The Radical Experiment Saving the Lives of Drug Users
February 18, 2022 9:26 AM Subscribe
How a once fringe idea — making it safe to get high — became a reality.
A look at the first supervised injection sites in the United States (in NYC). They had been promised by former mayor DeBlasio, who then waited til the end of his time in office to implement them.
Elsewhere:
In Philadelphia, Judges Rule Against Opening 'Supervised' Site To Inject Opioids
Lessons from Vancouver: U.S. cities consider supervised injection facilities
A look at the first supervised injection sites in the United States (in NYC). They had been promised by former mayor DeBlasio, who then waited til the end of his time in office to implement them.
Elsewhere:
In Philadelphia, Judges Rule Against Opening 'Supervised' Site To Inject Opioids
Lessons from Vancouver: U.S. cities consider supervised injection facilities
Yes, but in this case some change is happening. Insite was opened in 2003, a radical idea it took years of court cases to legitimate. Now, almost 20 years later, we've finally cracked the wall in the U.S. with the two NYC sites.
posted by praemunire at 9:53 AM on February 18, 2022 [9 favorites]
posted by praemunire at 9:53 AM on February 18, 2022 [9 favorites]
ummm, and while we are at it can we please git the liver ripping Acetaminophen out of my pain pills?
posted by wmo at 10:02 AM on February 18, 2022 [8 favorites]
posted by wmo at 10:02 AM on February 18, 2022 [8 favorites]
From the article it sounds like the sites in NYC are testing for fentanyl, or at least offering to. I’d been wondering about that because I’d thought that a lot of the spike in overdoses is driven by fentanyl-laced heroin, and was wondering if that was also true of the overdoses that have been reversed at these centers.
posted by yarrow at 10:12 AM on February 18, 2022 [1 favorite]
posted by yarrow at 10:12 AM on February 18, 2022 [1 favorite]
I'm a little shocked. a lot of rich people's kids did the oxy>junk>fentanyl>death road, too.
no one event, even with obvious outcomes, changes anything in the US (barring 9....11).
muthafuckers like their status quo.
posted by j_curiouser at 10:25 AM on February 18, 2022 [2 favorites]
no one event, even with obvious outcomes, changes anything in the US (barring 9....11).
muthafuckers like their status quo.
posted by j_curiouser at 10:25 AM on February 18, 2022 [2 favorites]
Yarrow, I think that is relatively common practice at supervised injection sites. Obviously they'd prefer to give people the option to check ahead of time!
posted by praemunire at 10:28 AM on February 18, 2022
posted by praemunire at 10:28 AM on February 18, 2022
Unfortunately it sounds like these sites are such a political football that an opposing party can score easy points by enforcing the existing federal laws, as well as anyone running for higher political office. The mayor was forced to support the idea and it took the resignation of the governor and a party change at the federal level to make this happen.
posted by meowzilla at 10:31 AM on February 18, 2022 [2 favorites]
posted by meowzilla at 10:31 AM on February 18, 2022 [2 favorites]
People should not have to die to get high. Sometimes, EVEN WITHOUT DRUG TREATMENT PROGRAMS, people get out of addiction and find their way to a sober life. This cannot happen if they OD on crummy drugs of uncertain potency.
Obviously, we should also fund and support drug treatment programs, but STOPPING THE DYING seems like a no-brainer of a first step. Can we do needle exchange too? There is nothing wrong with harm reduction.
posted by which_chick at 10:32 AM on February 18, 2022 [10 favorites]
Obviously, we should also fund and support drug treatment programs, but STOPPING THE DYING seems like a no-brainer of a first step. Can we do needle exchange too? There is nothing wrong with harm reduction.
posted by which_chick at 10:32 AM on February 18, 2022 [10 favorites]
Life is cheap.
posted by Czjewel at 10:54 AM on February 18, 2022 [1 favorite]
posted by Czjewel at 10:54 AM on February 18, 2022 [1 favorite]
Harm reduction works.
It saves lives and that saves money.
I've spent the last seven years in NZ being part of building the world's first fully legal drug checking organisation - KnowYourStuffNZ. It's taken lots of time, money, and legal risk. We've ended up with public funding for our work and two Acts of Parliament to allow us to do what we do .
There are two sides to the political debate about harm reduction. On one hand, you have people who look at the evidence from around the world and conclude that harm reduction approaches are the way to go. On the other hand, you have people who think that drugs are bad, that people who use drugs are bad, and that that those people should suffer and die.
The political discussion about drug checking followed exactly this pattern. I had a meeting with an MP who literally said that it was wrong to save people's lives. Luckily, this is NZ where those views are rare. The Parliamentary vote went in our favour 88 votes to 33, so fuck that guy.
NZ has the Needle Exchange Programme, set up thirty years ago in the height of the AIDS crisis. It was illegal then to exchange needles then so some good people just said "arrest us if you dare" and gone on with it. Because of their work, NZ has very low rates of HIV and Hep C in injecting drug users.
We still don't have supervised injection facilities, despite about 50 people dying per year. I suspect that's because opioid use in NZ is large and rural, rather than urban. It's harder to develop more distributed services. It's also really underground - it's a problem we can ignore, unlike Glasgow or Vancouver or Melbourne where the problem is obvious to the middle classes. We also don't have widely available naloxone - we privately funded some this year but that's a drop in the ocean.
So it's simple - the evidence is there that this works. Politicians should be on the side of keeping people alive, not letting them die.
posted by happyinmotion at 11:00 AM on February 18, 2022 [37 favorites]
It saves lives and that saves money.
I've spent the last seven years in NZ being part of building the world's first fully legal drug checking organisation - KnowYourStuffNZ. It's taken lots of time, money, and legal risk. We've ended up with public funding for our work and two Acts of Parliament to allow us to do what we do .
There are two sides to the political debate about harm reduction. On one hand, you have people who look at the evidence from around the world and conclude that harm reduction approaches are the way to go. On the other hand, you have people who think that drugs are bad, that people who use drugs are bad, and that that those people should suffer and die.
The political discussion about drug checking followed exactly this pattern. I had a meeting with an MP who literally said that it was wrong to save people's lives. Luckily, this is NZ where those views are rare. The Parliamentary vote went in our favour 88 votes to 33, so fuck that guy.
NZ has the Needle Exchange Programme, set up thirty years ago in the height of the AIDS crisis. It was illegal then to exchange needles then so some good people just said "arrest us if you dare" and gone on with it. Because of their work, NZ has very low rates of HIV and Hep C in injecting drug users.
We still don't have supervised injection facilities, despite about 50 people dying per year. I suspect that's because opioid use in NZ is large and rural, rather than urban. It's harder to develop more distributed services. It's also really underground - it's a problem we can ignore, unlike Glasgow or Vancouver or Melbourne where the problem is obvious to the middle classes. We also don't have widely available naloxone - we privately funded some this year but that's a drop in the ocean.
So it's simple - the evidence is there that this works. Politicians should be on the side of keeping people alive, not letting them die.
posted by happyinmotion at 11:00 AM on February 18, 2022 [37 favorites]
As seen with the whole 'Biden giving out crack pipes' brouhaha, we have a long way to go.
posted by 922257033c4a0f3cecdbd819a46d626999d1af4a at 11:17 AM on February 18, 2022 [7 favorites]
posted by 922257033c4a0f3cecdbd819a46d626999d1af4a at 11:17 AM on February 18, 2022 [7 favorites]
And please can we stop saying "addiction"?
It's stigmatising - people who are stigmatised are less likely to seek help and more likely to be mistreated by others.
It's dehumanising - it implies the person is only their diagnosis and nothing more.
It's clinically misleading - it implies the person is making a choice or has a character defect, rather than suffering from a chronic, relapsing brain disease.
It's isolating - addiction focuses on an individual's problem of character, rather than the systemic approaches to problems within communities.
Addiction implies "just say no". That phrase maybe killed more people than any other three words I can think of.
We should use better framings because the solutions are right there in front of us. We just need to make better and stronger arguments for the actions and services that will keep people safe, get people on board with providing the resources to deliver those services at scale, and get on with doing the job.
posted by happyinmotion at 11:19 AM on February 18, 2022
It's stigmatising - people who are stigmatised are less likely to seek help and more likely to be mistreated by others.
It's dehumanising - it implies the person is only their diagnosis and nothing more.
It's clinically misleading - it implies the person is making a choice or has a character defect, rather than suffering from a chronic, relapsing brain disease.
It's isolating - addiction focuses on an individual's problem of character, rather than the systemic approaches to problems within communities.
Addiction implies "just say no". That phrase maybe killed more people than any other three words I can think of.
We should use better framings because the solutions are right there in front of us. We just need to make better and stronger arguments for the actions and services that will keep people safe, get people on board with providing the resources to deliver those services at scale, and get on with doing the job.
posted by happyinmotion at 11:19 AM on February 18, 2022
What would be the appropriate term?
posted by Selena777 at 11:21 AM on February 18, 2022 [3 favorites]
posted by Selena777 at 11:21 AM on February 18, 2022 [3 favorites]
"Person with substance use disorder" is the recognised and professionally accepted term.
posted by happyinmotion at 11:23 AM on February 18, 2022 [7 favorites]
posted by happyinmotion at 11:23 AM on February 18, 2022 [7 favorites]
Another 'Elsewhere' for you from just yesterday:
In Scotland, all police officers are now to be issued with Naloxone and trained how to use it to save lives in case of overdose.
This guy is a bit of a hero - he's set up a safe consumption van of his own in Glasgow and parks it up in the city centre to give people somewhere safe to go to inject. AFAIK the police turn a blind eye as far as possible. (The Scottish Government and City Council want to set up official supervised drug consumption facilities but the UK Home Office has blocked them from doing it and says it's against the Misuse of Drugs Act 1971).
posted by penguin pie at 11:50 AM on February 18, 2022 [12 favorites]
In Scotland, all police officers are now to be issued with Naloxone and trained how to use it to save lives in case of overdose.
This guy is a bit of a hero - he's set up a safe consumption van of his own in Glasgow and parks it up in the city centre to give people somewhere safe to go to inject. AFAIK the police turn a blind eye as far as possible. (The Scottish Government and City Council want to set up official supervised drug consumption facilities but the UK Home Office has blocked them from doing it and says it's against the Misuse of Drugs Act 1971).
posted by penguin pie at 11:50 AM on February 18, 2022 [12 favorites]
God dude I cannot believe I am getting to see a sympathetic write-up in NY Mag of a supervised injection site. So good.
Here's to more sites across the country in the next 20 years, and to getting rid of fucked up federal drug statutes.
posted by nixon's meatloaf at 1:34 PM on February 18, 2022 [7 favorites]
Here's to more sites across the country in the next 20 years, and to getting rid of fucked up federal drug statutes.
posted by nixon's meatloaf at 1:34 PM on February 18, 2022 [7 favorites]
I've been listening to an amazing podcast on this topic: the first season of Last Day. Thing I didn't know before -- the structural changes your brain goes through in response to opioid use are not fully reversed until around five years after your last use. So yeah, people are going to relapse and that should be considered normal, and they're going to live with a need/intense urge to use for literally years. And you can actually live a normal life on methadone, suboxone, and/or other medical treatments, so of course the healthcare costs of covering that medication should be covered -- if the compassion argument doesn't work for you, it's also cheaper than dealing will all the fallout from forcing people to use illegally.
At some point listening to the podcast it hit me that I am actually taking a controlled substance to deal with a brain structure disorder, and I will be taking this controlled substance for the rest of my life (because my brain problem isn't reversable). I have ADHD that I treat with a legally prescribed amphetamine derivative. If I get to have my controlled substance prescribed and covered by insurance, why shouldn't they?
Other thing I learned from the podcast that I didn't know: rehab isn't regulated in the US. There's no guarantee that the rehab program you send your loved one to has any competence. And since most program are short in-patient programs, they're pretty well doomed to fail since getting "clean" doesn't change your brain and any therapy happens while you're sequestered away from your day-to-day life (and day-to-day problems) so there's little chance of learning effective coping skills. There are effective medication-assisted programs out there, but you have to seek them out, and I have no idea how widespread they are or what sort of limitations insurance puts on coverage, but I think most people aren't even aware of them as an option. And they do mean taking an opioid derivative long-term if not for life, so we still all need to get comfortable with the idea that that is just fine and ok. Because it is.
posted by antinomia at 2:10 PM on February 18, 2022 [14 favorites]
At some point listening to the podcast it hit me that I am actually taking a controlled substance to deal with a brain structure disorder, and I will be taking this controlled substance for the rest of my life (because my brain problem isn't reversable). I have ADHD that I treat with a legally prescribed amphetamine derivative. If I get to have my controlled substance prescribed and covered by insurance, why shouldn't they?
Other thing I learned from the podcast that I didn't know: rehab isn't regulated in the US. There's no guarantee that the rehab program you send your loved one to has any competence. And since most program are short in-patient programs, they're pretty well doomed to fail since getting "clean" doesn't change your brain and any therapy happens while you're sequestered away from your day-to-day life (and day-to-day problems) so there's little chance of learning effective coping skills. There are effective medication-assisted programs out there, but you have to seek them out, and I have no idea how widespread they are or what sort of limitations insurance puts on coverage, but I think most people aren't even aware of them as an option. And they do mean taking an opioid derivative long-term if not for life, so we still all need to get comfortable with the idea that that is just fine and ok. Because it is.
posted by antinomia at 2:10 PM on February 18, 2022 [14 favorites]
One more wee thing I could have added in my comment re. Scotland - there's also a current publicity campaign from the Government/NHS encouraging the public to start viewing drug and alcohol problems as a health issue like any other illness, that deserves compassion and medical treatment. There are billboards and TV ads with slogans like "No, I'm not well. I have a drug problem," encouraging people to respond with compassion rather than judgement.
It sounds such a simple thing, but the first time I saw one, I was like "Oh! Yeah. That's a good point, well made." It feels like the kind of thing that can crystalise an idea in the national consciousness and make a subtle change in public attitude, that (hopefully) means that in 5 or 10 years time we'll look back at the posters and it'll see weird that it was a point that ever needed to be made.
posted by penguin pie at 4:11 PM on February 18, 2022 [3 favorites]
It sounds such a simple thing, but the first time I saw one, I was like "Oh! Yeah. That's a good point, well made." It feels like the kind of thing that can crystalise an idea in the national consciousness and make a subtle change in public attitude, that (hopefully) means that in 5 or 10 years time we'll look back at the posters and it'll see weird that it was a point that ever needed to be made.
posted by penguin pie at 4:11 PM on February 18, 2022 [3 favorites]
Luckily, this is NZ where those views are rare
I don't want to derail and maybe I should take it to AskMe but I am curious about why that is and how we replicate that elsewhere.
posted by pelvicsorcery at 6:28 PM on February 18, 2022
I don't want to derail and maybe I should take it to AskMe but I am curious about why that is and how we replicate that elsewhere.
posted by pelvicsorcery at 6:28 PM on February 18, 2022
Is this really a solution, or do we need legalization? A person addicted to heroin needs their medication (drug) to avoid feeling very sick. As I understand it, the need to use is so acute that you have a harder time injecting safely. How many people are going to be able to plan to get to a safe injection site in time, even if they become more widespread? A prescription for a safe amount of medicine (drug) in an appropriate quantity seems like a better solution.
posted by haptic_avenger at 7:40 AM on February 19, 2022 [1 favorite]
posted by haptic_avenger at 7:40 AM on February 19, 2022 [1 favorite]
This might be an interim solution for a country with radically different mainstream attitudes about drug use than legalization would require. So far, doesn't only Portugal have legalization?
posted by Selena777 at 8:46 AM on February 19, 2022 [1 favorite]
posted by Selena777 at 8:46 AM on February 19, 2022 [1 favorite]
Is this really a solution, or do we need legalization?
It's a solution in the sense that some number of people who would otherwise have died now will not. I personally count that as a win.
posted by praemunire at 9:10 AM on February 19, 2022 [3 favorites]
It's a solution in the sense that some number of people who would otherwise have died now will not. I personally count that as a win.
posted by praemunire at 9:10 AM on February 19, 2022 [3 favorites]
I am currently in a Southern California twelve-step-based rehab program that I have found VERY effective and has different levels of care to “step down” patients through medication-assisted detox, 24-hour residential rehabilitation, halfway housing for multiple months of intensive outpatient therapy, and longer-term sober living for men and women. MeMail me for info.
posted by infinitewindow at 11:01 AM on February 19, 2022 [3 favorites]
posted by infinitewindow at 11:01 AM on February 19, 2022 [3 favorites]
haptic_avenger:
Selena777:
"Legalization" is kind of an ambiguous term, and I personally wouldn't use it unless I could go to a store and purchase the product in question without a prescription, and be sure that the contents are consistent with the labeling on the box, and that the money paid wouldn't fund criminal enterprise.
posted by The genius who rejected Anno's budget proposal. at 5:05 AM on February 20, 2022
How many people are going to be able to plan to get to a safe injection site in time, even if they become more widespread? A prescription for a safe amount of medicine (drug) in an appropriate quantity seems like a better solution.They don't call methadone "liquid handcuffs" for nothing.
Selena777:
So far, doesn't only Portugal have legalization?Maybe I'm splitting hairs, but heroin isn't strictly-speaking legal in any country that is a party to the Single Convention on Narcotic Drugs. In practice, the law isn't enforced with criminal penalties in Portugal, and anyone caught with personal-use amounts is referred to a "Dissuasion Committee".
"Legalization" is kind of an ambiguous term, and I personally wouldn't use it unless I could go to a store and purchase the product in question without a prescription, and be sure that the contents are consistent with the labeling on the box, and that the money paid wouldn't fund criminal enterprise.
posted by The genius who rejected Anno's budget proposal. at 5:05 AM on February 20, 2022
They don't call methadone "liquid handcuffs" for nothing.
Stigmatizing medication-assisted treatment is not helpful.
posted by praemunire at 9:00 AM on February 20, 2022
Stigmatizing medication-assisted treatment is not helpful.
posted by praemunire at 9:00 AM on February 20, 2022
praemunire
posted by The genius who rejected Anno's budget proposal. at 4:16 AM on February 21, 2022 [2 favorites]
Stigmatizing medication-assisted treatment is not helpful.I apologize for being unclear. I don't think that medication assisted treatment, in the abstract, is worthy of being stigmatized. I was specifically referring to medication-assistant treatment that doesn't allow patients to keep an appreciable quantity of doses at home, thus making it more difficult for patients to hold jobs, plan activities, and avoid leaving the house during the pandemic. The doctors and politicians who think that this is an acceptable way to treat adults should absolutely be stigmatized.
posted by The genius who rejected Anno's budget proposal. at 4:16 AM on February 21, 2022 [2 favorites]
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Also see: universal basic income vis-a-vis poor people.
posted by Reyturner at 9:36 AM on February 18, 2022 [10 favorites]