Many communities that hard being hit particularly hard by the opioid epidemic are looking for innovative ways to increase efforts to reach out to PWID and reverse the exponential increases in overdose deaths, infectious disease, and substance use in their regions by operating supervised safe injection sites. The city of Philadelphia is well on its way to becoming the home to the first of such sites.
In October, U.S. District Court Judge Gerald McHugh ruled that opening a safe injection site in the city of Philadelphia would not violate a 2003 law that prohibits the operation of a facility for illegal drug use. The judge held that since the purpose of operating such a site is to navigate PWID towards care and treatment, rather to promote continued substance use, such facilities would not violate the law. Harm reduction programs such as syringe services programs that provide sterile injection equipment to people who inject drugs (PWID), naloxone opioid overdose reversal medication, medical care, and a host of other services, have been at the forefront for the past three decades as vital tools to provide non-judgmental, accessible care to this population. However, these programs are often shunned in communities both by citizens and legislators as enabling drug use and criminal activity. Safe injection sites are the newest type of harm reduction initiative being proposed to address this public health crisis, and studies show that they are highly effective in reducing overdose deaths and rates of infectious diseases such as hepatitis C and HIV. Philadelphia’s leadership has been supportive of this effort, despite significant push back from the U.S. Justice Department to prevent these sites from ever opening.
Overdoses, largely from opioid drugs, are the main driver of drug-related deaths in this country, causing over 70,000 deaths in 2017. The rise in injection drug use associated with opioid use disorder over the past decade is also largely responsible for a 380% increase in cases of hepatitis C in the U.S. since 2010. The public health and social consequences of this issue are significant and catastrophic, yet the response to it in many communities has lagged far behind the need.
Political and social will have been slow to act due to lingering negative attitudes about drug use that frame it as a personal choice and moral failing, rather than a health condition worthy of compassion and treatment. This is despite established clinical and research evidence that proves that harm reduction efforts aimed at improving drug user health are an essential and highly effective means of engaging people with substance use disorder in disease prevention, substance use treatment, and addressing their other well-being needs. However, it is past due that politicians and the public writ large acknowledge that the status quo is clearly not having the needed effects to address the opioid epidemic, and more acceptance and support of the need to pilot unconventional strategies to reverse the adverse outcomes associated with this crisis are needed if we ever want to see significant progress. We failed the millions of people who died, were jailed, or suffered with crippling addiction during the crack epidemic in the 1980s and 1990s when the focus was on punishment, not treatment. The U.S. needs to humble itself to that mistake and take the needed out-of-the-box leaps of faith needed to end the nation’s opioid and hepatitis C epidemics.
