A se­cret, su­per­vised place where users can in­ject drugs in U.S.

Re­searchers note that the pro­gram fo­cuses on ‘harm re­duc­tion’

The Washington Post Sunday - - POLITICS & THE NATION - BY LENNY BERN­STEIN leonard.bern­stein@wash­post.com

Some­where in a U.S. city, a small non­profit or­ga­ni­za­tion has been host­ing a se­cret site where users can in­ject drugs un­der the su­per­vi­sion of trained staff who pro­vide clean nee­dles and guard against over­doses, re­searchers said Tues­day.

The site, which is il­le­gal un­der fed­eral law, has been op­er­at­ing for three years, ac­cord­ing to a pa­per pub­lished in the Amer­i­can Jour­nal of Pre­ven­tive Medicine. It is part of the “harm re­duc­tion” strat­egy adopted by 98 fa­cil­i­ties in 10 coun­tries where su­per­vised in­jec­tion sites op­er­ate le­gally.

The ap­proach has been de­bated in the United States for many years, but it is gain­ing pop­u­lar­ity in some places as the num­ber of over­dose deaths from il­le­gal drugs con­tin­ues to sky­rocket. Cal­i­for­nia, New York City, Bos­ton and Ithaca, N.Y., are ex­plor­ing the idea. The county that in­cludes Seat­tle has ap­proved open­ing two lo­ca­tions.

“The whole coun­try knows this is a cri­sis. We need some new so­lu­tions,” said Alex Kral, an epi­demi­ol­o­gist for RTI In­ter­na­tional who re­vealed the pro­gram in a com­men­tary Tues­day. “We need in­no­va­tion at this point. This is not in­no­va­tion out of thin air. This is in­no­va­tion that’s been proven.”

More than 52,000 peo­ple died of drug over­doses in the United States in 2015, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Preven­tion. Data re­leased Tues­day by the Na­tional Cen­ter for Health Statis­tics show that num­ber may rise sharply, to about 60,000, when fi­nal to­tals are avail­able for 2016.

Kral, who has pub­lished re­search on sub­stance use for many years, said he was ap­proached by the or­ga­ni­za­tion and asked to col­lect data on the site’s op­er­a­tion. He and co-au­thor Pe­ter J. David­son, of the Uni­ver­sity of Cal­i­for­nia at San Diego, did not re­veal the site’s lo­ca­tion in their ar­ti­cle. Kral said the peer-re­viewed jour­nal did not ask for proof that it ex­isted, and the uni­ver­sity’s panel that su­per­vised the re­search did not re­quire that he re­veal its lo­ca­tion.

The ar­ti­cle’s data, taken from the first two years of the site’s op­er­a­tion, pro­vide a sober­ing glimpse at the hard-core ad­dicts who use the fa­cil­ity. More than 100 users who gave them­selves 2,574 in­jec­tions there were sur­veyed. Eighty per­cent are home­less, 91 per­cent are men, and 80 per­cent are white. The vast ma­jor­ity in­jected heroin, but some used metham­phetamine, co­caine or pre­scrip­tion opi­oids. On av­er­age, they in­jected drugs about 114 times per month.

Four peo­ple have been re­vived at the site with the an­ti­dote nalox­one af­ter over­doses dur­ing the first three years of op­er­a­tion, Kral said.

The pro­gram is open by in­vi­ta­tion only to drug users who are known to the non­profit group’s staff. Many other su­per­vised in­jec­tion sites around the world are open to any­one who wants to in­ject drugs. The clan­des­tine U.S. pro­gram op­er­ates four to six hours a day, five days a week, and is staffed by peo­ple trained to re­spond to over­doses and to pro­vide ad­vice on safe in­jec­tions. It has five small spa­ces where users can in­ject drugs and a sec­ond room with couches where they can re­main after­ward.

Cana­dian and U.S. law en­force­ment groups op­posed the open­ing of the first site in North Amer­ica, in Van­cou­ver, Bri­tish Columbia, in 2003, and many com­mu­ni­ties have raised ob­jec­tions about the im­pact that open­ing such a fa­cil­ity would have on their neigh­bor­hoods.

Re­search has shown that su­per­vised in­jec­tion sites re­duce deaths from over­doses, cut the risk of HIV and hep­ati­tis trans­mis­sion by elim­i­nat­ing needle­shar­ing, and pro­vide users with ac­cess to health and so­cial ser­vices, Kral and David­son wrote in their pa­per. For the sur­round­ing com­mu­nity, such sites re­duce pub­lic in­jec­tions, im­proper dis­posal of sy­ringes and drug-re­lated crime, they wrote.

The sites also help get some users into treat­ment by of­fer­ing them care and a chance to talk with staff in a safe, re­laxed place, said Taeko Frost, western re­gional di­rec­tor of the Harm Re­duc­tion Coali­tion, who has stud­ied su­per­vised in­jec­tion sites. “It’s re­ally hard to cre­ate any space or time for any­one to fo­cus on any­thing else when they’re wor­ried about not get­ting ar­rested or dy­ing alone,” she said. In Kral’s pa­per, more than 92 per­cent of users said they would in­ject drugs in a pub­lic re­stroom, park or park­ing lot, or on the street, if the site didn’t ex­ist.

“We re­ally ap­plaud the work they’re do­ing,” Frost said of the un­sanc­tioned in­jec­tion site. “It’s ex­tremely courageous to op­er­ate a life­sav­ing ser­vice like this.”

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