Injection Sites Prove Merits of Adult Use Toleration

In my book Kill the Drug Trade, I advocate a reformed system of allowing adults to use safely manufactured drugs by adults as the better way to keep harmful substances beyond the reach of the young and vulnerable. According to a CASA study, 90% of substance use disorders stem from initiation under age 18. Other than for marijuana, most Americans have a hard time getting their heads around the concept of use toleration, though it would drive out illegal drugs accessed by teens and preteens.

Though people generally know about the harms of our pursuit of drug prohibition, most remain woefully uninformed. We understand that arrest records damage educational and employment careers. We grasp that jails and prisons are crime schools for the young, and that jailing parents may unnecessarily wreck the lives of their children. People read almost daily about the massive violence and corruption endemic to the illegal drug trade that arose because of prohibition, and that many addicts commit crimes because of a desperate need for drugs they can’t afford. What is seldom understood is how prohibition promotes and maintains substance use disorders forcing users to buy their drugs from sleazy peddlers and to lard their lives with drug-use reinforcing relationships and other cues that trigger drug craving.

What keeps setting the addicted back, mentally trapped in an erroneous self-identity, is what they see in the eyes of the rest of us: condemnation and hostility, blame for their condition and circumstances,  their objectification as subnormal people, contempt for their  “weakness” and failure in life, and the aim to punish and teach them a lesson. They don’t get that kind of negativity from people who understand the processes of recovery.

The addicted often respond effectively to minimal motivational counseling and go right to work on their own sobriety. That alone should tell us something, but in the past several years mountains of new evidence have emerged that when, without demanding abstinence, we give people the space and time they need to come to their senses, they do.

Clean needle exchanges often help addicts, who, as program volunteers, develop relationships with caring people and gain a new self-respect that encourages them to move toward rehab.

Even more impressive proof comes from the supervised injection facilities (SIF), which are legal in several European countries and in Canada’s British Columbia. Typically these facilities offer a clean, well-lighted place to inject drugs brought in by the user, under the supervision of a nurse who provides guidance in safe injection methods and is ready with nalaxone to treat overdose. Lives are being saved. And, these facilities promote sobriety as well.

Insite in Vancouver, pictured above, is a $3 million dollar a year operation. Nurses and counselors  oversee and instruct on safe injection practices and, when requested, provide counseling toward rehab. A second floor of the building provides private rooms with beds where a user can detox for up to eight days, and a third floor recovery facility where they can stay for weeks.  An up-to-date YouTube video describes the amenities. The data collected there indicate substantial rehab success rates as well as reduced disease spread and lives saved.

In the U.S. such facilities have shown similar benefits, though they are underground and so cannot offer the professionalism like Insite’s. Registered nurses could lose their licenses. All that can be offered here is clean paraphernalia and a safe space. Still results are phenomenal.

One such facility began in 2014 with a renovated restroom designated for injecting drug users. Later that year the operating organization converted two rooms into a monitored injecting space equipped with clean needles and disposal facilities, with a separate room for users to recuperate and rest. Even with only limited word of mouth advertising the site attracted more than 100 individual users. Around 80 percent of those were homeless and more than 90 percent of them said they would otherwise have shot up in a public space such as a street, park, parking lot or public bathroom.

The site was described in a recent report by KTVU in San Francisco, about a cost benefit study sponsored by the city, which showed SIFs produce reductions in blood carried diseases (HIV, Hepatitis C and STDs), prevent overdose deaths, and get more people started in rehab.  The study was headed by an epidemiologist and the researchers estimated savings from operating a SIF in San Francisco based on mathematical models that combine local public health data with previous research on the effects of existing SIFs. They found that each dollar spent on a 13 booth SIF in the city would generate $2.33 in savings, for a total annual net savings to the city of $3.5 million.

Hidebound prohibitionists continue to argue that such programs promote acceptance of drug use and enable addiction. Those are ignorance-based arguments. There is a host of sobriety promoting facets to programs such as Insite, which provides a full range of services. They try to create one on one relationships so encouraging to the addicted. The counselors don’t preach or cajole,or make the users feel even more guilty than they do already. Instead they are on hand as friendly coaches to be accessed by the users when wanted.

That’s a formula for success; one that could be adapted to an adult use tolerant system.

© Rights reserved to Dave Finch 1/19/2018

For a preview of my book and more detail on my use-tolerant reform idea, visit Reform Drug Policy Project.

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