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Safe Injection Sites: What Are They & How Do They Work?

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The risks associated with intravenous drug use are dire. One hundred thirty people die every day from overdose in the US. The risk of dying from an opioid overdose is higher than that of a car crash. With opioid addiction numbers escalating and killing 400,000 people since 2010, some countries have become creative in an effort to control or slow down the death rate: safe injection sites.

A Safe Space to Inject: What is a Safe Injection Site?

Opioid addiction can lead to unsafe injections in unsafe places. Intravenous drug use in public spaces such as parks, tunnels, public bathrooms is dangerous. 

Safe injection sites give control back to the user in at least one aspect – their location of use. Safe injection sites are otherwise known as supervised injection sites, overdose prevention centers, and drug consumption rooms. They provide a user with a safe place to use with a ready clinician prepared to step in in the event of an overdose.

Some of the Services Provided by Safe Injection Sites:

  • Sterile supplies: This includes injection equipment, including syringes, clean cookers, filters, and tourniquets. They do not provide or inject clients with IV drugs. 
  • Secure environment, free from criminal prosecution: Small, open booths keep clients in view of clinicians. Legally sanctioned facilities are exempt from prosecution for having illicit drugs on the premises.
  • Lifesaving support: Clinicians on staff are ready with supplies to respond immediately to an overdose.
  • Withdrawal Management: Some safe injection facilities provide detox management services for clients. When users are ready to begin this transition, they will have access to clinician monitored facilities throughout the entire process and are paired with counselors for support. 
  • Primary Care: Many safe injection sites offer primary care services that include but are not limited to HIV/AIDS tests, Hepatitis tests, pregnancy tests, and sick visits.  

What is the Purpose of a Safe Injection Site?

Advocates for safe or supervised injection sites believe that they can become a bridge to treatment. The belief is that with the medical help provided in these sites, more overdoses can be prevented, and a larger number of IV users that need help can be reached. 

The overarching theory of safe injection sites is one grounded in harm reduction. Harm reduction is a set of strategies and ideas that intend to mitigate the negative impacts and consequences of drug use. 

As needle exchange programs gain broader acceptance in this country, safe injection sites can potentially pave the way to reduce harm for IV users and provide them with a safe space of acceptance and supply them with the knowledge that help is available. 

Overdose Prevention and Syringe Safety

The numbers do not lie: safe injection sites save lives. 

  • In Vancouver, BC, individuals living less than a ½ mile of safe injection sites saw overdose death rates decrease from 253 to 165 per 100,000 people per year. 
  • Before the safe injection sites opened in Vancouver, 35% of 598 intravenous drug users were admitted to hospital in a 3-year period, 15% for skin infections. After these sites were opened, the number decreased to 9%
  • Near one safe injection site, average monthly ambulance calls with naloxone treatment for suspected opioid overdose decreased from 27 to 9.
  • Educating IV users about safe syringe use at safe injection sites has decreased syringe borrowing from 37% in 1996 to 2% in 2011.
  • Out of 1000 injections, there is one overdose and no fatalities on record. 

Reduction in HIV/AIDS and Hepatitis Transmission

There is still a significant risk with intravenous opioid use for HIV/AIDS and Hepatitis C infection. In 2017, six percent of people living with HIV cited IV drug use as their source of the disease. 1 in 23 women and 1 in 36 men will become infected with HIV in their lifetime if IV drug use continues to climb. By avoiding needle-sharing and unsafe discarding of used needles, safe injection sites may reduce the transmission of HIV/AIDS and Hepatitis C. 

Long-Term &  Meaningful Help for People and Communities

While many have argued that safe injection sites encourage open drug use, It has been established that safe injection sites can save lives and lead users onto the path to recovery.  

  • Staff members of safe injection sites establish relationships with visitors. This can be incredibly valuable in helping to get these individuals into a treatment program or detox center. Staff members at these sites are in an optimal position to provide information to users for when they are ready to get the help that they need. 
  • Safe injection sites help destigmatize drug addiction by recognizing that it is a disease that requires long-term medical treatment. 
  • Safe injection sites decrease healthcare costs in cities that have these sites and increase the use of recovery centers and addiction programs. In 2016, San Francisco experienced a $3.5 Million savings in healthcare costs by merely opening a single safe injection site. 

Two white women talk, one is facing the camera wearing glasses, the other has her back to the camera. Both wear white shirts.

Are Safe Injection Sites Legal in the United States?

At this time, there are no sanctioned safe injection sites in the United States. As with the legalization of marijuana, individual states have the power to permit activity at their discretion. This can create a direct conflict with federal law under The Controlled Substances Act. Until a safe injection site is built, this federal law cannot be enforced. 

Additional Initiatives to Reduce Harm 

Individual cities across the US have created needle or syringe exchange programs to provide sterile supplies and proper disposal of used needles.  There are 320 needle exchange programs in 39 states. Unlike safe injection sites, these programs are unable to provide onsite staff to monitor use. 

In November of 2020, Oregon made great strides and became the first state in the nation to decriminalize hard drugs. Voters passed a ballot measure that decriminalizes possession of personal-use amounts of hard drugs such as heroin, methamphetamine, LSD, oxycodone, and others. 

Instead of going to trial and potentially facing time in jail, a person in possession of small amounts of drugs will now have the option to pay a small fine or to attend addiction recovery centers. These centers are fully funded by the millions of dollars that Oregon collects in tax revenue from their legalized and regulated marijuana industry. 

Sounds pretty radical, right? However, the measure will lead to fewer felony convictions – which ultimately create larger obstacles such as the inability to get work or find housing – and will help save lives. Additionally, the measure will reduce racial and ethnic disparities in both convictions and arrests.

While Oregon may be the first state to decriminalize hard drugs, other countries have already taken this step. In 2000, Portugal decriminalized hard drugs and saw no surge in drug use. Furthermore, drug deaths dropped while the number of people seeking treatment for drug addictions rose. 

While it may seem counterintuitive to decriminalize drugs, to create safe injection sites, or to pioneer a needle-exchange program, each act serves to destigmatize drug use. Through these measures, we can remove the shame associated with substance use and encourage those living with substance use disorder to seek help or – at the very least – to safely ingest. 

When a drug user asks for help, immediate assistance and support is critical. 

If you or someone you love is experiencing addiction, please visit our website at Integrative Life Center or give us a call at (615) 378-8806.

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