New Mexico Legislature to Study Supervised Injection Sites [FEATURE]

In a groundbreaking move, the New Mexico legislature has approved a proposal to study how to enhance and expand the state's already cutting edge harm reduction programs, including a look a medically supervised injection sites (SIJs -- sometimes also known as safe injection sites) for hard drug users. That could clear the way for an eventual SIJ pilot program to operate in the state, although considerable political and legal hurdles remain.

The legislation, Senate Memorial 45, was sponsored by Sen. Richard Martinez, whose constituency includes Rio Arriba County, which has a drug overdose fatality rate five times the state's rate. The state's rate is double the national rate, making New Mexico the nation's leader in drug overdose-related deaths per capita.

"These deaths are preventable," said Martinez. "Overdose spares no one and affects everyone, especially families."

State health officials estimate the state has at least 24,000 injection drug users. Other estimates put that figure as high as 50,000.

The memorial, which was also endorsed by the New Mexico Public Health Association, passed the Senate on a 43-0 vote Monday night and does not need any further action to go into effect. It directs the University of New Mexico's Robert Wood Johnson Foundation Health Policy Center to undertake the study of emerging and evidence-based harm reduction approaches, including SIJs, and report back to the legislature by November 1.

"Sadly, our drug overdose epidemic has outgrown our current harm reduction approaches," said Emily Kaltenbach, director of the Drug Policy Alliance (DPA) New Mexico office. "On Monday, our state senators realized this and did not let politics trump science. They clearly stated their intent to go beyond the status quo and explore innovative strategies to help New Mexico’s families."

"Wow, getting something like that on the state level is huge," said Hilary McQuie, Western director for the Harm Reduction Coalition (HRC). "New Mexico once again takes the lead in state harm reduction efforts; it's one of the few states to take a statewide approach to these things."

"Heroin is still the number one cause of ODs here, but we're also seeing a high number of prescription drug overdose deaths," said Kaltenbach, "so I'm incredibly encouraged that the legislature is willing to look beyond the status quo and start studying proven programs like supervised injection sites. We're hoping to study the feasibility and legal and ethical implications, leading to a pilot site in New Mexico."

If that actually happens, it would be the first SIJ in the nation. Although SIJS are operating in at least 27 cities around the world, including Vancouver and Sydney, and have been proven to reduce the spread of HIV, Hep C, and other blood-borne diseases, as well as prevent overdoses, without increasing criminality or drug use, political and legal obstacles in the US have so far prevented them from spreading here. They face morality-based opposition as well as federal issues including a "crack house law," which bars anyone from knowingly allowing others to use controlled substances.

"These same sorts of issues came up when syringe exchange programs were first discussed," said Kaltenbach. "I think the legal issues can be overcome, but the states have to be willing to look at it as an extension of syringe exchange. This study will address those issues."

While New Mexico is the first state to order a study of SIJs, it isn't the only place in the country where they are on the agenda. In San Francisco, drug user groups, activists, and advocates are working toward winning approval for one there, while in New York City, a similar effort is going on.

"The biggest obstacle is the perception of legal barriers," said DPA's Laura Thomas, who has been working on the San Francisco effort. "We have these crack house statutes, as well as state laws, that say it's illegal to knowingly allow people to use controlled substances. We have to figure out if there's room for a research project, like in Sydney, or create an exemption, like in Vancouver, or get a state law passed, like in New Mexico. We need a ruling that says 'yes,' this is not a violation."

http://www.stopthedrugwar.org/files/richard-martinez.jpg
Richard Martinez
In the meantime, the achingly slow process of building political support for an SIJ, or at least a feasibility study, goes forward. A year ago this week, a city Hep C task force recommended looking at SIJs. That followed on a similar recommendation from the city's HIV coalition.

"We continue to try to build support for a safe injection site," said Thomas. "During the mayoral campaign last year, at one of the candidate forums, they were all asked if they would support evaluating whether it would work for San Francisco, and most of them said they did, including our current city attorney, Dennis Herrera."

But despite the recommendations and expressions of support, nothing has happened yet. The San Francisco Drug Users' Union is trying to change that.

"We will be pressing the Board of Supervisors to study the possibilities," said the group's Isaac Jackson. "We're also doing a SIJ community design competition, a project in community imagineering. We'll give the winner a nominal prize and we'll present the winning design to the Board," he said.

"We think the city's Human Rights Commission will recommend safe injection sites in April," said HRC's McQuie. "But there have been other bodies and other recommendations. It's a matter of where the political will is and the priorities are."

For HRC, said McQuie, getting a safe injection site up and running in San Francisco is a back burner issue right now, but that could change.

"We have a lot of really great harm reduction projects going on, like the DOPE Project, that aren't getting financial support, and while there was a lot of enthusiasm for awhile about working toward a safe injection site, we kept planning meetings, but nobody would show up. It didn't feel like the energy was there. If the San Francisco Drug Users' Union wants to take some leadership, we would be happy to support it," said McQuie. "I think we will be going back to San Francisco and asking somebody to do something on this issue, but we're not sure who yet."

On the other side of the country, street-level activists are aiming for an SIJ in New York City. Citiwide Harm Reduction in the South Bronx, which is on the verge of opening the city's first fully staffed primary care clinic at a syringe exchange, is preparing to build a full-scale model of an SIJ at its 144th Street building. It may seem like performance act, but its purpose is educational.

"Our inspiration is the Smithsonian museums, where you can go inside the cockpit of the space shuttle," said Citiwide executive director Robert Cordero. "People have this grisly misconception of what a safe injection site would be like, and we want them to be able to have this Smithsonian experience here in the Bronx."

Such a model could be quite useful in educating elected officials and law enforcement, Cordero said.

"SIJs are a humane public health approach to reducing overdoses, HIV, Hep C, and crime, and can provide compassionate care for addicted people until they are ready to get into treatment," he said. "Do we want that, or do we want them just hanging out in front of the bodegas on 149th all day?"

Citiwide isn't going it alone on agitating for SIJs, and it isn't even taking the lead. Instead it is working with groups like HRC and the Vocals-NY Users' Union in a broader campaign.

"We're not trying to be the HRC or Vocals-NY," said Cordero. "We advocate through demonstrating what it would be like while partnering with others who are advocating every day. Our effort is to build the SIJ model, and when anyone comes to New York who is interested in these issues, there can be an educational moment."

Supervised injection sites are not a reality yet in the US, but pressure for them is mounting. Whether it's New Mexico, New York City, or San Francisco, one of these years someone is going to lead the US into the ranks of nations that understand their utility -- and their humanity. New Mexico has just taken a giant step, but let's hope it has to move fast to beat San Francisco and New York.

Santa Fe, NM
United States
Permission to Reprint: This article is licensed under a modified Creative Commons Attribution license.
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Sounds too familiar

Of course we already have a safe injection site in Vancouver but we had a heroin maintenance program once as well.The reason meetings are losing steam is that there is usually a bunch of splinter groups that get offended by the "majority"(I think that's democracy)and don't feel they're being heard so they start another group and so it goes.The hard core that really want to get something done are eventually questioning motives because everyone seems to have an agenda and it rarely includes the addicts that need the help now.I went to half a dozen meetings back in the end of the first decade of the 21st century.The main group was/is backed by 4 Mayors and a senator but they must have realised it was futile to try to elicit cooperation from our current government.That's the same government that ran Insite through every court in the land to justify it's existance.They wasted millions of tax dollars on that and now want to go on a prison building spree with the proud exclamation that there will be enough cells for everyone.I mean in this day and age,that's their attitude.It was the Harper government that canceled Naomi and has stalled cheos,another heroin program that's stuck in limbo as long as Harper runs the country.The job is never done and until the evangelicals are out of power,nothing will change.Harper is on a major social engineering program and for progressive minded Canadians,the future looks bleak indeed.

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DOPE project < SIJ < CHEOS >= NAOMI >= SALOME

DOPE PROJECT!!!? DUDE SERIOUSLY, when are they gonna just STOP with the nonsense with the suboxones/subutex/buprenorphine and methadone/methadose and even worse the naloxone. I DO realize maybe half of the blame falls on us for you know, being desperate at times over the past decades and just telling "the man" what they wanna hear as fast as we can say it just to get relief from the w/d but most ppl on opiate substitution hate all of those things (including me, who used to be in that boat) w/ds just suck so much and prohibition eventually catches up to you when you're not rich and your income aint so great. but there's a reason we call the stuff liquid handcuffs. and now theyre acting like naloxone is so great? lol. just take a look around. naloxone is a joke. i think its so funny how these doctors think these lame drugs are gonna do some good and they brag about them and talk them up so much... just take a freakin look at the facts man and scope out the ridiculous drop out rates in naloxone. lol. its so funny man. The TRUTH is, right around when buprenoprhine became prescribable and not limited to dispensaries, that was the limit for those kind of drugs. we dont REALLY want them (and you self righteous AA/NA types i dont wanna hear it mmkay because your not the majority with regards to the people im talking about and sorry but as any educated folk know in the only sponsored research done by your evil organization they found a pitiful 3% success rate.. on a study that lasted 10 years and cost millions - so save it, this aint about you - though i do realize you do think the world evolves around you, it doesnt.) Anyway. Yeah so terms like liquid handcuffs spread around. The bottom line is the maximum potential of that theory was achieved when suboxone was made available to take home wide scale... and most folks prefer methadone anyway but most folks dont really care as long as whatever it is is cheap, paid for by govt and kills w/d's when needed. (of course, younger folks, in their infant years in this... 'subculture' prefer suboxone...but as we all know, eventually the years add up and they change and w/e. to quote the 20th century artist, Tupac Shakur 'that's just the way it is.')

 

so mr sintired - id like to go ahead and say great great post friend. i really liked your reply and i too am sicntired. thanks for writing man. thumbs up and kudos.

 

lol, users are by far, as documented by francis moraes phd, the most persecuted scapegoats of the modern day, akin to the persecuted during the spanish inquisition and other historic eras of persecution.  SIJ help, they're great... and, you know, as far as new york is concerned, you know, it'll be a super way to help the... less... hm, let's call them, 'street inclined' dope banger new to the city, without connects, risking their confidentiality and safety by posting online (just search) to find middle men and connects. I could totally see the battered, beaten down, and tired user leaving a NYC insite only to be approached by a non-narc, middle class, user, desperate for some help. 

 

You know, as a native American who is quite sensitive to the injustices suffered by my cultural ancestors, this sad, sad state of affairs has me, personally, thinking of all the suffering and torture suffered by the tribes... And after many years of sad, pathetic warfare, the abuse of an entirity of people (sound familiar?) finally, when the tribes as a whole were so broken, beaten, tired, the US FINALLY created the Bureau of Indian Affairs. A little late. Nevertheless, that organization was always run by veterans of the indian slaughter whom used that organization, the organization whose supposed original intention was not to help further the genocide of the natives but to HELP them, but those in charge for the long beginning used that Bureau to help destroy them. Only when a president came into power whom had been good friends with, bar room brawled with and fought in the Civil War with a Native, did a NATIVE become the head of that organization and he tried in vain to help his people but was eventually dismissed by his friend, the president, because he fought against the genocide of his people. I see it applying now in that these drug czars, these politicians, lol, gimme a break man, at the most they were your typical run of the mill high school loser who maybe did the house party drink scene with some pot, and then in college let loose, you know and as has been said countless times if this supposedly ethnically, class blind system worked how it was supposed to, W, Obama, Bubba, they'd all have been arrested. LOL, how can so many people, drug counselors too, be authorized to act as authorities on this matter when they have no experience in it. YES we SHOULD have a junkie as the drug czar. You know it deep inside its the only way to get this done right.  Whatever man, this merry go round is so retarded and this country sucks for it. Bottom line is this, who'd wanna let a friggen priest's set of personal morals dictate their own behavior? well, of course those who know, know that Bishop/Cardinal or whatever was behind this at the beginning, and those who know also know the world outside of the U.S was NOT drinking his kool aid and it has been documented that he and his temperance constituence was not thrilled with the lack of interest the rest of the world had in their so called progressive purification - i.e the queen saying, screw america and keeping heroin as a medicine. great stuff. you know, i think ultimately the sad truth is, like it or not my fellow user friends, the best place and solution for folks like us is simply to get the hell out of here. So, you know, bottom line, check your ancestry, hope your dad or grand dad or in some cases great grand dad was from europe, find that birth and death certificate, hopefully you dont have a felony and get that EU citizenship, get yourself to Germany, Denmark, England, Switzerland, Holland etc - cuz it's the only way to save yourself. I guess that means cold turkey time, motel room vomit time for a few weeks, save that dope dough for passport/document money and a one way ticket out of this hell hole. thats my advice. see you there. if i can keep my head up and eyes open long enuf  hahaha ;)

Yes

You are absolutely correct about 'users' being the marginalized scapegoats of our society.  We've got crime problems?  It's because of drug addicts.  Unsafe streets?  It's the drug addicts.  Neither of which is true.  Talking about 'addicts' and 'users' is really a form of code, a sort of vocabulary of socially-accepted euphemisms, that privileged folks use to indirectly refer to and marginalize other groups.  You have described the dynamic at play within the state perfectly.

And safe injection sites will be of limited value so long as the stigma associated with drug use or overuse, and the threat of long prison sentences, prevents society from really addressing the issue in an open, honest manner.

For example, what casual user who is beginning to develop a real habit is going to go for treatment or whatever, when he or she knows that by reaching out to others for help, the individual will be branded as an "addict," risking jail time, job loss and social marginalization?  So long as use (as opposed to the sale) of dope is criminalized, no real progress can be made to integrate such folks into mainstream society.

addendum

To add one thought to my other response, I had once assumed, perhaps like many folks, that it was impossible to have a regular heroin habit and hold down a job, and to function more or less normally in society.  Yet, I discovered (through another neighbor) that one of my neighbors where I used to live actually had a fairly hefty drug habit and, nevertheless, went to work everyday, pretty much just like anyone else.

Now suppose that he had gotten arrested for possession.  He would instantly be branded and gain membership into the society of the marginalized.  He'd probably lose his job, maybe spend a few years behind bars with hardcore criminals, and find it difficult, if not impossible to ever reintegrate himself into 'mainstream' society.  In other words, the system does at least as much as the drug habit itself to marginalize folks for using it.  It is cultural and while safe injection sites may help addicts to find a safer place to use, it will not radically alter the picture until a cultural shift takes place concerning perceptions about 'drugs' and 'addiction.'

Yes, but...

It is awesome that New Mexico is considering harm reduction approaches.  But on the other hand, New Mexico is also considering a new senate bill, SB 159, which will potentially adversely affect both chronic and acute pain sufferers.  The bill, among other things, limits supplies of pain medications from 30 days to 7 days for ill-defined "acute" conditions and, more importantly, prohibits doctors from issuing refills on such medicines as the current system allows.  Instead, the doctor is allowed to write multiple prescriptions on the same visit.  The net result will be that doctors will be reticent about doing so (for fear of diversion, etc), and patients will have to schedule additional unnecessary visits to get their pain-related issues treated adequately.  This will have the greatest impact on the state's poor, who will be burdened with the costs of additional doctor consultations, etc.

The ostensible purpose of SB 159 is to reduce the incidence of heroin-related deaths, a drug which is already illegal and for possession of which, there are already stiff penalties on the books.  There is no evidence that restricting the availability of medicines for legitimate acute and chronic pain sufferers will in anyway reduce heroin-related deaths, especially since it will have no effect on the heroin supply within the state, except maybe to lead to a slight increase in demand as supplies of illegally-diverted substitutes become less widely available to recreational users.

It is time to re-evaluate current approaches about drug use and addiction, which have failed in every respect to curtail drug-related problems.  From a psychological standpoint, limiting or restricting availability of certain substances which are in high demand by addicts, only fuels their obsessive behaviors and leads to more problems with addiction and related issues.  Safe injection sites and harm reduction should be the goal in any effective program designed to combat social problems caused by overuse of drugs.  Thus, while I applaud New Mexico on this front, it needs to bring its other policies in line with the concept of harm reduction so that there is internal consistency in how it deals with the issue of drug misuse and overuse.

credible

Why is your go-to source for information on the environmental impacts of fracking a representative of EDF? One of the EDF's largest financial contributors is Julian Robinson who gave them $40million to lobby for cap and trade regulation. He has also contributed $1.3 million to Romney's election campaign. He has a clear motive for influencing policy and this is the organization you go to as a credible source? tania

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