A Grain Of Saul: Every Major City In America Should Create Safe Injection Sites For Heroin Users

Just because it makes us uncomfortable doesn't mean it won't work.

A Grain of Saul is a weekly column that digs into some of the biggest issues we face as a nation and as an international community in search of reliable data, realistic solutions, and — most importantly — hope.  

On Tuesday, news broke that Philadelphia could become the first city in America to open supervised consumption facilities — also known as "safe injection sites" — for drug users. If we're lucky, it won't be the last.

For many Americans, safe injection sites are controversial. "My tax dollars are going to pay for the government to help a bunch of junkies shoot heroin?" I saw a friend on Facebook ask incredulously. If you're someone who opposes safe injection sites, there's a good chance you share that Facebook poster's anger: why should your money go towards helping addicts use heroin more safely? 


First, you should know that while many safe injection sites across the globe are government-funded, the one in Philadelphia is not. Seattle appropriated $1.3 million for a safe injection site, but it is yet to be completed. The city of Philadelphia plans to help the private sector develop sites, but won't be funding or operating them. 

The truth is that your money is already being used to support addicts, and safe-injection sites would make it a lot cheaper for all of us.

Every time a drug user gets a skin infection, overdoses, contracts HIV or needs an ambulance, we — the taxpayers and many of us enrolled in health insurance programs — help to pay their medical bills. Market Watch estimates that we spend over $500 billion on the opioid epidemic every year. But safe injection sites could drastically reduce the rates of those incidents, and would consequently save you money. A review of the effect safe injection sites would have on Philadelphia found that they would save $1.5 million to $1.8 million annually on hospitalization costs related to skin and soft tissue infections alone. The costs related to overdoses? They'd decrease by $12.4 million to $74.7 million dollars every single year. 

And that's just the financial side of it. 

There's the medical side, too: a study of Insite, the injection site in Vancouver, Canada that became the first to open in North America in 2003, found that overdose deaths decreased by almost 35 percent and the average monthly ambulance calls with naloxone treatment for opioid overdose dropped from 27 to nine. The sites are extremely safe — more than 3.6 million clients have injected at the site since 2003, and there have been 6,440 overdose interventions without any deaths, according to Insite's internal data.

The sites are also a first step off the streets and into treatment. In 2016, over 8,000 people visited the Vancouver safe injection site, and there were 5,321 referrals to other social and health services. The reality is that once someone gets in the door for a safe injection, which can be more appealing to an addict than checking into rehab, they are one step closer to having medical professionals help them combat their addiction. 

But closest to my heart is the moral obligation of this moment. I grew up just north of Philadelphia. The school district I lived in has been hit harder by the heroin epidemic than just about any place in America. I've been through periods of my life where it seemed like every week I'd find out another classmate had overdosed. 

I've lost so many friends to heroin that when I get a text message reading "did you hear about Rob?" my first thought isn't that Rob was engaged or got a new job, it's that he overdosed and died. This is my reality. And it's the reality of millions of other people living in and around Philadelphia, the major city with the worst fatal overdose rate in all of America — more than 1,200 Philadelphians died due to overdoses in 2017. 

Shutterstock / Corey Lee

Overdoses are now the leading cause of death for Americans under the age of 50, and the rate of overdose is rising faster than ever. Many of those dying are killed injecting heroin. In safe injection sites, we have a solution that is both cost-effective and proven to save those lives. Being uncomfortable with the idea of sanctioning drug use is not enough of a reason to ignore the evidence that we could be giving addicts another chance.

There will be obstacles. First and foremost are the legal issues — nobody is quite sure what the federal government would do if a U.S. city began operating a safe injection site. Pennsylvania Attorney General Josh Shapiro, a Democrat, says there would need to be changes to federal and state law for sites to operate legally and seemed to oppose the idea in public comments he made recently. Despite the White House's point person on the opioid crisis, Kellyanne Conway, being a die-hard Philadelphia Eagles fan and growing up in the area, the city's announcement has been met with silence from the White House, which begs the question of whether or not the Trump administration would support such sites.

Part of that could be fear of the voter backlash. When uber-liberal Seattle announced its $1.3 million dollar appropriation, some residents were so infuriated they actually tried to pass a ballot measure to ban the sites. The idea is obviously not palatable to many Americans, but it should be. Philadelphia has embraced a solution that could have saved the lives of my friends and could save the life of your loved ones as well. It's backed by the data from medical experts who have already seen it work in cities across the globe and so long as it's implemented with a broader fighter against opioids it's a solution that would save the country money and heartbreak. 

The biggest obstacle isn't a federal law or figuring out whether it works, it's our own willingness to accept the fact that a solution we might be uncomfortable with could be the best solution we've got. 

You can follow @Ike_Saul on Twitter

Cover photo: Shutterstock/ Diego Cervo


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