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Safe injection sites aren’t answer to curb drug epidemic

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. 

Sincerely,

Michael W. Shore, M.D. DLFAPA, DFASAM

One response to “Safe injection sites aren’t answer to curb drug epidemic

  1. I do agree with a lot of what you said and I absolutely agree with you about having treatment be readily available and on demand. That is so important and so lacking which is such a bummer. But I do think safe injection sites are a good idea and a lot of your concerns over it are valid but aren’t enough to sway me to think that safe injection sites are a bad idea. There has been a lot of positive outcomes in places that do have safe injection sites and honestly for people that are homeless I think its way better for them to have a place to go to use safety and be able to dispose of their needles responsibly as well. It also puts addicts closer the nurses and doctors that won’t judge them and will make them feel that they have a place to go not to just use safely but also when they are ready to get help they will be able to go there and feel comfortable enough to talk to the nurses and doctors there knowing that they are on their side. When you are an active user it is very hard to talk to medical personnel because they treat you like shit and put you in a one size fits all addict box. They treat you like a criminal and assume you are a liar and all these other sorts of things. It is hard to ask someone for help when you can tell by the way the talk to you that they think you are a lost cause and can’t be bothered with you. Doctors are supposed to be healers yes but you would be surprised at how many pick and choose the people “deserving” of being healed. That is why needle exchanges and things of this nature are so important. Addicts need to be connected with people and organizations that aren’t demonizing them for having a drug problem. When you are made to feel that you are a criminal over a health issue it fills you with shame and makes you want to use more to cope with it. Addicts don’t need to be over policed and they definitely know more about their addiction then most addiction “specialists”. Having a place to go to safely use may not be the answer to the opiate epidemic but it sure is one of the small things that could def help save lives. Its much better then having people shoot up in the dark corners of the city and under bridges and in alleys and then leaving their needles behind. If they have somewhere to go to use safely AND with nurses and doctors around that want to be there and want to be apart of the solution then I think thats great. Then they can form relationships with medical personnel where they won’t feel judged and when the time comes and they feel ready to stop then they will have nurses and doctors that they feel comfortable talking to and getting the help they need. This isn’t a one size fits all type of problem and I think that any ideas that help save lives should be taken into serious consideration. Safe injection sites aren’t as radical and crazy as everyone may think and they have been around in other states and countries for some time. Addicts don’t need to be policed they need to be treated like human beings and educated about drugs as does everyone. If people are going to use wouldn’t you want them to use responsibly? People are going to do drugs for whatever reason and thats something they consent to so if thats what they are going to do I think that harm reduction should really be a serious focus as much as treatment. Education is so important and they way we treat one another is too. Addicts don’t need to feel shame anymore then they already do. Unless you have been a heroin addict yourself then I think you really have no idea whats best for heroin addicts, bottom line. I think it should really be up to the addicts and past addicts whether they want safe injection sites or not. Its horrible in Philadelphia down by the train tracks in north Philly. It is sad and people are dying left and right. There is so much garbage and dirty needles maybe if their was a safe injection site nearby it would be way easier to keep the dang city cleaned. I know there isn’t just one answer to all of this and there are so many layers to it all and so many other questions open up after you think you have found an answer. All in all I totally get where you are coming from and you did make so many good points but coming from a recovering addict I do think safe injection sites are a good idea. I don’t want anyone to ever feel unsafe.

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