by Rachel Retter
The opioid crisis is now a major public health issue in America, as addiction and overdoses have become common. In 2017, over 70,000 Americans died from drug overdoses. Various causes are used to explain this rise in addiction and deaths from opioid overdoses, including increased use of Fentanyl, a potent synthetic opioid, and increased prescriptions of opioids for pain relief. Oftentimes a person will get prescribed an opioid after some kind of injury or surgery and will become addicted and turn to opioids even after their prescription expires.
Over the past few decades, opioid overdose has become a leading cause of death in the US in adults under 50. In the past, the strategy to combat opioid abuse involved criminalizing drug use, zero tolerance policies, and the singular promotion of abstinence. However, all across the socioeconomic spectrum, opioid use and fatal overdose rates have continued to rise, despite these efforts.
In light of these failures, public health workers have come up with a new approach called harm reduction. The philosophy of harm reduction is to recognize that if people are going to participate in risky behaviors or activities, then we should at least attempt to make these activities as safe as possible. Harm reduction acknowledges the fact that it isn’t realistic to expect all drug users to be able to completely abstain from opioids right away. The reason for this is both psychological and physiological; in addition to becoming emotionally dependent on the drug, the body of an opioid user adjusts to the substance and becomes physically dependent on it. According to americanaddictions.org, withdrawal from opioids, prescription and nonprescription, can be extremely painful and can even lead to dangerous complications.
For this reason, although the ultimate goal remains stopping addiction completely, harm reduction does not solely promote total abstinence from opioids. It also works to protect addicts even while they are still addicted, by coming up with practical strategies to reduce the dangerous consequences of opioid abuse.
This is the motivation behind supervised injection sites. Supervised injection sites are government sanctioned places stocked with clean needles and medical professionals who know how to reverse overdoses. There are resources at these sites to connect addicts with rehab centers for when they are ready to quit using drugs; however, the overall function is to provide addicts with a safe, clean place for them to use drugs while under medical supervision. The hope is that by providing addicts with a safe, supportive, non-judgemental place to go, we can reduce the number of lives lost to overdoses and give addicts the resources they need for when they are ready to stop using. Another positive consequence would be fewer publicly discarded syringes as well as fewer cases of infections that result from using unclean syringes, such as HIV.
Supervised injection sites have been, and remain, quite controversial. Many argue that these sites enable drug users, and seem counterproductive to the ultimate goal of stopping opioid abuse completely. Some worry that removing the stigma and judgment surrounding opioid abuse might serve to normalize it.
Those in favor of these sites argue that while abstinence will, of course, remain the ideal and ultimate goal, it is important to acknowledge that there is a sizable population of people in our country who are vulnerable, and it is incumbent upon us to protect them. Past methods of stigmatizing and criminalizing drug use have proven ineffective in decreasing opioid overdose and addiction rates, and new solutions are needed.
Several supervised injection sites are currently operating legally in various cities and countries, including Vancouver, Canada, and Sydney, Australia. These sites are currently not legal in the US, and the US Justice Department has taken a strong stance against them. Many cities in the US, however, including New York City, have been trying to lobby the government to promote these sites. As this political struggle continues, researchers are currently exploring the long term effectiveness of these sites in reducing opioid addiction and overdose rates.
There are a number of harm reduction agencies operating in the US, such as the Corner Project which serves the Washington Heights community, which serves a similar function as a Supervised Injection Site, but at a much smaller scale. YU’s Chapter of UAID (United Against Inequities in Disease) worked with the Corner Project last year to host a naloxone training, in which students were taught how to recognize an opioid overdose and use naloxone to reverse the overdose. The Corner Project will once again be teaming up with UAID to host another naloxone training on April 1st at 7:30pm in the Sky Caf. At this event, representatives from the Corner Project will discuss what it means to promote harm reduction, further elaborate on the work they do to combat the opioid crisis, and provide a complete training for students on how to spot an overdose and how to administer naloxone.
Whether or not harm reduction is the answer, it is important that we as a society continue to explore innovative and creative ways to fight the opioid crisis, and educate ourselves on how we can help people who are at risk. Please consider coming to hear more about harm reduction and supervised injection sites on April 1st!