"Safe Injection Houses"- What's This?

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    I gotta tell ya'll, this was a tough article to write objectively, I wanna hear what you think! I had strong opinions on this subject at first, and then I did some research. Not saying my thoughts changed, but new questions did pop into my mind. "Safe injection Houses" are here in the USA. What are they and what do you think about them?

    "Safe Injection Houses"- What's This?

    A "safe house" for drug users to use drugs with clean equipment and trained professional supervision using public funding.....what the what????!!! Am I reading this correctly? This instantly stirred up strong feelings and opinions for this nurse, mom and taxpayer. While this concept was news to me, "safe injection houses", which are currently illegal in the United States, have secretly been in existence in the US for at least 3 years. The idea is to provide drug users with clean needles and equipment as well as medical supervision by professionals in the event of overdose. The staff on hand is also available to guide, educated and provide services to willing participants who wish to get clean. Injection sites are legal in countries such as Australia, Canada, Denmark, France, Germany, Luxembourg, the Netherlands, Norway, Spain and Switzerland. This is different than the clean needle exchange programs that at one time were also illegal in the US and now are legal in 33 states.

    I read an article in the New York Post about two researchers who secretly evaluated a "safe injection house" in the United States. This sparked my interest to research more on the subject so that I could form a more educated opinion on the matter. According to a New York Post article, two researchers have been evaluating a "safe injection house" for over two years and recently published their report online in the American Journal of Preventive Medicine. "As a condition of their research, they didn't disclose the location of the facility - which is unsanctioned and potentially illegal - or the social service agency running it", reports The New York Post.

    According to the researchers, the underground space consists of two rooms. One "injection room" with stainless steel clean stations with stools and mirrors. Drugs such as heroin, cocaine, methamphetamines, and pain pills are allowed to be used there, however smoking is not. The second room is where participants go afterward to be monitored by trained "non-medically licensed" staff. Not much information was provided through the research. It is presented that over 100 participants utilized the "safe injection house" more than 2,500 times. They released that only 2 overdoses were reported and one death at the site itself, but little to no additional information on population, cost service etc due to the secrecy of the program.

    Such sites have been backed by lawmakers in New York and California, along with officials in cities like Seattle, San Francisco, Boston, and Ithaca, New York in an effort to combat overdose rates as well as drug use related transmission of Hepatitis C and HIV. This report may help support lawmakers in their efforts to pass laws allowing "safe injections" to exist in the US. As one would expect, there are many opponents to "safe injection sites", for a number of reasons. According to the New York Post article: "critics have argued these places may undermine prevention and treatment, and seem to fly in the face of laws aimed at stopping use of deadly illicit drugs."

    As nurses we have a duty to do no harm. If we know that these drugs are so harmful that they cause death, have long term side effects and addiction, how would we stand a collective group on this subject? It is an interesting topic that I am sure we will hear more about in the coming years. The initial response from those I talked to casually about this subject was that this is the worst idea anyone has ever come up with and how on earth did we get here as a society? After much discussion some interesting questions regarding this and other similar topics arose creating some "grey areas" in the thoughts.

    In researching this, I think I am left with more questions than I answered for myself. I would love to hear what you all think. Do such places encourage drug use though ease of access and legal use? Would new users take advantage of "safe injection sites" to try new drugs? Who pays for these places? Does the cost of running them outweigh what is spent yearly in Emergency Room visits and hospitalizations for overdose or addiction treatments? What kind of regulations and research are needed to determine the societal worth of such places? What do you think?

    Report reveals 'safe house' where heroin users shoot up under supervision | New York Post
    Last edit by Joe V on Jun 14
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  3. by   Triddin
    But... the patients would be doing these drugs regardless of safe injection sites or not. However, safe injection sites provide immediate assistance if the patients od, decrease the spread of hiv by providing clean needles and condoms, decrease the incidence of cellulitis, and increase the number of detoxification/ provide resources for those who want to quit.

    Safe injection sites have been extensively studies in peer reviewed journals and found to be a positive health initiate with no significant increase of crime in the area.

    http://www.bccsu.ca/wp-content/uploa...report-eng.pdf Is a great resource as is provides a summary of many of the studies done about Insite, the local supervised injection site (with references included).
    Here is a summary of some of their findings:

    * in the first year and a half, 273 witnessed overdoses occurred with no deaths
    * a year after it opened, there was a 33% increase in patients who went through detoxification
    * there was no stastitical significant increase to drug trafficking and a decrease in vehicle thefts and BE in the neighborhood
    *there were decreased used needles found in the neighborhood
    * an increase in Condom use to prevent HIV
    * lower skin infection rate in IVDU

    Recently, 80% of Vancouver's illegal narcotics were found to be cut with fentanyl. Treating overdoses and drug addiction is a multifaceted approach. Providing safe place to do drugs is only one aspect. You need to address the social determinants of health as well, which is another benefit of Insite.
  4. by   KatieMI
    Canada and Europe have extensive experience with "safe houses".

    Apparently, people responsible for socialized medical care know their math better. Leaving alone discussion about "lives saved" alone (as the very same lives are arguably being cut short by continued abuse), 300+ overdoses treated with Narcan then and there cost WAY less than the same 300+ patients being rushed to hospital and ICU for the very same reason. Plus, yeah, "safe injections" save at least some from getting hepatites and HIV, which cost insane $$$$$$.

    Re. where moneys come from, some "safe houses" are relied on donations and volunteers, some are wholly or partially financed through budget and some patients pay for use. In one article, I saw cost of $25000CA/year, OOP. It is not cheap but definitely less than $200/day plus all associated risks.

    On the other hand, "safe and tolerant" practices of using drugs made downtown Vancouver the place I won't come back to till this wave subsides. There is not much crime there, that's true. But this alone doesn't justify making a whole place pretty horrific skid row.
  5. by   Fiona59
    I grew up in Vancouver. The corner of Main and Hastings and a lot is Hastings is like hell on earth.

    I have done shifts in a needle exchange. Never felt threatened, the users were polite and appreciated the service.

    Safe flight njection sites will be opening in my area soon. One is in a hospital for admitted patients. Nothing beats trying to figure out what you patient is on when they've come back from a smoke break. We've been told that the hospital site staff will discourage patients from using their peripheral and PICC lines to shoot up.

    Narcan kits are available to anyone after a short info session at no charge.
  6. by   SaltySarcasticSally
    If this were made legal in the US, there would be very few areas that would let one pop up in their area. We in America feel if we don't see it then it doesn't exist ya know.

    We need to do something different, the drug epidemic is just getting bigger and bigger. It's insane the amount of people we get in the ER each day with endocarditis, cellulitis, etc. The cost of the treatment they need is astronomical so a safe house, if proven to be effective to reduce these complications, would be far less expensive.
  7. by   Sour Lemon
    It may not be politically correct to say so, but I think this is a horrible idea. Maybe we should provide "safety escorts" for people while they rob businesses to get their drug money, too.
  8. by   NightNerd
    I chose this as a topic for research in my community health class. I am very passionate about this and would actually be interested in working in one of these facilities, which I'm hoping will show up in my area sometime soon. Research by the European Monitoring Centre for Drugs and Drug Consumption has shown that this approach has had several positive effects in various nations over the years, including reducing drug-related deaths, increased pursuit of substance abuse treatment, fewer risky injection practices, increased access to health care services, and more consistent contact with at-risk populations. Importantly, there is no evidence that drug use increased due to the presence of these facilities.

    People are going to use whether or not they have a safe place to do so. Ultimately the goal should always be to eliminate drug use, but I'd rather do that by saving lives and encouraging people to get treatment, rather than letting the epidemic claim more victims. This is an opportunity to meet people where they are and optimize their chances of recovery without alienating them from much-needed help and compassion.
    Last edit by NightNerd on Feb 12 : Reason: Syntax n stuff
  9. by   NightNerd
    Non-violent drug offenses and robbery are very different things. Just sayin'. Safe injection houses can at least serve as a gateway to treatment, which is worth the seemingly counterproductive appearance they have now.
    Last edit by NightNerd on Feb 12
  10. by   AceOfHearts<3
    Quote from Fiona59
    Safe flight njection sites will be opening in my area soon. One is in a hospital for admitted patients. Nothing beats trying to figure out what you patient is on when they've come back from a smoke break. We've been told that the hospital site staff will discourage patients from using their peripheral and PICC lines to shoot up.
    Yikes, that sounds like a good way to get a spike in central line infections! If those patients are to be allowed to use their drugs they should be banned from using any lines placed by the hospital. I'd honestly be afraid of giving pain meds to a patient if they left and came back high- not knowing what and the amount that they took would make me uneasy.
  11. by   Sour Lemon
    Quote from NightNerd
    Non-violent drug offenses and robbery are very different things. Just sayin'. Safe injection houses can at least serve as a gateway to treatment, which is worth the seemingly counterproductive appearance they have now.
    Where do these hard-core addicts get the money for their daily highs? And how much of that type of crime is drug related? I've been robbed at gunpoint a few times. The thought of the robber hopping over to get high in a safe and supervised situation makes me ill.
  12. by   Triddin
    Quote from Sour Lemon
    Where do these hard-core addicts get the money for their daily highs? And how much of that type of crime is drug related? I've been robbed at gunpoint a few times. The thought of the robber hopping over to get high in a safe and supervised situation makes me ill.
    Studies from Insite showed no significant increase in crime in the area since its opening
  13. by   squishyfish
    Nope, nope, nope, nope. Why are we rewarding dangerous and addictive behaviors with zero consequences? This sounds like such a bad idea.
  14. by   KatieMI
    Quote from Sour Lemon
    Where do these hard-core addicts get the money for their daily highs? And how much of that type of crime is drug related? I've been robbed at gunpoint a few times. The thought of the robber hopping over to get high in a safe and supervised situation makes me ill.
    Many of them beg, prostitute themselves and use cheap, low-qualty drugs which kill them quicker and more painful. Real hard vore addicts will do pretty much anything to avoid police because being in custody = withdrawal.

    Since we as society have no tools to force addicts into treatment (which is, in turn, notoriuosly low effective), everything that remains is to make using safer for everyone. This way, at least, you and me, hopefully, won't have those 3 to 6 months of soul-searching after an accident poke with insulin needle waiting for HIV and hep panel "window" to pass.

    Although I too do not support making those "safe houses" pretty much about everywhere, especially near schools and known tourist zones.

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