Drug overdoses in the United States have increased dramatically over the past five years. As a result, public health officials across the country have pushed for harm reduction policies. In December 2021, New York became the first city in the United States to open a supervised injection site, hoping that a safe haven for drug users would reduce overdose rates and disease transmission from used needles. Critics of the sites, meanwhile, point to the illegality of the drugs themselves and, by proxy, safe injection sites. However, neither side is really addressing the root causes of drug overdoses: in particular, the persistent gaps in access to health care.
Since 2015, overdose death rates in the United States have doubled. Initially, the spike in drug use coincided with the widespread use of fentanyl in drug production. As a more potent yet less expensive drug, fentanyl has gained ground in drug markets, especially for heroin. In turn, the United States saw an unprecedented rise in drug overdoses last year, totaling 100,000 deaths in the first 12 months of the Covid-19 pandemic alone. Growing increases in mental health issues, loss of social connections and diminishing access to treatment have led to record overdoses. In response, local health departments across the United States lobbied for safe injection sites.
New York City’s safe injection sites set an important precedent for drug policy. These sites were created with the aim of reducing the number of drug-related deaths from overdose and disease transmission. Equipped with clean needles, staff with emergency medical training and the opioid antagonist naloxone (which quickly reverses a drug overdose), officials hope these centers will tackle the immediate risks to drug use. Additionally, the promoters of these sites hope that they will disseminate information about rehab centers and treatment alternatives. New York is not the only US city to campaign for this public health intervention, however. Four other cities across the country have tried unsuccessfully to establish their own safe injection sites. But in March 2022, the Rhode Island Legislature passed a law that would allow private parties to submit applications to establish “harm reduction centers” controlled by the Rhode Island Department of Health. This pilot program will provide a clearer picture of Rhode Island’s opioid epidemic – which claimed 322 lives in 2021 – and save lives. This is the first national law authorizing safe injection sites.
In San Francisco, developers have come under fire for fears that these sites will promote crime in surrounding neighborhoods. Seattle & King Country Public Health “gave the green light” to the injection sites before facing a backlash from Acting Attorney General Jeffrey A. Rosen for their alleged illegality. In Boston and Philadelphia, Massachusetts Governor Charlie Baker and the United States Court of Appeals for the Third Circuit, respectively, have pushed for a legal approach to drug overdoses. In opposition to establishing safe injection sites, they cited the Drug Abuse Control Act 1986, which makes it illegal to operate a drug treatment facility. Although efforts in these places have been unsuccessful, the creation of safe injection sites in New York and Rhode Island illustrates important changes in the long-term management of the opioid epidemic. State legislatures and supporters of safe injection sites are now looking to the Biden administration for new direction.
Supporters of these sites hope that President Biden will follow the loosening drug policy of former President Barack Obama, whose Justice Department has not challenged the states’ legalization of marijuana. In a November 2021 press release, the Biden administration announced measures to address the “overdose epidemic.” Although the announcement did not explicitly name safe injection sites as a method of primary overdose prevention, it did outline the intention to establish “harm reduction, evidence-based treatment and recovery support for all Americans. Despite the Biden administration’s intention to manage the overdose crisis with more lenient policy, it has still failed to overcome the single most important obstacle to lasting change for people who use drugs: comprehensive drug reform. Health care.
“The site’s promoters in the United States, however, did not consider that the greatest obstacle to treatment is not the will of the users, but rather access to health resources.”
Rising rates of overdose and drug abuse are not unique to the United States. Proponents point to successful drug injection sites in Canada and Australia, hoping their own cities can mirror the drop in drug overdoses seen in those countries. In Canada, the pilot site in Vancouver showed a significant reduction in fatal drug overdoses. Since 2003, the site’s medical staff have responded to more than 6,000 overdoses. A study published in Canadian Family Physician found that establishing safe injection sites reduced HIV infections; another study published in the Lancet found that users of safe injection sites were more likely to seek treatment and less likely to engage in HIV risk behaviors.
Although studies in Canada have shown that safe injection sites can successfully reduce drug overdoses, there is a key difference between the United States and other developed countries with similar drug programs. One of the fundamental arguments in favor of safe injection sites is that these centers will act more than just a safe haven for drugs, but as a potential gateway to treatment centres. The site’s promoters in the United States, however, did not consider that the greatest obstacle to treatment is not the will of the users, but rather access to health resources.
The main difference between the United States and comparable countries with safe injection sites is access to treatment. In the United States, the lack of a comprehensive healthcare system means that in the United States it is “easy to get high and hard to get help”. Detox costs in the United States are high and not always covered by insurance. The total treatment cost ranges from $15,000 to $27,000, depending on the duration, location, and amenities of the program. Those struggling with a substance abuse disorder may not be able to afford these fees. According to the National Comorbidity Survey-Replication, 15% of people with mental health and addictions who refuse treatment cite lack of insurance or high costs as the biggest barriers to addiction care.
Establishing safe injection sites in the United States is an important step in ensuring the long-term management of the overdose epidemic. The effectiveness of safe injection sites beyond clean needles will, however, depend on a greater effort to implement accessible treatment for drug users. Without a healthcare system and a treatment plan to support safe injection sites, however, they won’t come close to solving the opioid epidemic.