“From a physician’s point of view, there’s no such thing as a safe injection site. You can still die,” Adams said at a recent conference.

Surgeon General Jerome M. Adams has again expressed reservations about supervised injection sites, also known as safe injection facilities (SIFs), as a harm reduction strategy for fighting the opioid crisis.  

Speaking at a conference hosted by the Independence Blue Cross Foundation in Philadelphia—titled “Someone You Know: Facing the Opioid Crisis Together”—Adams voiced support for the opioid overdose reversal drug naloxone and medication-assisted treatment (MAT), but in regard to SIF, Adams doubled down on previous statements that urged caution before communities embraced such sites.

“From a pragmatic point of view, let’s crawl first before we try to figure out how to sprint—particularly on controversial policy solutions,” said Adams.

At the same time, Adams stated that he did not want to dismiss SIFs as an alternative form of treatment. “It’s not to discourage discussion,” he said. But he also noted that “from a physician’s point of view, there’s no such thing as a safe injection site. You can still die. You can still get an infection. You can still get endocarditis. You can still have negative outcomes even when you’re injecting in a supervised fashion with illegal substances.”

In its coverage of the conference, Philly Voice quoted Adams’ comments about strategies that have shown to be more effective than granting access to supervised injection.

“There’s still a lot of low-hanging fruit out there, a lot of evidence-based interventions which have been accepted by the community that still needs to be optimized,” he said, referring to both MAT and naloxone. “There’s still so many more things we could be doing to optimize warm handoffs in connection to treatment. Let’s focus our energy on the things that already exist and aren’t optimized.”

Adams’ stance on SIF differs in tone from that of the Trump administration, which has expressed no reservation in opposing such facilities. Both also contrast the opinion of Luke Gorman, co-founder of the recovery support group The Flock, who was also on the panel with Adams at the conference.

“It’s my personal opinion that [SIFs] would be an incredible effective measure to save lives,” said Gorman, who is in recovery from opioid dependency. “Right now, with the epidemic and the proportions that it’s reached, saving lives should be in the forefront of all of our minds.”

Gorman’s take was echoed by Daniel J. Hilferty, CEO of Independence Blue Cross and another speaker on the panel. “It’s not up to us as to whether we’re pro-safe injection sites or we’re opposed to safe injection sites,” he said. “We just want to create a web, as a company connected with other partners, to catch every single person that we can and help them find that right path to true professional services and treatment.”

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