Addiction needs to be gradually reduced in individuals and it would be naive to sit here and say "We should be putting money into programs that eradicate drugs versus encouraging their use." I don't believe safe injection sites promote drug use but rather promote public safety and emphasize the ideology that safe spaces exist for the citizens of a city. By increasing the life span of drug users through reductions of overdose, the hope that drug users become clean in the future remains a possibility, which is a possibility that would not exist if said users overdose and die on the streets. At the end of the day, drug users understand the consequences of their actions and slow introduction to the idea of services that can help them with their addictions will without a doubt help in the long-term in dealing with the drug crisis.
- I find the discourse on this page lacks an acknowledgment of several items. First, we need to acknowledge that, while safe injection sites are pretty new in the U.S., Vancouver's Insite facility was founded in 2003. In their almost two decades of existence, they have registered over 3.6 million visits to their facility and recorded 6,440 overdose interventions. Zero people have died at their facility. Zero. This information is freely available on their site, linked here for fact-checking purposes.
In fact, no one has died at one of the more than 100 safe injection sites established globally. So, we have established that these sites are in fact, safe. Let's review some of the common attacks against safe injection sites.
People claim that this will lead to spikes in crime; that this will encourage drug use; on this very page, someone claimed that it will end up costing him money. The University of Pennsylvania's Wharton College conducted a study of Insite and determined that Insite has saved the city of Vancouver $14 million over 10 years, in addition to saving roughly 940 "life years," which presumably can also impact economic activity. Insite prevented 35 cases of HIV annually, with savings of $1.6 million per year. A model for San Fransisco, noted in this article, predicted that for every dollar spent on a safe injection site, the facility would generate $2.33 in savings. I hope this assuages some concerns.
Moving on to the second point, Insite provides a valuable model for how we should base these facilities in the US: right above the SIS is a rehab facility, and recovery resources are available for all who visit. Co-locating recovery resources near safe injection sites provides a valuable opportunity to help individuals suffering from drug addiction; an opportunity that Insite took advantage of. Between 2003-2006, 46% of visitors ultimately sought treatment for addiction. The National Institutes of Health noted that Insite's opening was associated with a 30% increase in detoxification service use and that this behavior was associated with higher rates of long-term addiction treatment. Rather than encouraging drug use, increased use of detox services was observed.
Finally, a common refrain is that safe injection sites will cause increased crime in a number of ways. The data simply does not back this up. Only one instance exists globally where higher crime rates correlated with the establishment of a safe injection site, but it is far from clear that the establishment brought higher crime. We are, after all, still debating what caused crime spikes in the previous millennium.
The obvious rejoinder to much of my argument and data is that I am relying far too heavily on data from an area that is not even within the U.S., and models from various academic or health institutions. That is a very valid point. But it reinforces my point. The data is so overwhelmingly positive in these few cases outside the U.S. that it merits experimentation and trials within the U.S. The number of opioid deaths has been climbing for years, partially fueled by synthetic opiates and fentanyl – stronger drugs that are more resistant to naloxone. We have been presented with an as of yet unexplored opportunity to reduce the number of Americans who die from opioid overdose, with positive implications for long-term public health costs. Whether we take advantage of this opportunity will reflect how willing we are to abandon a parochial view that universally faults drug users and views law enforcement as the only solution.
- While safe injection sites may reduce drug overdoses, it also encourages continued drug use. I read the word "free" many times referring to the actual site, needles, sterile water, saline, cotton, etc. We all know nothing is free, I will end up paying for all of this because I work, pay taxes. I don't believe this is a good idea to implement for those reasons. If we are going to spend other people's money, let's encourage these folks to change their lifestyle and help them to get free of their addiction, not encourage it.
- Quit giving up and falling for the media position that the drug war is lost. Addicts have to be convinced to help themselves to become clean, not led on by sites and Narcan use. Prosecute the dealers with all that is possible. Give them long jail terms and when they cause death it should be a mandatory life sentence.
- An addict who wants an immediate "fix" will pay little to no attention to a specific location where they can use. San Francisco already has a safe injection site, called the Tenderloin. An addict here will not look for a location to use "safely" when they can use on the street without penalty or consequence. There are droves of individuals, including officers, armed with naloxone (Narcan) who have administered it countless times. Until the rules of engagement change and addicts may be mandated into treatment before they get to the irrevocable state of "gravely" disabled (from which it is extremely difficult if not impossible to recover), there will be no solution to the problem.