“That’s a bridge too far for me.”
~Brian Moran, Seattle’s newly minted U.S. Attorney (Western District of Washington)
Adding to the rhetoric revolving around supervised injection facilities (SIFs), Mr. Moran hammered yet another nail in the coffin of dozens of proposed sites across the US. You don’t have to dig too deep to get a sense of how the conversation on US-based SIFs is unfolding. A quick Google search reveals both sides of an impassioned conversation, outlining a mountain of obstacles that currently prevent several states from opening their own facility.
Supervised injection facilities aren’t the gamble they’re made out to be. They don’t constitute boldly going where no [country] has gone before. Canada, Australia and many countries in Europe have supported these sites for decades. Evidence of their effectiveness is becoming increasingly difficult to ignore.
So, for a moment, let’s set aside the extraneous aspects that bog down conversations about SIFs: parties politicizing the issue, the optics of providing a government-sanctioned site wherein illicit substances would be consumed, moral perceptions, etc. Instead let’s get down to brass tacks: Do supervised injection facilities work? What does the data show? Do they constitute a sustainable solution to curb the opioid crisis that is largely responsible for their proposals?
Leaving Our Collective Baggage at the Door – What Do the Stats Show?
Overdose-related Death Prevention
There are numerous metrics from which to assess whether supervised injection facilities work, and death prevention rightly sits at the top of the list. Do SIFs successfully prevent overdose deaths?
Let’s take Vancouver, Canada, as the model for our discussion. The 1990s saw the number of fatal overdoses reach endemic levels in the city, especially in the Downtown Eastside (DTES). In March 2003, North America’s first medically supervised injection facility opened its doors in the heart of the DTES. Data collected between March 2004 until February 2008 shows that over 750,000 injections took place in the facility, with 1,004 overdose (OD) events (68% heroin, 17% cocaine, for those keeping score at home) occurring in that same timespan. How do those numbers compare to unsupervised injections in Vancouver during the same timespan?
You may have noticed a significant statistic missing above: SIF OD deaths. The reason for their absence? There were none! Not one of the 1,004 overdose events that occurred within the confines of the supervised injection facility led to death. In baseball terms, the DTES SIF was a ringer! Batting a thousand! Of the 1,004 supervised OD events, approximately half of them were assessed as potentially fatal and required administration of naloxone, a 911 call and/or an ambulance.
Data extrapolated from the DTES study led to the following conclusion: The potentially fatal overdoses in the SIF during those five years could have resulted in upwards of 51 deaths if they had occurred outside the facility.
Chalk up one point for supervised injection facilities.
Detoxification Service Usage
A longstanding fear of supervised injection facilities: Providing a safe place for drug use enables users. Is this fear founded in fact?
An independent study conducted in Vancouver, Canada, found that there was a significant increase of 30% among intravenous drug users in the uptake of detoxification services the year after the SIF opened. (The monthly average of users entering detoxification programs in the year prior to the SIF opening was 21.6, in comparison to a monthly average of 31.3 during the year after the SIF’s opening.)
Why the up-tick in detoxification among SIF users?
More than just supervising injections, the SIF has an addiction counselor on staff who seeks to bridge the gap between users and addiction services, and actively refers high-risk users to said available services.
Knowing is half the battle, it would seem. The study concludes that Vancouver’s “SIF facilitates sustained contact between the health-care system and a population which is normally highly marginalized and difficult to reach with conventional addiction treatment services.”
Death prevention in cases of overdose and an increase in detoxification?
2:0 for SIFs.
Do Supervised Injection Facilities Make Cents? (Ugh, I’m sorry)
The cynic in me realizes that many decisions are made by considering the bottom dollar above all else. How do supervised injection facilities hold up under this type of scrutiny?
How about another Vancouver-based study? The cost-effectiveness of Vancouver’s SIF was evaluated as follows: The monetary toll that transferable diseases and continued drug use/mortality would take on Canada’s public healthcare system compared to the potential aversion of disease transmission (such as needle-exchange programs) and overdose treatment that SIFs provide, as well as taking into account the cost of keeping the doors of an SIF open. Time for a table.
If we distill the nicely charted data, we find that needle-exchange programs alone account for savings of up to $14 million over 10 years. Safe injection practices and decreased disease transmission resulted in another $4 million over the same time span, with 1,175 life-years gained.
The study’s conclusion? “Vancouver’s supervised injection site is associated with improved health and cost savings, even with conservative estimates of efficacy.”
It’s a blowout!
Where Does This Leave Proposed US-Based Safe Injection Facilities?
This was by no means an exhaustive look at the topic. And it wasn’t meant to be. SIFs are a complex issue that demand time and energy that exceed the potential of a post on invisiblepeople.tv. Opening America’s first supervised injection facility is more than a curiosity. Findings from other countries demand that US lawmakers investigate the topic further. And as far as Seattle’s US Attorney is concerned, that might be the underlying problem.
The political stick in Seattle’s mud, Mr. Moran acknowledged that he hasn’t even studied the issue. That’s like reviewing a movie that he hasn’t seen. The US Attorney said that the idea of allowing people to inject toxic substances in a government-sanctioned site ‘is fraught with peril.’ (I would have said that a Paul Walker-less Fast and Furious sequel would be fraught with peril too, but egg would have been all over my face.)
We’re looking at an emotional knee jerk reaction to what should be a very data-driven decision. The ugliness of the solution makes people turn away in disgust and shirk the responsibility that lawmakers must investigate any potential answers to an issue that has remained unresolved for far too long. Not liking the way it looks on paper is a luxury we can no longer afford. In fact, we never could.
Albert Einstein (perhaps?) tells us that ‘the definition of insanity is doing something over and over again and expecting a different result.’ How long are we going to keep trying the same tired methods in efforts to get a handle on the opioid crisis?
[This was a heavy article. Lots of statistics to take in. You deserve a Fritz compilation.]