Public Health News: Supervision

Supervised Drug Consumption: Evidence-Based Public Health
INNOVATIVE STRATEGIES TO PREVENT OVERDOSE & REDUCE HARM

President Obama proclaimed this week as Prescription Opioid and Heroin Epidemic Awareness Week. In the Proclamation he asks us to “pause to remember all we have lost” and “recognize the importance of raising awareness of the epidemic.” With more than 28,000 people lost every year to heroin and other opioid overdose, public awareness is no longer enough. It’s time for action. Every day this week Harm Reduction Coalition will be concentrating several different evidence-based public health interventions that are urgently needed to turn the tide on the opioid epidemic.

Research has demonstrated that modifying the environment in which drugs are used is critical for preventing overdose fatalities. Supervised rooms for drug consumption are an evidence-based public health response to reduce harms associated with drug use. There are around 90 supervised sites for drug consumption globally operating across 3 different continents (Europe, North America and Australia). These facilities provide safer environments for drug consumption, as an alternative to using in public parks, restaurant bathrooms, libraries, parking lots, and other public or semi-public settings. Models include both supervised injection facilities (SIFs) and supervised drug consumption rooms; both have been successful in reducing drug-related harms and preventing overdose fatalities in several countries, including Canada (link to InSite), but have not yet adopted in the United States.

“The argument for safe spaces is that it’s better for both users and the public to have (people) injecting indoors in a place where they won’t die, rather than in a high-risk place like a park, alley, sidewalk, or indoors alone. In addition to providing sterile needles, staff members at safe injection sites typically carry the overdose antidote naloxone.” (Vice News)

The prescription opioid and heroin epidemic has propelled new interests in innovative public health strategies to prevent overdose fatalities and reduce drug-related harms such as HIV and viral hepatitis. Last week a county heroin task force in Washington state released a 100-page report which included a recommendation that Seattle-King County pilot at least 2 supervised rooms for drug consumption, which would be a first for the United States. The report’s rationale was to:

“offer a supervised place for hygienic consumption of drugs in a non-judgmental environment free from stigma, while providing low-barrier access to on-site health services and screenings, referrals, and linkages to behavioral health and other supportive services (for example, housing)” (King County Heroin and Prescription Opiate Addiction Task Force).

The model proposed for Seattle aims to engage individuals who use drugs and provide them multiple services and supports to reduce drug-related harm, including overdose fatalities, and to ultimately improve health outcomes. The proposal for Seattle is congruent with established models in Canada, Australia, Germany and several other European countries. These sites have been extensively evaluated and have demonstrated public health benefits for both people who use drugs and the wider community.

In late 2015 Harm Reduction Coalition convened a consultation with international law enforcement and public health experts to understand the local dynamics shaping the establishment and implementation supervised spaces for drug consumption. The consultation found that:

People who use supervised sites take better care of themselves, reduce or eliminate their needle sharing, use their drugs more safely, and ultimately reduce their drug use.

Participants to these sites gain access to other medical and social services and entry into drug treatment;

There has not been a single overdose death in any of these programs over many years of operation and many thousands supervised of injections;

The sites do not increase drug use in the area, nor do they encourage young people to initiate drug use;

Crime and public nuisance decrease in the areas around these programs.

As overdose rates show no signs of slowing across the country, we need to consider bold evidence-based public health interventions that are effective in preventing overdose fatalities, reducing drug-related harms and providing gateways to health care, treatment and support.

Next week more than 30 thought leaders around the country will convene in Baltimore, MD for a think tank focused on supervised injection facilities hosted by Project Inform. Harm Reduction Coalition has been part of the planning committee and will be participating in this important meeting. The goal of the think tank is to develop a national coordinated effort that drives public policy in support of SIFs.

The conversation on supervised consumption will continue at the 11th National Harm Reduction Conference in San Diego in November.

Read the report: Alternatives to Public Injecting.