Opioid addiction is a chronic medical condition marked by a physical and psychological dependence on opioids (often prescription drugs or heroin). As the disease progresses, patients often require increasing amounts of opioids to prevent debilitating withdrawal symptoms. As a result, many of our patients resort to intravenous injection of drugs, which is a more efficient and cost-effective way for them to treat their withdrawal.
Unfortunately, it is also far more dangerous.
Intravenous injection of drugs puts our patients at increased risk of fatal overdose. It also increases patients’ risk of bloodstream infections, including HIV and hepatitis C. Bacterial infections may also lead to more serious conditions such as sepsis, endocarditis, and cellulitis. Viral and bacterial infections costs healthcare spending and, more importantly, lives.
And due to stigma around injection drug use, many of our patients must resort to public injecting in abandoned buildings, public parks and bathrooms and in remote rural areas. Public injection increases the risk of injection drug use even further as these spaces are often 1) unsupervised, putting patients at increased risk of overdose death, and 2) unsanitary, putting patients at increased risk of infection. A recent study in San Francisco found that 86% of participants of syringe exchange programs had injected in a public place at least once in the past three months; 40% reported they most frequently injected in public places. The consequences of injecting drugs in a public setting include rushing injections, not properly cleaning injection sites, and reusing injecting equipment due to fear of arrest or public view.
In addition to injection-related infections and adverse health outcomes, anyone who uses opioids is at risk of opioid overdose. In 2015, 4,659 Californians died of an opioid overdose. While initiatives to distribute naloxone, an opioid overdose antidote, reduce fatal overdose, we need to prevent overdoses from happening to begin with.
While our goal is to link patients who inject drugs to long-term comprehensive treatment for addiction, many are not ready for a variety of reasons. It is these patients who are at the highest risk of harm from their drug use. And it is these patients who are failed by our current healthcare system.
Safer Drug Consumption Services (SCS) are part of a comprehensive public health approach to reducing the harms of drug use. A SCS is a controlled healthcare setting where people struggling with addiction are able to self-inject or smoke pre-obtained drugs in a hygienic environment under the supervision of trained medical staff. SCS bring a vulnerable and high-risk population out of the shadows -- where overdose and injury are more common -- and provide a safe, clean space for those who inject drugs but who are not yet ready to engage in drug treatment.
Decades of research on SCSs is strong and compelling. They have been shown to reduce public injecting, overdose deaths and both HIV and Hepatitis C infections. They also increase access to drug treatment for a population that is less likely to seek treatment on their own due to mistrust of the healthcare system. Contrary to popular belief, they do not lead to increases in drug use or drug-related crime.
Moreover, SCSs have been proven to be cost-saving by reducing the need for emergency medical services and by reducing incidence of expensive chronic conditions such as HIV and Hepatitis C. One study in San Francisco estimated that one facility would result in a net savings of $3.5 million annually. Several feasibility studies have indicated that participants of harm reduction programs would access services at a SCS (86%) and believe that others would use the site (90%). Potential benefits identified by people who use drugs include avoiding drug-related arrest, fatal overdose, more time to prepare and administer injections, improve access to sterile injecting equipment, reduce the likelihood of reusing and sharing injecting equipment, and promote a sense of community and connection to other support services.
And despite skepticism by those unfamiliar with the data, SCSs do not increase drug use in the surrounding community. SIFs do not increase initiation of injection drug use. And SCSs do not increase drug related crime. Multiple peer-reviewed studies have shown that SCS reduce improper disposal of syringes in the community. After the implementation of many SCS in cities around the world, popular opinion and approval of the sites increased over the years.
There are over 100 SCS sites operating in 66 cities in 11 countries around the world. Yet despite evidence of their success, there is not a single SCS in the United States. In recent years, many states have started conversations to implement SCS in light of the opioid overdose epidemic and new outbreaks of HIV among people who inject drugs. We are long overdue. And California, which has experienced a steady increase in overdose deaths in the past several years, is in particular need of such a public health intervention.
SCS cannot prevent all risky drug use or related harms. But evidence demonstrates that they can be remarkably effective and cost-saving, while improving the lives of people who inject drugs and the safety and health of our communities.
[List of Providers - include your name by completing the information below]