Supervised Consumption Sites
Debunking 6 Myths about Safehouse, the nation’s first Supervised Consumption Site
Supervised Consumption Sites (SCS) are at the forefront of national debate due to the proposed opening of Safehouse in North Philadelphia. While SCSs exist in several other countries, Safehouse would be the first SCS to be established in the United States. In September of this year, the Trump administration made moves to block the opening of Safehouse. Despite this, SCSs are gaining support- including amongst presidential candidates. Bernie Sanders, Elizabeth Warren, Andrew Yang and Bill De Blasio have all expressed their full support for SCSs.
According to the Health Department, in the first quarter of 2019 alone, there were 230 fatal opioid overdoses. As a city, we appear to be on track to surpass last year’s opioid related death toll, which was 937. That means that the overdose rate in Philadelphia is currently more than triple the homicide rate. While the Health Department has done phenomenal work distributing Narcan, training thousands of civilians in overdose prevention, and providing syringe disposal boxes throughout the city, the death toll will likely continue to rise without an SCS. SCSs are more necessary than ever, and are a critical way to prevent more deaths and provide much needed support for those who use drugs.
SCSs as a Harm Reduction Tool
To understand the concept of SCSs as a response to the opioid epidemic, we have to understand Harm Reduction. Harm Reduction is a public health framework, most often used in the context of high risk behaviors related to drug use. Some well known Harm Reduction measures include syringe exchange programs and Medication Assisted Treatment. But really, all of us use Harm Reduction on a daily basis. Some common examples are wearing a seatbelt to reduce the risk of car accidents, or looking both ways before you cross the street to reduce the risk of being hit by a car.
Harm Reduction values the inherent dignity and worth of individuals, and recognizes their ability to make the best choices for themselves when given the right resources. Harm Reduction recognizes that drug use has always existed, and will likely always exist. That said, much of the harms associated with drugs come from the prohibition of drugs and the context related to use, rather than the drugs themselves. For example, to evade law enforcement, many individuals consume their drugs in dangerous places, such as a railroad tracks, under bridges, and in abandoned homes. Such places often have no running water or sanitation, and individuals often end up sharing their syringes, or reusing them. SCSs reduce the harms associated with drug use; primarily death, overdose, and the spread of diseases.
It is critical to understand that a Harm Reduction approach does not require your acceptance of people’s choices or health behaviors. In fact, it removes our own opinions entirely, and focuses on enhancing the health of the individual and offering them the tools to make the best decisions for themselves. Harm Reduction is about meeting people where they are- it means that support is provided to individuals who use drugs regardless of where they are in their addiction and/or their recovery process. The support is not contingent on people getting sober, or approaching recovery in any particular way.
The debate about the ethics of a Safe Injection Site is rife with misinformation and misconceptions about the purpose and efficacy of such programs. Below, I’ve outlined six major myths about SCSs, and Safehouse in particular.
The Most Common Myths about SCSs
Safehouse is just a place for people to get high
SCSs are medical facilities that provide services from a range of medically trained professionals. These professionals include social workers, case managers, certified peer specialists and recovery specialists, all of whom are trained in overdose prevention. SCSs also offer counseling and referrals to treatment and education related to harm reduction. All participants will receive Narcan and training on how to use it. Further, individuals can be initiated on Medication Assisted Treatment in the facility, which is an evidence based approach to treating addiction. People can get medical services such as screenings and wound care. SCSs also typically offer drug testing, which is increasingly important given the high rates of contamination with drugs in Philadelphia. Fentanyl is showing up in most heroin at this point, and increasingly in cocaine as well. We are also seeing an increase in tranquilizers in opiates. Drug testing is a major Harm Reduction tool to reduce death and overdose caused by contamination.
SCSs aren’t effective
Safehouse would be the first SCS in the nation. While this is a new concept for the U.S, we can look to the significant body of evidence provided by SCSs in other countries. While this may seem like a radical concept for us in the U.S, this is something other countries have been successfully doing for years. The first SCS was opened in Switzerland over 30 years ago. The first in North America opened in Vancouver, Canada in 2003. In 2019, it is estimated that there are more than 120 supervised consumption sites worldwide.
We actually have a significant body of evidence suggesting that SCSs are incredibly effective in reducing overdoses, both fatal and non fatal, and connecting individuals with needed supports. A study of Vancouver’s SCS found that overdoses were reduced by 35% within 500 meters of the facility within 3 years of it opening. In Spain, overdose deaths were almost halved within a decade of opening.
Beyond this, SCSs prevent the spread of diseases, which often happens through syringe sharing. When people have a safe, clean place to use, the risk of spreading diseases decreases dramatically. A major concern brought up is the amount of syringes on the streets throughout the city. When SCSs are utilized, children are not exposed to people using drugs, and we don’t have to deal with syringes found on the floor in our neighborhoods. Reducing drug use in public spaces- something that is in literally everyone’s interest. Every person in Philadelphia wants a clean and safe community. SCSs are a reliable way to reduce drug use in public spaces and this increases general safety and wellbeing.
Safehouse will be paid for with public funds/taxes
Zero tax dollars or public funds of any kind will be used for Safehouse. Safehouse will be entirely funded by private donors. In May of this year, Safehouse was officially declared a non profit organization, and was granted tax-exempt status by the IRS. Interestingly, Safehouse is expected to save the city of Philadelphia at least $2 million a year in health care costs by reducing hospital visits, emergency room trips, ambulance services and providing overdose prevention services.
Safehouse will make drugs legal
No laws are changed due to the existence of any Safe Injection Site. The production, sale, and possession of drugs will remain illegal. No drugs or equipment are bought, shared, or sold at SCSs, and no staff member at Safehouse will be injecting anyone with drugs themselves. Noone under 18 will be permitted in the facility.
SCSs just enable drug use
When we talk about this, it’s worth breaking down what enabling actually means. Enabling refers to a behavior being incentivized by giving positive consequences for the behavior. The question then becomes, are we encouraging people to use drugs if we give them a safe and clean place to do it? A larger question for us to look at, is, has prohibition ever discouraged people from using? During alcohol prohibition, people continued to find many ways to drink, both in public and private settings. Alcohol has been proven to be one of the most addictive drugs of all. And yet, we have bars where we condone people drinking.
The fact remains that people will be using drugs regardless of whether there are safe places to do it, and regardless of whether they are given clean syringes. There are already injection sites in all of our neighborhoods. They’re just UNsafe consumption sites. But what we DO find, is that when people are given safe and clean places to use, the rates of death go down dramatically. Even if you believe that sobriety should be the only goal for treatment, the fact remains that people cannot get sober if they are dead.
Safehouse will discourage people from getting sober
There is actually a high likelihood that more individuals will be connected to treatment through services provided at Safehouse. Many individuals who are in active addiction are not connected to services or outreach teams, and would not otherwise have the services provided through SCs. There is not any data or research that supports the idea that drug use increases when individuals are given tools to use more safely, whether that is a SCS or syringe exchange.