On May 19, The Mayor’s Task Force to Combat The Opioid Epidemic in Philadelphia released its report and recommendations to develop a plan to reduce the effect of addiction on the city. Most news coverage focused on the task force’s support of “user engagement sites,” which would allow individuals to use substances under the supervision of a doctor or nurse.
Dr. Michael W. Shore, Medical Director of the Malvern Treatment Centers Cherry Hill outpatient center, wrote the following editorial on how these sites fail to appropriately address substance addiction. Here’s what he wrote to the Courier Times:
To the Editor:
I am compelled to respond to the article in the 5/22 Issue entitled “Philadelphia to consider safe heroin injection sites.” I am a dually board certified Psychiatrist and Addiction medicine specialist in Cherry Hill and the Medical Director of the Malvern Treatment Centers Cherry Hill substance abuse treatment program. While the statistics are quite sobering (no pun intended) with increasing opiate overdose deaths every year, the answer is not to provide “safe” injection sites for those addicted to heroin. What makes it “safe”? Does this mean that there is trained staff on site to recognize an overdose and administer Narcan? Does it mean that the bags of heroin will be tested to ensure there are no contaminants or deadly combinations with fentanyl or carfentanyl? Does it mean that addicted individuals will be first tested to ensure they are not co-administering Xanax or other sedative hypnotics that when taken with heroin are often deadly? Will there be ID checks to ensure that nobody under the age of 18 is using the site? How long will patients be able to remain in the “safe site” before they have to leave? Will efforts be made (again with having trained staff on site) to refer patients to appropriate treatment programs? Will participants be able to “share” their heroin with others? Will there be monitoring to ensure that nobody is selling their heroin to others?
While many other questions and considerations are important, in essence this approach is in some ways legitimizing the continued addiction to an increasingly deadly illicit drug. What message does this send to young people?
What is necessary is to have readily available treatment on demand, with the ability to get the patient into medication assisted treatment to effectively treat the addiction and withdrawal symptoms safely and effectively. Law enforcement, family members and others need to know that treatment will be available within hours, not days or weeks later. Individuals addicted to opiates cannot wait for treatment – they get too sick and invariably go back to using. As a society we must see opiate addiction as public enemy #1 and devote the necessary resources to effectively treat these patients, often our relatives, friends, colleagues and neighbors in an effective manner. If we can budget 30 billion more dollars to defense spending certainly we can budget a paltry 3 or 4 billion dollars to combat an epidemic that is destroying our society more and more each year.
Michael W. Shore, M.D. DLFAPA, DFASAM