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 The clandestine operation – the first disclosed in the U.S. –
probably saved the lives of two visitors in two years when staffers
used the medication naloxone to reverse their overdoses, according
to an American Journal of Preventive Medicine report by researchers
who evaluated the facility.
Lead author Alex Kral called the privately funded social services
organization’s opening of the unsanctioned site in a hidden urban
location an act of “civil disobedience.”
Operators of the underground program opened the site in September
2014 after they tired of waiting for legislators to sanction
supervised injection facilities, Kral said in a phone interview.
“They basically said, ‘We’ve got too many people dying,’” he said. A
San Francisco-based epidemiologist, Kral directs the behavioral and
urban health program at RTI International, a nonprofit research
institute with headquarters in Research Triangle Park, North
Carolina.
An estimated 100 drug users injected themselves 2,574 times in the
hidden site in its first two years, according to statistics Kral and
his co-author Peter Davidson of the University of California, San
Diego, compiled from anonymous and confidential surveys.
The vast majority were homeless white men who injected heroin
purchased elsewhere. If not for the unsanctioned injection facility,
most of the site’s visitors told researchers they would have shot up
in a park, public restroom, street or parking lot.
As far as Kral knows, the facility he evaluated is the only one of
its kind in the U.S., though 11 other countries, including Canada,
have authorized supervised injection sites.
Since the first supervised injection facility opened in the Swiss
city of Berne in 1986, about 100 similar facilities began operating
in 66 cities across 11 countries.
As public health officials have wrestled with the fallout from a
growing opioid epidemic, U.S. cities from Seattle to New York have
considered allowing supervised injection sites. But no U.S. city or
county has been able to clear the political and legal hurdles.
Overdose deaths killed more than 52,000 people in the U.S. in 2015,
according to the U.S. Centers for Disease Control and Prevention.
Dr. Alex Walley, a Boston Medical Center addiction specialist who
was not involved with the new study, said the findings illustrate
the benefits of supervised injection sites.
“In the midst of the opioid crisis, which is hitting the United
States harder than any other country now, we need to use every tool
that’s working,” he said in phone interview.
“Not everyone who has opioid-use disorder wants treatment,” he said.
“It’s really important that we keep people safe and alive until they
come into treatment.”
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Critics object to enabling addicts to flout laws about illicit drugs
and say injection facilities could thwart efforts to treat and
prevent drug use. Advocates, however, contend that the sites save
lives, prevent needle-sharing diseases like HIV, and steer drug
users into treatment.
Advocates also argue that supervised sites help communities by
keeping drug users out of public places, where they can leave
dangerous refuse, unnerve passersby, and disturb businesses.
Some restaurant managers and librarians have begun to keep naloxone
on hand because people regularly overdose in their bathrooms, Walley
said.
In a prior study, Kral estimated that a 13-booth supervised
injection facility in San Francisco could save $3.5 million a year,
mostly in reduced medical costs.
To avoid telltale lines, the unsanctioned site allows access to
fewer than 60 people at a time. Employees of the social services
agency that runs the facility must invite visitors to the site,
which is open four to six hours a day five days a week.
The facility consists of two rooms, one with five stainless steel
injection stations equipped with mirrors and stools, and an
adjoining room for post-injection monitoring.
The facility is tiny compared to similar facilities elsewhere in the
world. In Vancouver, for example, in just three days, drug users
inject the same number of needles - about 2,500 - as injected within
two years at the unsanctioned site, Kral said.
Unsanctioned and unsupervised injection sites are popping up all
over the nation, including in an abandoned church in Philadelphia,
said Leo Beletsky, a professor of law and health sciences at
Northeastern University School of Law in Boston, who was not
involved with the research.
Plumbers frequently are summoned to fix public restroom pipes
clogged with discarded syringes, he said in a phone interview.
“We need to transition from having these spaces be hidden and unsafe
to being open and safe,” he said. “We can’t go on pretending this is
not happening.”
SOURCE: http://bit.ly/2wIDQqQ American Journal of Preventive
Medicine, online August 8, 2017.
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