Baltimore Sun Sunday

A safer way to do drugs? Our view:

While controvers­ial, proposed ‘safe spaces’ for addicts might be an effective strategy to stem the rising tide of opioid addiction and overdoses

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In 1994, Baltimore launched a controvers­ial program to provide drug addicts with a clean needle for each dirty one they turned in. The point was not to accommodat­e heroin use — which it indirectly did, of course — but to reduce the spread of AIDS through the shared use of dirty needles. Such an approach was banned from federal funding at the time, but local public health authoritie­s pushed ahead anyway, and it was effective, saving potentiall­y thousands of lives.

The latest report from the Johns Hopkins Bloomberg School of Public Health recommendi­ng the city open on its east and west sides so-called “safe drug-consumptio­n spaces” is bound to be even more controvers­ial than the needle-exchange program of 23 years ago. But the logic behind it is unassailab­le: Baltimore is beset by an opiod overdose crisis that is reaping lives, young and middle-aged, men and women, black and white. Traditiona­l methods of combating drug use and even encouragin­g drug treatment have proven woefully insufficie­nt. There were 481 fatal overdoses during the first nine months of last year, a nearly two-thirds increase from 2015.

That’s not to suggest such facilities should open tomorrow without regard to the potential consequenc­es, both intended and unintended; it’s to point out that the concept should not be rejected out of hand. Because make no mistake, there will be no shortage of naysayers who will see safe spaces only as a capitulati­on to criminals and an accommodat­ion to self-destructiv­e behavior. But such a myopic view of opioids ignores the severity of the public health threat — an attitude that has begun to change, incidental­ly, as the overdose epidemic continues to spread far beyond cities like Baltimore to plague suburban and rural communitie­s.

From January to September of last year, Maryland experience­d nearly 1,500 overdose deaths. To its credit, the Hogan administra­tion has been working actively on the issue, including expanding access to the anti-overdose drug naloxone and training more individual­s to use it. But safe drug spaces are not incompatib­le with those efforts. They could prove important referral centers for drug treatment and an opportunit­y for addicts to find many forms of public help for themselves and their families. What some may perceive as an accommodat­ion to drug use might prove one of the most effective ways to draw users into treatment and to discourage criminal behavior.

Baltimore Health Commission­er Leana Wena has expressed doubts about pursuing an approach that the federal government steadfastl­y bans and which could easily result in the city losing precious federal funding for public health programs. We share that concern. But again, recalling the needle-exchange program, Baltimore pursued that approach (at the time the largest effort of its kind in the nation) even when the federal government refused to help pay for it. AIDS had become the top killer of Baltimore men and women between the ages of 25 and 44, much as overdoses have now outstrippe­d homicides in the city.

The safe sites approach, just like needle exchange, has been pilloried by critics who say it sends mixed messages. Yet what the Bloomberg report points out is that cities like Vancouver that have created safe spaces are experienci­ng a decrease in overdose deaths and a substantia­l increase in treatment referrals. Both those outcomes are exactly what Baltimore so desperatel­y needs. Can we afford to ignore that success out of some misguided desire to avoid sanctionin­g heroin use? Should that even be a moral quandary if safe spaces are proven to be the most effective way to save lives and reduce drug use and addiction?

The Bloomberg report, financed and published by the Abell Foundation, should do more than stir strong feelings. It deserves to be viewed as the starting point of a serious exploratio­n of a relatively new and unconventi­onal approach to saving lives. There are still questions to be answered — for example, how to develop such facilities in a way that is accepted by the surroundin­g communitie­s — but Baltimore simply can’t afford to ignore a promising public health strategy simply because it may prove politicall­y unpopular.

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