"Safe Injection Houses"- What's This?

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? Nurses General Nursing Article

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

Specializes in Geriatrics, Dialysis.

Is it possible to support the addict while condemning the actions of the addict? That's where I have problems.

I do feel for the people caught in the cycle of addiction. Treatment even when it's sought out by the addict is not always successful. For many addicts it takes several attempts and even when successful keeping that hard earned sobriety is usually a life long battle.

Unfortunately the stories of addiction that are publicized are the ones that involve the addicts many crimes in their quest to feed their addiction. We don't often see the success stories in the news.

As a result of this addiction has naturally become criminalized. The crime is a direct result of the addiction so of course the addict is a criminal. Maybe if the news would stop spinning the story that way it wouldn't be such an uphill battle to change societies perception of who an addict is.

Specializes in Hospice.
Is it possible to support the addict while condemning the actions of the addict? That's where I have problems.

I do feel for the people caught in the cycle of addiction. Treatment even when it's sought out by the addict is not always successful. For many addicts it takes several attempts and even when successful keeping that hard earned sobriety is usually a life long battle.

Unfortunately the stories of addiction that are publicized are the ones that involve the addicts many crimes in their quest to feed their addiction. We don't often see the success stories in the news.

As a result of this addiction has naturally become criminalized. The crime is a direct result of the addiction so of course the addict is a criminal. Maybe if the news would stop spinning the story that way it wouldn't be such an uphill battle to change societies perception of who an addict is.

I agree with you right up to your last paragraph. The laws against use of certain drugs (and not others, equally as mood-altering, addictive and destructive of mental and physical health) are NOT natural. They resulted from a conscious social decision to declare certain addicts criminals while other addicts are not.

During Prohibition, alcohol use was declared a crime and, behold! We thereby created an organized crime apparatus that we are still fighting today. Nothing "natural" about it.

It's Hobson's choice: criminalize addiction and you basically lose any chance you had of solving the problem on an individual or societal level. Providing the environment needed to maximize chances of recovery and reversing the epidemic and be accused of "enabling" addiction.

Perhaps it would be useful to think about why so many people feel the need to alter their mood regardless of consequences and address that.

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/uploads/2016/10/insite_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.

Yes yes yes! Well said!

Another benefit to these types of safe injection sites are that they enable health care professionals to interact with marginalized populations that can be notoriously difficult to reach. Relationships are formed and trust is established. As others have mentioned, other interventions (wound care, social assistance- i.e. housing, infection treatments, etc) can be initiated in facilities that offer a multi-faceted health care approach.

I am inclined to believe that people who have a problem with these types of harm reduction interventions believe that drug addiction is a choice people are making, and not a disease. As a comparison, to a certain extent, some forms of diabetes are preventable. However, it doesn't have the same amount of blame and stigma that surrounds drug addiction. When a type 2 diabetic is newly diagnosed, they generally don't get berated for ignoring their elevated H1C levels and failing to adjust their diet and exercise habits. As a general rule, they are simply prescribed medications (along with advice pertaining to diet and lifestyle modifications) that treat their disease.

It's harder to be compassionate for someone who we believe has full autonomy of their decisions but continues to engage in bad ones. And I know (I know!) that the substances the drug-addicted population consume are illegal (unless prescribed- and then abused). So my comparison is flawed. But I believe that if we could change the perception of drug addiction, we would have more of an inclination to address it, and we would come up with better methods (and funding) for doing so.

Specializes in Mental Health, Gerontology, Palliative.
From a public health perspective, this is a fantastic concept and I can't believe it's taken the US such a long time to even consider the concept. This has been a thing around the world for a very long time.

No sane medical provider is going to promote illicit drug use as a positive life choice. Neither is alcoholism, but that didn't stop us from giving our alcoholics beer TID with their meals to keep them from going into DTs while hospitalized. If a person has no interest in quitting, the best rehab in the world is going to be a waste of everyone's time and money.

Next best thing? Reduce what risk you can. Make sure people have clean needles. Have sharps boxes in public restrooms (this is already a thing I've seen, so hooray) so they're not left lying about to stick others accidentally, or so other folks can't come along & use it to shoot up. The fewer people walking around with HIV, HepB, and HepC the better. The fewer ED visits for an ODed John Doe, the better. There's no reason a needle exchange depot can't have information about rehab as well for those who are considering quitting. This doesn't have to be an either/or proposition.

Said so much better than I could have

Specializes in Mental Health, Gerontology, Palliative.

And I beg you not to insult your and my intelligence by saying one disease was chosen and the other wasn't.

Addiction starts with a choice, however it doesnt stay a choice for very long

My mum for example is dying of terminal small cell lung carcinoma, exclusively caused by smoking.

And despite the fact that her addiction is killing her, she still cant give it up

Dont insult my intelligence by suggesting people should 'just give up their addiction"

Were it really that easy we could just nix the whole A & D treatment industry

Specializes in Addictions, psych, corrections, transfers.

you have to think about it from a community health stand point and allocation of resources. I work in addictions. So many of my clients develop abscesses, sepsis, and Hep C. If you think about it all of those issues require money and resources to care for. These can include emergency services, urgent care, and primary care resources that wouldn't otherwise need to be accessed. I've had multiple clients take up multiple days in the ICU or med surg due to sepsis, cardiomyopathy, multiple system organ failure, massive abscesses, etc. Due to using dirty needles. If we can prevent this overuse of resources, and make the community safer. I'm all for it. Also, less resources would be used to overdose which takes away emergency services for the rest of the community.

Specializes in Transitional Nursing.
If it was just safe injection sites, I would agree with you. However, the sites (again, basing this off the Vancouver model) promote detoxification and rehabilitation. They have an interdisciplinary team involved in addressing the cause of a patients addiction and trying to work with the patient to address concerns. I recommend reading through the link I attached in the first post. It's a summary of the peer reviewed research published and written in a manner that makes it accessible.

Its not uncommon for EMS to have 8 OD's a shift around here. It makes it hard for them to respond to other emergencies and the folks who are ODing have less of a chance of survival. For some situations and areas, this is a necessary evil.