Are safe drug injection spaces beneficial?

A supervised injection site in Montreal, Canada, called CACTUS Montreal. Sites like these have been argued to encourage drug use by addicts, but the evidence is flimsy.

These days it’s easy to find someone who believes in the supposed benefits marijuana provides for pain, municipal income, or even curing diseases. But the buck often stops there. What’s much rarer is to find someone extolling the usage of harder drugs like cocaine, ecstasy, or heroin. The latter’s effects on the user have been etched into the collective mind. But just because these drugs are definitively harmful, how do we help those who are already addicted? One such proposal has come under fire due to its seemingly absurdist logic: helping those addicted by providing safe spaces to consume drugs. The blog piece entitled “‘Let me inject heroin in a safe place, it’s my citizen right’” by Arnelious Dominich illustrates some arguments against such an idea. But is it actually such a bad idea?

First, we need to understand what exactly we are talking about here. The idea is called a supervised injection site, and, though it may seem counterintuitive, its logic makes some sense. These sites are areas where people who want to take illicit drugs can do so under supervision. The idea is to provide drug addicted users with sterile equipment, easy access to addiction specialists and professional help, and medical supervision in a stress-free environment. These places do not provide drugs for the addicts to use, they only use narcotics that the user brings inside. One key aspect of supervised injection sites that must be remembered is that what they provide can vary from place to place. For instance, some might provide easy access to counseling while others may not. The common thread in all instances, however, is a safe place for addicts to use drugs under strict supervision by professionals.

One way to understand these facilities is to imagine the situation of a person addicted to opioids. Opioid addiction, which killed 47,600 people in 2017, has been declared a public health emergency by the Unites States Health and Human Services Department. One intriguing aspect of opioid overdose, however, is that a drug called naloxone can be used to prevent death from overdose if administered quickly enough. So, if that opioid addicted individual decided to take opioids on the street or in his house, one risk is that he may overdose on the drug. If he’s alone, who will be there to prevent his death? If a doctor was nearby who could administer naloxone in the event of an overdose, that addict’s life could be saved. In the same way, if a person addicted to heroin uses their own dirty, rusty needle to inject the narcotic, they are likely to get deadly diseases like AIDS. In a controlled environment with clean needles, those diseases can be avoided, and the person has a greater opportunity for intervention. Other benefits, such as being safe from abuse, criminals, and thieves, or keeping drug users off public streets when they inject, thus keeping cities cleaner, are also worth noting.

Still, Dominich argues that those things should “push the people, who are addicted to illegal drugs, to make a positive change for their lives.” The problem with this logic is that those who encounter these issues often do not have life left to see change through. How can a person who is killed by a criminal, or abused to the point of suicide, ever hope to recover if they’re already dead? Even worse is the fact that some addicts who are abused or stolen from may become traumatized to a point of further drug addiction.

Dominich also states that the staff and medical professionals hired at these supervised injection sites “won’t be cheap” and “is coming out of our pockets, citizens who work hard to earn their money and pay their bills.” By this logic, however, we should also not pay for services like hospitals, police, or fire departments. After all, the staff and facilities of the fire department costs a hefty sum out of the peoples’ pocket, and it’s not my fault that some people don’t have the initiative to keep their houses up to proper fire codes. To put it specifically, the issue here is that those who are addicted to drugs aren’t necessarily doing it out of choice. Some, for instance, were so traumatized though things like childhood abuse or war service that they felt their only option to cope was with drugs, as this study suggests. These are the people who might be helped with these spaces. And unless we believe that we should not help a fellow person in need, then the potential help to these people is worth the cost to everyone’s pocket. But that brings up a good question: is it helpful?

The evidence is certainly promising. This 2018 meta-analysis from the European Monitoring Centre for Drugs and Drug Addiction overlooking multiple studies into the issue states that “in summary, the benefits of providing supervised drug consumption facilities may include improvements in safe, hygienic drug use, especially among regular clients, increased access to health and social services, and reduced public drug use and associated nuisance.” Even with this study, we likely still need more evidence to fully showcase these facilities’ harms or benefits, so caution should still be used in creating such spaces. Still, it might be worth a try. Dominich suggests, however, that creating these facilities is harmful and could be a slippery slope. He says, “if cities do open spaces like these, they would just encourage the use of those drugs.” Yet, according to the 2018 study, “there is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting. These services facilitate rather than delay treatment entry and do not result in higher rates of local drug-related crime.”

Again, caution is necessary here. However, it is abundantly clear that the potential benefit that comes with supervised injection sites is worth further research and could be a key part of helping addicts recover.