The case for supervised consumption services2
Why the Safehouse decision is a big step forward in the fight against overdose
By: Brandon DL Marshall and Abdullah Shihipar
Last month, a federal judge ruled that the not for profit, Safehouse, could go ahead with opening a supervised consumption site in Philadelphia. The group had been taken to court by the federal government which argued that such facilities violated federal drug laws, specifically the “crackhouse statute”; a segment of the Controlled Substances Act, which makes it illegal to operate a venue for the purpose of using controlled substances. Judge Gerald A. McHugh, however ruled that Safehouse would “reduce drug use, not facilitate it”, effectively allowing the project to proceed.
Supervised consumption sites (SCS) are designated facilities where people can use pre-obtained drugs safely under the supervision of a medical professional or trained peer. These sites provide a safe environment for people to use drugs without fear of arrest. To some people, it may seem like allowing people to use drugs in the midst of an overdose crisis is irresponsible. However, evidence suggests that these sites are highly effective at stemming the rate of overdose deaths — particularly in the neighborhoods in which they are located.
There are over 150 SCS in the world, but the first one to open in North America was Insite in Vancouver, Canada. Since opening in 2003, 3.6 million people have injected drugs under supervision by nurses at Insite. This translates to 48,798 visits and 6,440 overdose interventions with zero deaths. In fact, our study in The Lancet demonstrated a 35% reduction in overdose mortality in the community after Insite opened.
[Embed map from Drug Policy Alliance]
While no officially sanctioned sites are currently located in the United States, there is one secret site that has been operating since 2014 at an undisclosed location. A study conducted on this site, which only sees people by invitation, found that 8,400 injections were made, with 26 overdose interventions and like at Insite, there were zero overdose related deaths. Feasibility studies have been conducted in American cities like Boston, San Francisco and Baltimore, all showing that people at risk of overdose would like to use such a facility. Moreover, SCS have been endorsed by the American Medical Society as part of a broader approach to fighting the overdose crisis.
“Since opening in 2003, 3.6 million people have injected drugs under supervision by nurses at Insite. This translates to 48,798 visits and 6,440 overdose interventions with zero deaths.”
At places like Insite, people who use drugs find a safe, supportive environment where they feel welcomed. Here, they forge relationships and build trust with healthcare workers and other support staff. These places serve as a nexus to connect people to other services, including treatment and recovery services. In fact, at Insite, frequent use of the facility and interaction with an in house addiction counsellor, were found to increase uptake of treatment services by 72 and 98 percent, respectively.
These sites also reduce sexual and drug-related risk behaviors that lead to the transmission of infectious diseases like HIV and HCV. They also reduce the public disorder associated with drug use — in Vancouver, the opening of Insite was associated with significant reductions in public injection drug use, discarded syringes, and injection-related litter.
One of the prominent talking points used against supervised consumption services is that they will increase crime, promote drug use, and increase the amount of injection related litter. In past studies, these claims have been debunked. There is no increase in crime, no change in drug use patterns or increase in youth drug use and as stated before, a decrease in injection related litter.
These sites have also been found to reduce the burden on emergency services. Here, people are encouraged by staff to employ safer drug use practices like going slower, or using less. In this way, SCS’ also prevent overdoses in addition to intervening in them.
In the rush to stem the rate of overdose, some solutions have been pursued that lack the backing of evidence-based science. Vox documented this earlier this year when they received hundreds of reports of families spending thousands of dollars on treatment that was ineffective or damaging. With the overwhelming nature of the crisis, it can be easy to get lost in the statistics and lose sight of the fact that behind the numbers are real people. Supervised consumption sites are not only backed by evidence-based science, they treat people who use drugs with the warmth, dignity and respect they deserve.
The Safehouse ruling represents a real opportunity to enact supervised consumption sites in cities across the United States, giving us another a tool to respond to the overdose crisis. Policymakers across the country must now decide if they will heed the scientific evidence and move us forward in allowing these sites to open, or if they will continue to obstruct the path towards progress.
Organizing for a safe consumption site in your community? Want to educate your friends and family on the issue? Download our info sheet below.