Tag: injection drug use

Safe Injection Site In Philadelphia Ruled Federally Legal By Judge

The ruling goes against the wishes of the US Justice Department, which sued to stop the facility from opening.

A federal judge has ruled that a planned supervised injection site, where individuals can go to use illicit drugs safely under medical supervision, does not violate U.S. federal law. This has opened the door for the city of Philadelphia, where the facility in question would be located, to host the first legal safe injection site in the country.

“Crackhouse Statute” Does Not Apply

According to the Philadelphia Inquirer, U.S. District Judge Gerald A. McHugh ruled on Wednesday that a 30-year-old law created to address what was commonly referred to as “crack houses” does not apply to the safe injection site proposed by the non-profit organization Safehouse.

“The ultimate goal of Safehouse’s proposed operation is to reduce drug use, not facilitate it,” McHugh wrote in the document explaining his decision.

The ruling goes against the wishes of the U.S. Justice Department, which sued to stop the facility from opening. The government argued that the drugs that would be used are dangerous and the act of using them is illegal.

“This is in-your-face illegal activity using some of the most deadly, dangerous drugs that are on the streets. We have a responsibility to step in,” said U.S. attorney for the Eastern District of Pennsylvania William McSwain in February. “It’s saying, ‘Safehouse, we think this is illegal. Stop what you’re doing.’”

Saving Lives, Not Encouraging Drug Use

However, the Safehouse lawyers have argued that the purpose of a safe injection site, also referred to as overdose prevention sites, is to save lives and encourage the individuals who frequent it to get into addiction treatment.

“I dispute the idea that we’re inviting people for drug use. We’re inviting people to stay to be proximal to medical support,” said Ilana Eisenstein, chief attorney for Safehouse, in September.

Multiple studies on safe injection sites, including those that have opened across Europe and in Canada, show that they reduce the number of overdose deaths in the area without resulting in an increase in overall illicit drug use.

They also lessen the spread of dangerous viruses such as HIV and hepatitis by offering clean needles and a place to safely dispose of used ones. These successes have led the American Medical Association to endorse the bringing of these sites to the U.S. However, the Justice Department is determined to continue the fight.

“The Department of Justice remains committed to preventing illegal drug injection sites from opening,” said McSwain. “Today’s opinion is merely the first step in a much longer legal process that will play out. This case is obviously far from over.”

View the original article at thefix.com

4 October 2019
Most Drug Users Willing To Utilize Safe Injection Sites, Study Finds

A new study found that 77% of drug user were willing to utilize safe consumption sites.

“Safe consumption sites” provide a space to use drugs under medical supervision, away from the streets and with clean equipment such as syringes. They have existed abroad since the ‘80s but not in the U.S. (at least not legally). Some are for them, some are against them. But what about the drug using community?

Safe consumption programs (also known as supervised injection facilities or SIFs) in Canada and Australia have reported reductions in fatal overdoses and the spread of HIV and hepatitis B and C. As the U.S. faces crisis-level opioid abuse and overdose, it is now forced to confront the potential of SIFs across the country.

A new study confirmed the willingness of “high-risk opioid users” to utilize these sites as a form of harm reduction. In a survey of 326 people who reported using heroin, fentanyl and illicit opioid pills, about 77% of them reported that they were willing to go to SIFs.

Among the respondents, 60% reported habitually using drugs in “public or semi-public” spaces, and more than a third had overdosed in the past six months.

The research was led by a team at Johns Hopkins Bloomberg School of Public Health and was published in the Journal of Urban Health in June.

“On the whole, we found a strong willingness to use safe consumption spaces,” said study lead author Ju Nyeong Park. “This is important because often the voices of people who use drugs are not included in policy debates or in the implementation of public health interventions.”

The research confirmed that the majority of respondents are “motivated to be safe and take precautions to reduce their exposure to harm,” said study senior investigator Susan Sherman.

“It’s encouraging because even though these are people engaging in very high-risk behaviors in very different contexts… they were willing to use this harm-reduction intervention,” said Park.

100 Safe Consumption Sites In 12 Countries

Currently there are more than 100 such facilities in 12 countries, though none are in the United States. A legal battle taking place in Philadelphia may affect the future of SIFs in the U.S.

In April, it was reported that Safehouse, a local non-profit organization involved in efforts to establish the nation’s first SIFs in Philadelphia, countersued the government in its attempt to block efforts to open the sites. They argued that SIFs are less about drugs and more about providing a medical service, in addition to giving people the option to access treatment.

View the original article at thefix.com

14 July 2019
Surgeon General On Safe Injection Sites: There Are More Viable Options

“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.”

View the original article at thefix.com

19 October 2018
Church Of Safe Injection Sings The Praises Of Harm Reduction

The harm reduction initiative is applying for an exemption from federal drug statutes to operate legally.

Jesus supported safe injection—that’s the message behind the Church of Safe Injection.

The “church” is a harm reduction initiative in Portland, Maine—with plans for offshoots in other cities—spearheaded by local activist Jesse Harvey.

“[Jesus] would have supported safe injection,” Harvey argues in a new essay published in the Portland Press Herald. “All too often today, people who use drugs are offered only two choices: Get sober or die. Jesus would have rejected this shameful and lethal binary.”

Harvey said there was a need for a church to apply harm reduction to the drug using community because “overwhelmingly, the churches I’ve reached out to aren’t interested in helping people who use drugs.”

They may act like they want to help, Harvey said, “but they won’t really embrace them as Jesus would have done.”

He adds, “They won’t provide them with what they often need most: sterile syringes, naloxone and nonjudgmental support.”

The “church” already has three sister churches in Bangor, Lewiston and Augusta, with plans for more in New Hampshire, Philadelphia, Rhode Island and Nepal.

“It is our sincere religious belief that people who use drugs (PWUD) don’t deserve to die when there are decades of proven health intervention solutions that can be implemented to save their lives and reduce the harms they face,” Harvey writes on his official website.

The Church of Safe Injection is applying for an exemption from federal drug statutes under the Religious Freedom Restoration Act, that will allow them to operate legally. Under this law, “other churches in this country have secured the right under the First Amendment to consume otherwise illegal drugs,” Harvey writes.

One example is a federal court’s decision to allow the ceremonial use of peyote by members of the Native American Church.

“We’re not even arguing that it is our right to use drugs or get high… We do not encourage drug use,” writes Harvey, who himself is in recovery and is the founder of Journey House Sober Living and Portland OPS (an advocacy group). “However, it is our sincere religious belief that people who use drugs do not deserve to die, not when there is a proven, cost-efficient, feasible, compassionate solute that can be so easily implemented.”

Mayor Ethan Strimling is among those in support of safe injection in Portland. “I’m always looking for new ways of trying to confront the opioid crisis, and what I’m intrigued about with this idea is it creates yet another opportunity for somebody who is using to have an interaction with a medical professional,” he said according to WGME.

Seattle and San Francisco officials are considering safe injection in their cities as well.

View the original article at thefix.com

19 October 2018
Temporary Overdose Prevention Site Gets Extension

The site was expected to close by September’s end, but the government made a last-minute decision to extend it for another month.

At the end of September, the government of Ontario province in Canada decided to extend operations of its Temporary Overdose Prevention Site (TOPS) through October—but with no current plans for a permanent site, the community says it will be ready to pick up where TOPS left off.

“If the government was going to let these people down then our community needed to step up,” said community organizer Blair Henry.

TOPS, located in the city of London, was expected to close at the end of September, but the government made a last-minute decision to extend the site for at least one more month.

TOPS is the first sanctioned supervised consumption facility (i.e. supervised injection facility or SIF) in Ontario. The first SIF in North America, Insite, resides in British Columbia province in Vancouver. A handful of American cities are planning to establish SIFs as well, despite opposition by the U.S. government.

According to Canada’s Global News, about 2,000 people have visited TOPS 8,000 times since it opened in February. The non-profit that runs TOPS—Regional HIV/AIDS Connection—estimates that there have been about 400 drug-related deaths in London and greater Middlesex County in the last decade.

Currently TOPS remains a temporary program while the Ontario government considers a permanent site. While there is no guarantee of a permanent program, volunteers are prepared to serve the community if TOPS should close for good.

Last month Blair Henry organized about 200 volunteers to help operate a “pop-up tent” in the heart of London—equipped with medical supplies and treatment services—in case TOPS did close at the end of September.

But even though the government extended the program for one more month, Henry’s group, This Tent Saves Lives, still has work to do. “We have to help use this public momentum to inform Doug Ford (premier of Ontario) that there is support for this project,” said Henry.

“There will be an overdose prevention site of some sort that will be erected should that funding (for TOPS) go, but we are going to make sure that that messaging gets out so we can avoid that,” said Henry.

Another potential safety net for drug users—should TOPS close down in the near future—is to dispatch public health workers on bicycles throughout London.

According to the London Free Press, city health officials is considering a plan to reach drug users on the street with naloxone, medical supplies, and other harm-reduction supplies. A similar program exists in Vancouver.

“In urban cores, cycling tends to be the most efficient way of getting around,” said Chris Mackie, medical officer of health for the Middlesex-London Health Unit. “One thing we would do, that we’ve worked on with the London Bicycle Cafe, is we would put our staff on the street on bicycles, with naloxone, so that they’re traveling around.”

View the original article at thefix.com

4 October 2018
Seattle Not Intimidated By Threats Against Supervised Injection Facilities

“We took note of what the DOJ wrote about this, but we believe strongly in a public health approach to substance abuse disorder,” Mayor Durkan said.

The city of Seattle will move forward with plans to open a supervised injection facility (SIF), despite the possibility that the federal government will intervene, KUOW reports.

Seattle Mayor Jenny Durkan affirmed on Sept. 20 that the city will proceed despite the Department of Justice’s promise to respond with “swift and aggressive action.”

In a New York Times op-ed published in August, Deputy Attorney General Rod Rosenstein made clear the federal government’s opposition to SIFs, declaring that they will “only make the opioid crisis worse.”

“Because federal law clearly prohibits injection sites, cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action,” wrote Rosenstein.

But city officials and proponents say Seattle and greater King County need “an aggressive, comprehensive approach” to the drug crisis as drug-related deaths rise. According to a recent report by Seattle & King County Public Health, drug and alcohol-related deaths have increased for six consecutive years in King County.

“We took note of what the Department of Justice wrote about this, we’re cognizant of it, but we believe strongly in a public health approach to substance abuse disorder,” said Mayor Durkan.

Last Monday, Durkan released a proposed budget that would set aside $1.3 million to fund the SIF pilot program. “You’ll see in the budget that we will continue to work for safe injection sites,” said the mayor. “We want this to be part of a holistic system of treatment.” The final vote on whether to adopt the budget is set for mid-November, following budget proposal hearings in October.

Last we heard, the plan was to establish two supervised injection facilities—one in Seattle and one elsewhere in King County. The idea came from a list of recommendations on how to best address the region’s drug problem presented by the county’s Heroin and Prescription Opiate Addiction Task Force in 2016.

KUOW reports that Seattle officials are seeking a location “likely downtown or in Belltown” for the SIF, in addition to a mobile unit that will serve the same purpose. However, Durkan said they are still working on the “framework” with the county before they can set a location.

While opponents say the sites will do more harm than good, proponents say that they save lives and increase the probability of connecting people with treatment.

“Treatment is really the main bottom line that we’re trying to promote as the most effective, you know, population-wide intervention,” said Dr. Jeff Duchin, health officer for King County. “We want people getting in long-term treatment. And this is just one doorway that we can use to get people into treatment.”

View the original article at thefix.com

3 October 2018
Virus That Infected Our Ancestors May Play a Role in Addiction

Researchers studied whether the retrovirus played a part in promoting addiction in some individuals.

A virus that infected a human-related species more than 250,000 years may be the key as to why some individuals are more likely to develop dependencies towards drugs or alcohol.

A recent study found that traces of an ancient retrovirus – a virus that inserts its genetic code into its host’s DNA – known as HK2 was up to three times more likely to be found in the genetic makeup of individuals who had contracted either HIV or hepatitis C through intravenous drug use than individuals who had become infected through other means, such as sexual intercourse.

Traces of the HK2 virus are believed to exist in approximately 5 to 10% of the global population.

The study, conducted by researchers from the University of Athens in Greece and Oxford University in London, England, was published in the Journal of the National Academy of Sciences and was comprised of two parts: the Greek research group analyzed the genes of more than 200 individuals with HIV, while the English group looked at the DNA of approximately 180 individuals infected with the hepatitis C virus.

The Greek researchers found that the members of their study group that contracted HIV from intravenous (IV) drug use were 2.5 times more likely to have traces of the HK2 retrovirus in their genetic makeup than those who became infected through intercourse or other means.

The English researchers found similar results in their study group, with those who contracted hepatitis C through IV drug use and were long-time drug users 3.6 times more likely to have traces of the retrovirus in their genes than those who were infected in another manner.

As Live Science noted, when HK2 is found in an individual’s DNA, it is found in a gene called RASGRF2, which is involved in the release of dopamine – the neurotransmitter linked to the brain’s pleasure circuitry, and the chemical released by the brain in large amounts during drug use which scientists believe causes the repetition of such experiences.

The second part of the study yielded less concrete results: scientists inserted traces of HK2 into the RASGRF2 gene in human cells that did not already contain it. While they discovered that the virus changed the means in which DNA created proteins, it remained unclear as to its direct connection to addictive behaviors.

According to co-senior study author Aris Katzourakis, professor of evolution and genomics at the University of Oxford, the study is “the first time that researchers have shown that an ancient viral insertion that’s variably present in the population has a measurable, in this case detrimental, effect on our biology,” though as CNN noted, the RASGRF2 gene was associated with binge-drinking in a 2012 study.

The next step is to determine how HK2 influences dependent behaviors, with the end goal being a “drug to target” where the retrovirus has infiltrated the gene.”

Doing that may allow science to “help people recovering from this kind of behavior,” said Katsourakis.

View the original article at thefix.com

29 September 2018
San Francisco Unveils Safe Injection Site Prototype

Alongside accommodations for drug use, the facilities will offer a range of services geared toward giving clients a chance to get well.

With the city of San Francisco now closer than ever to opening the nation’s first supervised injection facility (SIF), it unveiled a prototype to show how a real facility will operate.

The public was invited to view the demonstration, titled Safer Inside, at Glide Memorial Church in the city’s Tenderloin neighborhood from August 28-31.

San Francisco is not the only city that has fielded the possibility of opening a supervised injection facility, which is prohibited under federal law. However, that’s closer to reality than ever, after final revisions of the bill (AB186) to allow the city to establish a SIF were approved by the state Assembly. AB186 now awaits the signature of Governor Jerry Brown.

The goal of opening such a site is to keep drug use off the streets, while giving people a safe place to use.

“I refuse to accept what we see on our streets—the needles, the open drug use, the human suffering caused by addiction—as the new status quo,” said Mayor London Breed in a statement. “Safe injection sites are a proven, evidence-based approach to solving this public health crisis.”

The San Francisco Chronicle offered a glimpse inside the Safer Inside demonstration. “Clients” who wish to use the facility register upon entering, and are then led to the injection room. They are provided with a “harm reduction kit” containing clean syringes, disinfecting wipes, cotton balls, tourniquets, and “cookers” to cook the drug.

They may inject at a table facing a small mirror that will allow staff to observe from a distance. “This way, we can check in on them without actually having to invade their space and their privacy,” said Kenneth Kim, clinical director at Glide. Afterwards, clients are ushered to a “chill-out room” where they can ride out their highs.

Despite the accommodations for drug use, public health officials are most proud that these facilities will offer a range of services geared toward giving clients a chance to get well. Services include meal services, showers, dental care, and mental health and medical referrals, according to the SF Chronicle.

“The readiness to take that next step or maybe go to recovery can start in a place where there’s dignity and respect and relationships,” said Anel Muller, who designed the prototype facility. “That’s not something that will happen overnight, but once you’re creating those great foundations, it becomes much easier to talk about a lot of different things.”

The greatest hurdle San Francisco officials may face is the federal government. Last Monday (August 27), US Deputy Attorney General Rod Rosenstein reiterated the federal government’s stance on SIFs—declaring them “very dangerous” and that they will “only make the opioid crisis worse.”

“Because federal law clearly prohibits injection sites, cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action,” said Rosenstein.

View the original article at thefix.com

11 September 2018
Safe Injection Sites Get Green Light From California Lawmakers

“I am committed to opening one of these sites here in San Francisco, no matter what it takes, because the status quo is not acceptable,” said Mayor London Breed.

Last week, California lawmakers green-lit a bill that would allow safe injection sites in San Francisco as part of a three-year pilot program.

The forward-thinking measure, authored by Assemblywoman Susan Talamantes Eggman and state Senator Scott Wiener, has already enjoyed support from local advocates and lawmakers.

“I am committed to opening one of these sites here in San Francisco, no matter what it takes, because the status quo is not acceptable,” Mayor London Breed said Monday.

Eggman voiced similar support for the proposed program. “Should we keep trying what has failed for decades,” she said in a statement, “or give San Francisco the choice to try something that we know saves lives, reduces disease, and saves money?”

The city’s Director of Health Barbara Garcia estimated that San Francisco has more than 22,000 people using IV drugs.

Last year, a slightly broader version of the bill stalled in the state Senate. That iteration of the would-be law would have authorized six counties—Alameda, Humboldt, Los Angeles, San Francisco, and San Joaquin—to participate in the harm reduction program.

The current version applies only to San Francisco:

“This bill would, until January 1, 2022, authorize the City and County of San Francisco to approve entities to operate overdose prevention programs for adults that satisfies specified requirements,” the bill reads, “including, among other things, a hygienic space supervised by health care professionals, as defined, where people who use drugs can consume preobtained drugs, sterile consumption supplies, and access to referrals to substance use disorder treatment.”

The revised version also retools the language, calling it an overdose prevention program instead of a safer drug consumption program. Whatever it’s called, greenlighting the program would not skirt federal drug laws and it’s not clear how the federal government would respond to such a program were it put into effect.

“People are injecting drugs whether or not we intervene,” Wiener said, according to the San Francisco Examiner. “Safe injection sites provide people with an opportunity to inject in a clean, safe environment, with healthcare personnel available to prevent overdoses, and with an opportunity to offer people addiction, healthcare, housing, and other services.”

Now, the bill is waiting for a vote in the state Assembly. The last time around, the lower chamber approved the bill 41-33, according to Curbed.

If the measure sails through the Assembly this time around, it’ll still need a signature from Gov. Jerry Brown before it becomes law, potentially taking effect at the start of next year.

View the original article at thefix.com

27 August 2018
Planned Safe Injection Sites Put On Hold In Canada

Advocates of safe injection sites called the Canadian health minister’s decision to halt the opening of the facilities “horrifying.”

A trio of planned safe injection sites in Ontario, Canada have been put on hold while the province’s new health minister conducts a review to determine if such facilities “have merit.”

Health Minister Christine Elliott said that she remains unconvinced that such sites are effective in reducing drug overdose deaths and the spread of HIV infection; she also cited concerns from neighboring businesses over security and biohazard refuse as core reasons for the review.

Advocates of safe injection sites and harm reduction policies called the health minister’s decision “horrifying,” that runs contrary to the needs of individuals in the midst of Canada’s opioid epidemic.

The CBC reported that in a letter sent on Friday, August 10, to health integration networks and health units in the province, Roselle Martino, assistant deputy minister of the population and public health division, said that the approval process for new safe injection sites in the cities of Toronto, Thunder Bay, and St. Catharines would be halted immediately.

The sites would allow for supervised injection of opioid drugs, grant access to harm reduction support and allow users to safely dispose of needles and other paraphernalia.

In the letter, Elliott wrote that she will be “reviewing the evidence and speaking to experts to ensure that any continuation of supervised consumption services and overdose prevention sites are going to introduce people into rehabilitation and ensure people struggling with addiction will get the help they need.”

CTV News also noted that Elliott will address how local businesses have been impacted by existing sites. The network cited concerns by Mark Garner, a member of the Downtown Yonge Business Improvement Area (BIA) in Toronto, who said that his organization has found discarded needles in the area near the Works, the city’s first supervised injection site, which opened in November 2017.

Garner stated to CTV that while his organization supports efforts to reduce drug overdoses, the businesses in the BIA have felt the need to increase security and allocate funding to clean up discarded needles, especially ones discarded in toilets which have caused plumbing issues.

“This is the number one tourist destination in Canada,” he said. “How do we integrate that into the neighborhood, what resources are needed, and how do we make it safe for everybody?”

But harm reduction advocates and health care professionals have expressed alarm at the province’s move, which some described as a decision motivated more by politics than any actual health concern.

“It’s a complete disaster, and I do worry about people on the ground,” said Marilou Gagnon, an associate professor of nursing and president of the Harm Reduction Nurses Association. “The science is very clear that overdose prevention sites do work, and we’ve known this since the ’80s. [I’m] extremely concerned about a government going against science.”

View the original article at thefix.com

16 August 2018