Tag: safe injection sites

Germany Doesn’t Have An Opioid Crisis. Here’s Why.

One German doctor believes the country’s hesitance to prescribe opioids plays a major role in helping avert a crisis.

With recent stories warning about addiction taking hold in India and Australia, it can seem like the opioid epidemic is much larger than North America. However, Germany has largely avoided the crisis, in part because of its approach to pain management and in part because when addiction does arise, it is treated more quickly and effectively.

While opioid prescription rates in the United States have been rising exponentially, they’ve only increased slightly in Germany, NBC News reported.

Dr. Peter Raiser is the deputy managing director at the German Center for Addiction Issues. He said that healthcare providers in the country take a much more controlled approach to opioid pain pills. That’s kept prescription rates relatively stable, even while they skyrocketed in other Western countries.

Raiser said, “Among the most important reasons we do not face a similar opioid crisis seems to be a more responsible and restrained practice of prescription.”

Doctors Need Special Permission To Prescribe Opioids

A major difference is that opioids are not a first-line option for pain management in Germany, as they often are in the United States. Doctors need special permission to prescribe opioids to a patient. In order to be granted that permission, they need to show that they’ve trial alternative treatments and medications, and that those have been unsuccessful. Then, patients need to be screened for addiction risk.

University of Hamburg psychiatrist Dr. Dieter Naber said those precautions lower the number of opioid prescriptions that are written.

He said, “Here in Germany, they prescribe opiates if all the other drugs don’t work. It’s much, much, much more difficult.”

Affordable Healthcare Means More Doctor Visits

In part because opioids are less prevalent, opioid use disorder is also less common in Germany. About 0.2% of Germans live with opioid use disorder, compared with 0.6% of Americans.

One reason may be because Germans are more likely to keep in touch with the doctors that prescribed their opioids, since healthcare is cheaper than it is in the United States. Since they’re seeing patients more frequently, doctors are better able to spot signs of opioid abuse.

When Germans do become addicted to opioids, they’re much less likely to die than their American counterparts with substance use disorder, since treatment is more affordable and widely available.

Naber explained, “Money regarding treatment is really not an issue here.”

In 2016, 198 Americans per one million died of drug overdoses, compared to just 21 Germans per million.

Harm Reduction In Action

For people who are not willing to go into treatment, Germany has harm reduction programs, including more than 20 safe injection sites. The United States has none (although some cities are considering plans).

Dr. Andres Roman-Urrestarazu, a University of Cambridge researcher, said the German approach recognizes addiction as a more complicated and nuanced problem that requires a variety of solutions.

“We know harm reduction works in terms of dealing with the problem of mortality,” he said.

View the original article at thefix.com

23 October 2019
Yang, Beto Discuss Unusual Solutions to The Opioid Epidemic

The presidential candidates made the case for marijuana legalization and opioid decriminalization during a recent debate.

Democratic presidential candidate Beto O’Rourke spoke about marijuana as a replacement for opioid pain pills during the Democratic primary debate on Tuesday (Oct. 15), while fellow candidate Andrew Yang expressed his support for decriminalizing opioids and opening safe injection sites.

O’Rourke shared a story about a veteran he had met who was addicted to heroin. He suggested that if the man had access to marijuana, he wouldn’t have become hooked on opioids, according to Marijuana Moment.

Marijuana Legalization

“Now imagine that veteran, instead of being prescribed an opioid, had been prescribed marijuana, because we made that legal in America [and] ensured the VA could prescribe it, expunge the arrest records for those who’d been arrested for possession and made sure that he was not prescribed something to which he would become addicted,” O’Rourke said.

Asked directly whether marijuana is part of the answer the the opioid crisis, O’Rourke answered, “Yes it is.”

As O’Rourke was speaking, Yang said, “Yes, preach Beto.”

Decriminalizing Opioids

During the debate, Yang expressed his support not only for legalizing marijuana, but for decriminalizing opioids, including heroin.

He said, “We need to decriminalize opioids for personal use. We need to let this country know this is not a personal failing, this was a systemic government failing. Then we need to open up safe consumption and safe injection sites around the country because they save lives.”

Yang continued, “We have to recognize [addiction] is a disease of capitalism run amok.”

He pointed out, “There was a point where there were more opioid prescriptions in the state of Ohio than human beings in the state of Ohio, and for some reason the federal government thought that was appropriate.”

Public Health Issue

Yang said that because the government was complicit in the over-sale of opioids, it needed to support people who are now addicted to opioids.

“If the government turned a blind eye to this company, spreading a plague among its people, then the least we can do is put a resource into work in our communities so that people have a fighting chance to get well, even though this is not a money problem,” he said. “We all know this is a human problem. Part of helping people get the treatment that they need is to let them know that they’re not going to be referred to a prison cell, they will be referred to treatment and counseling.”

Other more mainstream candidates including Bernie Sanders and Elizabeth Warren have supported harm reduction policies as well.

View the original article at thefix.com

18 October 2019
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
A Safe Place to Use Drugs: Lessons from Europe's Supervised Consumption Sites

“People are always against harm reduction programs at first. But once they see the results, their views change.” – Frederick Bernard, Liege Chief Commissioner of Police

My first visit to a safe consumption site (SCS), where people use illicit drugs under professional supervision, felt like a strange dream. On a tepid June day, I sat in a circular room decked with Star Wars posters in Liege, Belgium, drinking bitter coffee from a tiny plastic cup and listening to two Belgian police chiefs discuss the country’s first SCS, which had opened next to the police station nine months earlier. To my right, Liege Chief Commissioner Frederick Bernard praised the program for successfully removing illicit drug use from public spaces in Liege.

When I asked in halting French if the city had experienced pushback from other police or citizens about the site—especially considering that SCSs are illegal in Belgium—the commissioner waved his hand, saying, “People are always against harm reduction programs at first. But once they see the results, their views change.”

After our introductory meeting, Commissioner Bernard escorted a visiting police chief and me to the SCS, which was located on a pedestrian street near several restaurants and boutiques. Dominique Delhauteur, coordinator of TADAM, a private foundation that oversees the SCS, and a staff nurse met us at the door and welcomed us to a waiting area inside what looked like an old airplane hangar.

Using Illicit Drugs, with Supervision

A bald man with a long, forked beard and suspenders, it was hard to imagine that Delhauteur was once Belgium’s defense secretary. During our tour he recounted his bizarre journey from Parliament to coordinator of an illegal drug consumption site. Called Saf ti (a play on the word ‘safety’), the site had opened in September 2018.

“The city wanted to open a safe consumption room and they designated [TADAM] to open it,” explained Delhauteur, adding that mayor of Liege had been under pressure to do something about the open drug markets in Liege. “We were not put off by the illegality,” he adds, because local police supported the project from the beginning.

Currently, over 100 legal SCSs operate in 12 countries around the world, primarily Canada, Australia, and parts of Europe. Also called drug consumption rooms or supervised injection facilities, SCSs allow people to use drugs under the supervision of trained staff.

In order to prevent the spread of HIV, hepatitis C and other infections, SCSs offer sterile equipment for smoking or injecting drugs and provide education around safer use techniques. To prevent deaths, staff responds to overdoses and other emergencies. Most programs also offer wraparound services such as referrals to housing, healthcare, employment, and drug treatment programs. SCSs do not provide illicit drugs and forbid users to sell or share them onsite.

SCSs operate on a harm reduction model, which seeks to reduce the negative consequences of problematic drug use, such as death and disease, while at the same time recognizing that drug use is a part of our world. Harm reduction is a pragmatic approach to a complex problem, like providing condoms and safe sex education rather than pursuing the more elusive goal of abstinence for all people at all times.

Do Supervised Consumption Facilities Encourage Drug Use?

Opponents of SCSs argue that they encourage drug use—the same criticism often levied against other harm reduction programs such a syringe exchange or naloxone access. But although research on SCS outcomes is difficult (largely due to the ethical dilemma of creating a control group without access to SCSs and the difficulty of measuring illicit behaviors), existing reports point to positive outcomes for SCS users.

A 2014 review of 75 studies on SCSs around the world reported that the programs reduce drug use in public spaces, lower overdose rates, increase access to safer injection conditions (which can decrease infection and disease) and link users to healthcare. Other studies have reported lower overdose mortality, fewer ambulance calls, and a decrease in HIV infections among SCS participants.

A study published in Lancet on Insite, the first SCS in Vancouver, Canada, found a 35% decrease in overdose rates in the area immediately surrounding Insite (compared to a 9% decrease in the rest of the city). A study published in Addiction in 2007 reported that Insite users were 30% more likely to access drug treatment than non-participants. The study found no evidence that Insite increased or encouraged drug use.

How It Works

Saf ti – Liege, Belgium

During my tour of Saf ti in Liege, I was already aware of the benefits of SCSs (and their limitations, namely, that positive effects only extend to the site’s immediate area). But I wanted to see how the facilities actually worked.

Saf ti has only three rules: users must be 18 or older, they cannot sell or share drugs in the facility or surrounding area, and they must have a history of illicit drug use prior to their first visit. The program is open seven days a week at varying times and receives 50 or more visits per day, with some users returning several times a day. (To protect users’ privacy, our visit occurred outside operating hours.) Medical care for abscesses, burns (from smoking hot pipes), infections, or other complications is also available.

“We have a team of seven nurses, three social work educators, and two general practitioners who visit twice a week,” said Delhauter. “If someone asks for help, we listen and we help.”

After showing us the checkup room, which looked like any doctor’s office, Delhauteur led our little crew to the actual consumption area. Here, staff provides users with a tray containing sterile supplies for injecting (a syringe, a spoon, sterile water, alcohol wipes, and a filter to separate solid drugs from liquid after heating) or smoking (a pipe and a smoking filter). Heroin and cocaine are the primary drugs consumed at this site, with most heroin smoked and most cocaine injected (the reverse of drug trends in the U.S. and many other parts of Europe).

The injection room stands to the right of the supply counter. Several steel tables and chairs furnish the room, which is equipped with bright yellow biohazard containers to dispose of used injection materials.

Along one wall of the room, rows of tiny plastic drawers house multi-colored tourniquets, which are used to tie off the arm before injecting. Each tourniquet is labeled with the name of its owner so that it can be reused.

The smoking area stands to the left of the supply counter. The 12 steel smoking stalls resemble mini phone booths equipped with stools, tables for preparing drugs, and massive air vents to suck up smoke and sterilize the room. To facilitate cleaning and sterilization, every surface in the consumption area is metal.

Saf ti is clean, sterile, and professional, though I would hardly describe it as comfortable or inviting. Its purpose, of course, is to reduce health harms associated with illicit drug use, but it is also designed to conceal drug use from the public. The facility is hidden in plain sight on a busy street where passersby on their way to nearby shops and cafes would never guess that inside that unmarked warehouse, dozens of people take illegal drugs each day.

Quai 9 – Geneva, Switzerland

The Liege SCS was the first that I visited during a six-week drug policy tour through central Europe. The second facility, Quai 9 in Geneva, Switzerland, had a whole different personality.

If Saf ti hides in plain sight, Quai 9 makes no effort to hide at all. The building, a garish lime-green box, rises out of a concrete parking lot next to Geneva’s busiest train station. The setup to Quai 9 is similar to Saf ti. Before using the consumption rooms, participants enter a waiting area for intake. Quai 9’s waiting room resembles a coffee shop, except that in addition to espresso (served in tiny ceramic teacups), the shelves behind the expansive counter offer sterile drug use supplies, brochures on HIV and hepatitis C prevention, biohazard containers, and other resources. The room has tables and chairs and a medical office to the side where people can visit a nurse or doctor.

The Quai 9 consumption room is painted the same blinding green as the outside of the building. Several injection stations are equipped with biohazard containers for waste disposal and bottles of disinfectant for cleaning each station after use. In a smaller room cordoned off by a glass wall, users can sit at a metal table to smoke their drugs.

Quai 9 receives an average of 120 visits per day, 365 days a year. It opened in 2001 in response to a rash of infections and overdoses among Switzerland’s heroin user population. Like the rest of Europe and the United States, Switzerland experienced rapid growth in heroin use during the 1970s, accompanied by increases in overdose deaths and HIV transmission through needle sharing.

At first, Switzerland responded like the rest of the world, engaging law enforcement in harsh crackdowns on users and dealers. In the ensuing years, overdose deaths quadrupled from about 100 per year in the late 1970s to nearly 400 per year in the early 1990s. AIDS deaths related to injection drug use skyrocketed as well, from a handful per year in the early 1980s to a peak of 350 in 1994.

After Switzerland Implemented Harm Reduction Programs, Drug-Related Deaths Declined Sharply

But beginning in the late 1980s, Switzerland adopted a different approach to drug use, seeking to manage the harms rather than attempt to eliminate drugs altogether, which was proving impossible. The first SCS opened in Berne, Switzerland in 1986. In 1994, the Swiss also pioneered heroin-assisted treatment clinics, where heavily dependent users could receive prescription heroin under medical supervision, therefore reducing the user’s contact with the underground economy and associated crime. Since the implementation of these programs and harm reduction techniques, Switzerland has seen a 64% decline in drug-related deaths. The percentage of new HIV cases originating from injection drug use also plummeted from 50.7% during the 1990s to 2% in 2014.

Switzerland’s results could serve as a blueprint for drug policy in other countries, including the United States. In fact, in 2017 the American Medical Association threw their weight behind SCS, issuing a statement announcing the group had “voted to support the development of pilot facilities where people who use intravenous drugs can inject self-provided drugs under medical supervision.”

Plans to open SCSs are underway in several U.S. cities, though numerous roadblocks remain. In 2017, the Seattle City Council committed $1.3 million to open a site, while surrounding King County pledged $1 million towards the project. But Seattle’s new U.S. Attorney, who took office in April 2019, has vowed to block efforts.

Jesse Rawlins, Project Manager for the Public Defender Association, which is leading the SCS campaign, says that the Association is “rolling supervised consumption work into a larger local campaign focused on engagement and care for drug users.”

In 2018 New York City Mayor Bill DeBlasio put forth a pilot plan to open four SCSs, but the sites are still awaiting approval from the state Department of Health.

In May 2019, backed by a broad coalition of public and private sector stakeholders, a bill authorizing SCSs in San Francisco passed the California state Assembly. In January it will attempt to move through the Senate.

“We’ve done a lot of organizing and educating in San Francisco, and SCS has broad support here, but we continue to face frustrating delays, most recently the decision to hold the state legislation until next year,” says Laura Thomas of the San Francisco AIDS Foundation. “We know these delays are measured in lives lost and we’re looking for other ways to provide these services to keep people alive and get syringes off the streets.”

Safe Consumption Sites in the U.S. Face Opposition

In Philadelphia, a non-profit called Safehouse is suing the federal government for the right to open an SCS. The group enjoys support from local elected officials, including the mayor and the District Attorney, but federal prosecutors are gearing up for a court battle. Evidentiary hearings for U.S. v Safehouse are set for August 2019. The court’s decision may determine the future of SCS efforts across the nation.

“We have consistently maintained that overdose prevention, including supervised consumption, is a legal medical practice and not prohibited by federal law,” says Ronda Goldfein, Executive Director of the AIDS Law Project of Pennsylvania. “A win in Philadelphia will diminish the fear of criminal and civil liability and will encourage other communities to push forward with efforts to save lives.”

U.S. resistance to SCS echoes the pushback from Europeans, Canadians and Australians when they first considered the programs. The fear that harm reduction will encourage drug use remains ingrained in the national psyche despite science that contradicts these claims. But during times of crisis, people often become willing to set fears aside and try new solutions. Europe implemented harm reduction programs at the peak of drug and HIV epidemics. The U.S. is currently facing a historic overdose crisis. Harm reduction programs once considered politically impossible are launching all over the country. If trends continue, legal safe consumption rooms might be in the U.S. sooner than we think.

Peter Muyshondt, Dominique Delhauteur, Marylene Tommaso, and Tessie Castillo

View the original article at thefix.com

24 July 2019
Could The Nation's First Supervised Injection Sites Be Coming To Maine?

Maine’s bill would allow two facilities in the state and create a half-mile “tolerance zone” around each location, where individuals cannot be arrested for using drugs.

Maine officials held a public hearing Monday to consider a bill that could establish the first safe injection sites in the country. The bill, called “An Act to Prevent Overdose Deaths,” would certify two facilities to “provide safe and secure locations for people to self-administer drugs,” according to FOX 23.

A number of local governments across the U.S. have considered opening “safe injection sites” or “supervised injection facilities” (SIFs) where individuals can safely use illicit substances with clean equipment and under the supervision of trained medical professionals, without the threat of arrest.

The philosophy behind these facilities is that people will use drugs one way or another, and giving them a safe space to do so prevents overdose deaths and the spread of HIV and hepatitis C. At the same time, medical professionals on site can offer recommendations for addiction treatment and other health issues related to drug use.

Places like Maryland, Seattle, San Diego, and Philadelphia have also considered opening safe injection sites. But the process has been slow going, not to mention the threat of legal action from the government.

Most recently, the Philadelphia non-profit Safehouse was sued by state prosecutors and the U.S. Department of Justice to stop the opening of the city’s first SIF.

The legal challenge is based on a section of the federal Controlled Substances Act which intended to close “crack houses” in the ’80s. The ruling on the Philadelphia case is expected to determine the future of SIFs in the country.

Meanwhile, the first of these sites in North America launched over 15 years ago in Vancouver, Canada. According to the BC Coroner’s Service spokesman, Andy Watson, there has not been a single death reported at any SIF in the province since they opened. At the same time, new HIV cases among people who use injection drugs have fallen by 86% since 2005.

Maine’s bill would allow two facilities in the state to act as safe injection sites and create a half-mile “tolerance zone” around each location, where individuals cannot be arrested for using drugs. Said facilities would also gather and report demographic data and other information, which would be used to determine if additional sites should be opened.

According to Maine Public, no one at the Monday hearing spoke against the bill, but “supporters acknowledged that safe injection sites would violate federal law.” So far, it does not appear that there are any legal challenges to this specific bill.

View the original article at thefix.com

3 April 2019
Feds Sue To Stop Safe Injection Site In Philadelphia

Federal authorities are invoking a “crack house statute” from the ’80s in their attempt to stop the opening of the site.

Federal authorities in Philadelphia are suing to stop the opening of a safe injection site in the city.

“These folks have good intentions and they’re trying their best to combat the opioid epidemic,” William McSwain, the U.S. attorney for the Eastern District of Pennsylvania, told NPR. “But this step of opening an injection site crosses the line.”

McSwain is suing to stop Safehouse, a nonprofit, from opening a supervised injection site. The organization has said that it has support of city officials and plans to open the site this year. However, McSwain said that the site—where people would bring drugs to inject under medical supervision—is illegal.

“If Safehouse or others want to open this type of site, they need to steer their efforts to get the law changed,” he said.

The federal authorities cite a portion of the Controlled Substances Act that was written during the 1980s when people were concerned about the crack epidemic. The so-called crack house statute makes it illegal to operate a place to make, store, distribute or use illegal drugs. The law was originally written to prosecute people operating crack houses, but authorities have used it in other circumstances, said Alex Kreit, a law professor at Thomas Jefferson School of Law in San Diego and a drug policy specialist.

However, Kreit noted that this is the first time authorities will try to use the law against a safe injection site.

“It is completely untested in terms of how federal law will apply to safe injection sites,” he said. “People will be watching this very closely—particularly in other cities that have expressed their intention of starting a safe injection site.”

Although Philadelphia has been at the forefront of the supervised injection site debate, other cities from around the country are considering similar measures. There are no safe injection sites in the U.S., but data from Canada and other countries indicate that such facilities can help stop the spread of disease and reduce overdose deaths because medical professionals are on hand.

Proponents also argue that the sites will be able to connect drug users with resources including treatment.

Despite this, McSwain said in a letter to Safehouse that the law “makes no exception for entities, such as Safehouse, who claim a benevolent purpose.”

Safehouse’s vice president and attorney Ronda Goldfein said that she’s confident that a federal judge will recognize that the site is not the intended target of the statute.

“We have a disagreement on the analysis and intention of the law. We don’t think it was intended to prevent activities such as this, and perhaps it will take a court’s ruling to move the issue forward.”

View the original article at thefix.com

8 February 2019
How I Came To "Believe” In Safe Injection Sites

The part of me that understands service is the backbone of my recovery, demands something other than pretending that there aren’t options available to people still suffering.

So last night I’m at a town hall event on drug addiction and someone mentions safe injection sites in the audience. My heart begins to pound from having my hand up and hoping to get called on, so I can ask about this, among other topics.

The panel looks around at each other trying to see who will bite first, as it’s clearly a controversial topic. Finally, the one “token recovery guy” speaks up, “You know, studies are positive, but people are very opposed to the idea, and the last time we had a discussion about it a fight nearly broke out.”

And so, I wanted to get up. And I wanted to have that fight.

But I was taught to cease fighting anything and anyone. What about fighting substance use disorder? I thought my disease was doing pushups? Certainly, this disease is wreaking havoc across our country, especially with the younger generations, and what are we, as a community, prepared to do about it?

Who is fighting on the front lines? While communities claim “not in my backyard” absolution, so do the “anonymous people” who are in recovery in this country. They are told to have no opinion on outside issues. But, to me, this isn’t an outside issue, because the part of me that understands service is the backbone of my recovery, demands something other than pretending that there aren’t options available to people still suffering.

Thankfully, I have met many who are rank and file generals in this fight, however compared to the #’s we could have, it is disappointing, and makes creating change in our communities even more difficult.

Clearly, safe injection options are not a solution, but saying “he or she must not have wanted it enough” when they drop out of the only pathway we are offering, which for mainstream recovery is a 12-step program, is an even less valid answer.

12-step can be successful, alongside other treatment modalities, but it is often seen as “the” solution and not “a” solution.

And what about statistics? Research shows that overdose rates decrease around the area of the safe injection site. If this statistic alone isn’t a good enough reason to support them how about that the rate of people who were entering treatment in those areas increased?

Look, don’t get me wrong, I was once on the other side of this conversation. I had a lot of misguided beliefs before I entered recovery. I once thought when I was 16 and my drinking career had just begun, that if I could get my dad to give me driving lessons while I was drinking, I wouldn’t have a drinking and driving problem!

Clearly being open-minded that my own thinking could be wrong is an important aspect of recovery, and so while I was made to think I should be open-minded about the program, I was indoctrinated to believe recovery was a static black-and-white thing, and that I was a miracle because I didn’t use, and while this may be true, it also underlined another assumption, that those who didn’t make it were not entitled to these miracles.

The idea that there is a level of participation required for someone to enter recovery is not lost on me, but the fact of the matter is, more and more people, especially those from the younger generations, are struggling to find their way in recovery and our answer to the staggering overdose and relapse rates is “they must not have been ready.”

So now what? What do we do with people who aren’t ready? Tell them to go out and give their substances another try? Drugs which could easily kill them in one shot? In my mind, if someone is not ready for abstinence-based recovery it isn’t that they have failed, it’s that they may not have reached that point yet, they may never reach that point, and who are we to say what that should look like.

There are many people who reach a significant “bottom,” only to find themselves using again. Can anyone say, who is honest with themselves, that a “bottom” is what creates recovery? Surely it can help, but there are many who hit that point and beyond, and for those people, while their lives continue to crumble around them, what is available?

To me, this is why we need to offer as many solutions to this problem as we can. Not offering alternative methods like safe injection sites, or medically assisted treatment, is like saying to someone who has diabetes they can’t go to the hospital for support, or shouldn’t have to take insulin, they should just use their higher power, and if they can’t clearly, they don’t want to be healthy enough.

Change is possible without necessarily being at a point of relying on grace only. While I believe in grace and have my own stance on faith, I believe this “coveted” winners circle of recovery is an issue and is not saving lives, especially amongst young people.

Do I believe willingness is an important key to recovery? Certainly, yet how many of us become willing along our path of using? So why would we not want to create opportunities for the people who are using, to not only stay alive, but be near recovery support services?

When someone has a reoccurrence of use, do we no longer consider them in recovery? Therefore, by that logic, anyone who is in active use has the potential to effect this same change in their lives. Hospitals, fire houses, police stations, med express, anywhere, anytime someone wants out of the cycle, it should be as easy as getting a flu shot. It is that easy to get high or drunk.

Finding drugs is way easier than finding recovery, unfortunately, we don’t seem to be making much headway on that stat. It shouldn’t be so difficult to get help, and yet it is. Clearly, we have quite a way to go, and so while we stand at the frontlines arguing for much-needed treatment options, housing options, peer support options for people in early recovery, we need to also keep our eye on how we can affect those who haven’t gotten to that point yet.

So, I didn’t get up and fight at the town hall meeting, because I know that the only way change will be affected is if compassion and reason win over misunderstanding and hatred. The only way we can win, and by we, I mean the parents who lost children to overdoses, and by we, I mean the advocates who mentor peers who end up overdosed in alley ways, and never make it home to their families, is if we can convince society that shaming people is not working and giving them opportunities for change are the best ideas we have currently.

I understand clearly that this option is seen as enabling to some. That we are encouraging people to use by providing needles and a safe place to go. The concept is not lost on me, but current models are not working. Prevention talks often fall on deaf ears, and while it doesn’t mean we shouldn’t continue to try to reach people, it does mean we need to get real about whether we are doing all we can do to help prevent overdose deaths in this country.

If someone who is opposed has a better idea of how we can get the people in our communities, who are using illicit substances, out of the shadows and into the light where we can see them and help them, please by all means share it.

To me the big bad wolf in this situation is that we would have to admit as a community, that people in our community, have heroin problems. We don’t like to admit that, and unfortunately it’s killing people.

I would argue that whatever motives you have for being opposed to this option, check them against the idea that centralizing use as best as possible helps to a.) measure your community and its needs, b.) provide safety and support to a vulnerable part of the population c.) encourage the next step for people to move on with their lives and d.) minimize the risk to police and health care workers responding to overdoses.

One of these reasons alone in my mind is enough to at least give it a try. Saving just one life means so much, especially if it is your child, your brother, your sister or your parent. Sharing this pain with too many people in too short of a time period is how I came to believe in safe Injection sites.

Erik Beresnoy is a father, advocate, and a writer on topics that range from recovery, and spirituality to music and philosophy. Erik has been an active member of the recovery movement since 2008, when he himself entered recovery, and began to not only repair his life but to also seek help repair his community by working to implement new strategies. His current projects include Empowerment Coaching for the Ammon Foundation, and implementing a transformational program in NYC called Dare to Dream for Synergy Education. He is a certified recovery coach as well as a board member for Rockland Recovery Homes. His other works can be viewed at soberspiritmeditation.com.

View the original article at thefix.com

1 February 2019
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