Seattle Aims to Open the First Safe Injection Sites in the US [FEATURE]

Seattle and surrounding King County are on a path to establish the country's first supervised drug consumption sites as part of a broader campaign to address heroin and prescription opioid misuse. A 99-page report released last week by the Heroin and Prescription Opiate Addiction Task Force calls for setting up at least two of the sites, one in the city and one in the suburbs, as part of a pilot project.

The facilities, modeled on the Canadian government-funded InSite supervised injection site in Vancouver, just 140 miles to the north, would be places where users could legally inject their drugs while under medical supervision and be put in contact with treatment and other social services. There have been no fatal overdoses in the 13-year history of InSite.

Although such facilities, which also operate in various European countries and Australia, have been proven to reduce overdose deaths and drug use-related disease, improve local quality of life, and improve the lives of drug users, they remain controversial, with foes accusing them of "enabling" drug use. Thus, the report refers to them not as "safe injection sites," or even "supervised consumption sites," but as the anodyne "Community Health Engagement Locations" (CHELs).

"If it's a strategy that saves lives then regardless of the political discomfort, I think it is something we have to move forward," said County Executive Dow Constantine, discussing the plan at a news conference last week.

The safe sites will address the region's high levels of opioid and heroin use, or what the task force called "the region's growing and increasingly lethal heroin and opioid epidemic." As the task force noted, the number of fatal overdoses in the county has tripled in recent years, with the rate of death rising from roughly one a week (49) in 2009 to one very other day (156) in 2014. The current wave of opioid use appears centered on young people, with the number of people under 30 seeking treatment doubling between 2006 and 2014, and now, more young people are entering detox for heroin than for alcohol.

Outside Vancouver's InSite (vch.ca)
Overdose deaths actually dropped last year to 132, thanks to Good Samaritan laws that shield people who aid overdose victims from prosecution and to the wider use of the opioid overdose reversal drug naloxone. But that's still 132 King County residents who needn't have died. Task force members said the CHELs would help reduce that number even further.

"The heroin epidemic has had a profound effect not just on our region, but across our country as a whole," said Seattle Mayor Ed Murray. "It is critical that we not only move forward with meaningful solutions that support prevention and treatment, but that we remove the stigma surrounding addiction that often creates barriers to those seeking help.

Not only are key local elected officials on board, so is King County Sheriff John Urquhart. He said the safe site plan was workable.

"As long as there was strong, very strong, emphasis on education, services, and recovery, I would say that yes, the benefits outweigh the drawbacks," he said. "We will never make any headway in the war on drugs until we turn the war into a health issue."

The region may willing to embrace this ground-breaking harm reduction measure, but it is going to require some sort of federal dispensation to get around the Controlled Substances Act and the DEA. How that is going to happen remains to be seen, but Seattle is ready.

The task force wasn't just about CHELs. In fact, the safe sites are just a small, if key, component of a broad-based, far-ranging strategy to attack the problem. The task force report's recommendations come in three categories:

Inside Vancouver's InSite (vch.ca)
Primary Prevention

  • Increase public awareness of effects of opioid use, including overdose and opioid-use disorder.
  • Promote safe storage and disposal of medications.
  • Work with schools and health-care providers to improve the screening practices and better identify opioid use.

Treatment Expansion and Enhancement

  • Make buprenorphine more accessible for people who have opiate-use disorders.
  • Develop treatment on demand for all types of substance-use disorders.Increase treatment capacity so that it’s accessible when and where someone is ready to receive help.

Health and Harm Reduction

  • Continue to distribute more naloxone kits and making training available to homeless service providers, emergency responders and law enforcement officers.
  • Create a three-year pilot project that will include at least two locations where adults with substance-use disorders will have access to on-site services while safely consuming opioids or other substances under the supervision of trained healthcare providers.

Will Seattle and King County be able to actual implement the CHELs? Will the federal government act as obstacle or facilitator? That remains to be seen, but harm reductionists, policymakers, and drug users in cities such as Portland, San Francisco, and New York will be watching closely. There have been murmurs about getting such sites up and running there, too.

Permission to Reprint: This article is licensed under a modified Creative Commons Attribution license.
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ok for addicts but what about pain patients.

Im sorry for all those addicted to heroin or any drug, but, arent they the ones that chose to even use heroin? And because of the addicts the lowly documented chronic pain patient is denied help to try and live a normal and  functioning life as humanely possible. The uh, epidemic  blames the patients because we need the meds to function and be a part of a working society, so we are accused of causing this problem. Common sense will tell you  that taken over a long period, they become less effective and have to be adjusted accordingly, and we are then dependent not addicted. But, somehow the addicts are being treated with more compassion than people in chronic pain, and unlike the heroin addict we did not choose this, or the need to have some meds, like the diabetic needs theirs. I dont believe ive heard any dr saying, hmm, look at that dose you are on, we better get that down, hmm. But all my opinion aside, question, please? Where does all the new laws and regulations  leave a patient that does not abuse their meds, but, those same meds are being snatched away because we dont want the addict, which is what maybe up to 3% of those patients to be able to abuse them. So where does that leave the 97%? Suffering! But, yet, we are so worried that the addict who chose the drug a place to use the illegal drug so they wont get sick? Huh? Is there something im not seeing here. Its a sad state of affairs when an addict is treated with more understand and help than an honest citizen with pain and disability ?  i believe that because of our problems, they know we cant fight back as a healthy individual can, so we are just told to take ibuprophen and suck it up, while addicts are welcomed and helped? My opinion, is that these patients are collateral damage and it is now passive genocide. 

Chronic Pain and the Drug War

Hi Raz,

Look, I agree wholeheartletly with the above commentary regarding the treatment of addicts versus the treatment of chronic pain patients.

I have been under treatment for chronic pain for almost 21 years. Ever since I begin filling prescripitions of hydrocodone two decades ago I have been viewed with suspicion by pharmacists and, if I must go to a doctor while out of town or have surgery, treated as a criminal. I have been through the whole spectrum of opiate drugs because of the eventual tolerance that builds with these medications. Though I never have misused them, once tolerance begins to develope I have had to increase my dosage in orer to achieve the same level of pain relief. Okay, let me stop here to explain why I have chronic pain. I have genetic degenerative disk disease and as a result have had four lumbar spinal fusions. Once I get one level repaired it puts stress on the above level and that disk ruptures thus compressing the nerves that expend into my butt, legs and feet. I have developed neuropathy so bad my toes feel like they are immersed in boiling water and at night if the sheet touch them, they feel like 1000 volts of electricuty are passing through them. Then, two years ago I was hit in a hit and run motorcycle accident and crashed at 70 mph. I broke my left collar bone, seven ribs in multiple places, punctured my left lung, fractured my left tibia/fibula and ankle into splinters and fractured my right forearm and wrist in six places. My treatment for pain, even though I explained that I was opiate tolerant was for three day a morphine pump and the two hydrocodone pills every four hours. I couldn't breathe because it hurt so bad to inhale and screamed in pain everytime the physical therapists came to get me up for a meal.

I is, IMO a moral crime to allow people to suffer from intractable pain simply because a particular doctor or nurse has religious beliefs about certain drugs. I don't think opiate painkillers are any more dangerous and probably less dangerous than the substances our government deem "moral" or whatever. WHat is moral about having to use alcohol on top of meager amounts of pain medication to try to get pain under control? Why should pain patients have to undergo degradation such as peeing in a bottle, or pilll counts, or horrible withdrawal symptoms if their medication turns up short? Why do we face being treated as a criminal because we must have our medication or get sick? Do diabetics or people who have chronic infections or heart disease face the same treatment? No!

I am convinced that a large part of our problem has to do with, yes, "Christianity". Though I have never found anything in the Bible that relates to the use of opiates, "christians" tend to judge people if they use any kind of controlled substance. It was in fact a Christian missionary from the Phillipines who, along with the current president first outlawed opium use for Chinese immigrants and appointed the notorious Harry ANslinger to head the Federal Narcotics Bureau. Then of course came Nixon, an alcoholic himself, who passed the Controlled Substances Act and it's branch of thugs the DEA to enforce said act. EVery since drug use has continued to increase, not decrease and people who need the various drugs banned by said act can no longer get the medication they need to live a full life.

It's time to repeal the Controlled Substances Act, legalize and regulate for quality all drugs currently under said act. Let the CSA go the same way as prohibition, let responsible adults make their own decision as to what they choose to put in their own body, and eliminate the crime associated with drug use all in one stroke of a pen. That is the only responsible drug policy.

Addicted versus Dependent

There is no real difference and when they cut off your pills you will start doing things illegally. You will turn to heroin when they stop producing pills. Both of you are useing to reduce pain one is psyical the other emotional in the end you both need treatment.

treatment?

People are able to access treatment in Canada most of the time.The problems with treatment are that with opiates and even opioids,treatment has an abysmal record of failure in the majority of cases.People are forced into treatment through the courts too often even when the evidence of failure should prohibit it.People who actually want treatment are more than 50% likely to outright fail and 80% likely to relapse if they succeed.Those are just the numbers,although the treatment industry tries very hard to ignore them.Telling a heroin addict that they need treatment isn't wrong.What's wrong are the treatment choices that are currently being offered.Vancouver has the only heroin maintenance program in NA.After 47 years as a heroin user and a POW,I have been unable to get even a meeting.The program,in spite of rave reviews from doctors and clients is so restrictive that even with a governmental OK to treatment of addiction with heroin.It's still impossible to get even a meeting with anyone there.Anyone who knows me,knows what I think of Methadose,the new Fentanyl replacement that replaced methadone as the replacement therapy available everywhere in the free world.As a spinal deformation patient I am supposed to be on pain meds but the Province of BC.While supporting a heroin program,refuses to allow former addicts to access opiate meds.Over a thousand former addicts are on methadose for pain.It is even the most used medication in hospitals for pain.A drug that is full of adultrants that prevent abuse and also prevent any kind of high.Anyone who knows about pain medication knows the high is a huge part of why pain medication is effective.This duplicity of purpose gets more difficult to understand with every new edict from the Federal Government.The BC government is akin to the former Harper tories who destroyed all drug treatment and reform efforts in Canada for a decade.This is why their (BC)drug policy is impossible to understand.They (BC)are mostly anti drug zealots who are forced to deal with a more progressive federal government.Both governments are called the Liberal party.The federal liberals are actually neoliberals.The BC LIEBERAL party are former conservatives who have gone through many name changes in an effort to confuse voters.So far,it's worked very well for them.

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