What Are Safe Injection Sites? Pros and Cons of Harm Reduction

Harm reduction is a relatively new movement. If you haven’t heard of it, don’t be surprised—there are currently no legal harm reduction centers in the U.S. A harm reduction center is a place where drug users can safely and legally take pre-obtained drugs under the supervision of staff. The focus is on preventing overdoses and diseases like HIV, as well as promoting healthy lives for people who use drugs.

safe injection siteThese services are also known as:

  • Supervised consumption services (SCS)
  • Overdose prevention centers
  • Safe or supervised injection facilities (SIFs)
  • Drug consumption rooms (DCRs)

There are approximately 120 SCSs currently operating in more than 10 countries, including:

  1. Australia
  2. Canada
  3. Denmark
  4. France
  5. Germany
  6. Luxembourg
  7. The Netherlands
  8. Norway
  9. Spain
  10. Switzerland

Although there are none in the United States, movements in New JerseyColorado, and California are picking up speed.

Why Are Safe Injection Sites a Controversial Concept?

Harm reduction services exist along a spectrum. Isolated services, such as needle-exchange programs, are available in most U.S. cities. It’s the supervised consumption sites, existing in their own facilities, that are not available domestically. At these sites, trained staff answer questions about safe injection practices, monitor for overdoses, and provide first aid if needed. They can also make referrals to addiction treatment programs.

This concept is controversial because it seems to contradict what many people in the U.S. have been raised to believe about drugs. Americans, especially those who grew up in the era of D.A.R.E. and the War on Drugs, have been taught that to use drugs means to ruin your life. While this can certainly be true, the political climate has taken this a step further.

Many people view those who use drugs as deserving of their fate. If you look at it that way, overdoses, lost jobs, deadly diseases, and homelessness are natural byproducts of substance use. Traditionally, there is a strong gut reaction to treating drug addicts as people who deserve good lives. To some, treating addicts as worthwhile people would seem like an endorsement of drug use.

Harm reduction centers challenge this stigma. They operate out of a belief that drug use should not mean personal ruin and death. Supporters of this movement do not see their services as an endorsement of substance abuse but as important healthcare services designed to reduce the number of deaths and increase the numbers of people who go on to have the opportunity to change their lives.

Safe injection sites provide services such as:

  • Distribution of overdose-treating medications like Naloxone
  • Improving syringe access and reducing needle-sharing
  • Healthcare for people who use drugs
  • Trained supervision of drug-taking

One example of a supervised injection site is Vancouver Coastal Health’s (VCH) Insite program. VCH has these services, plus a big focus on relationships with staff. Frequent visitors become friendly with the program’s staff, which allows them to start conversations about how, when, and why to seek treatment. Clients are more likely to seek treatment when this approach is taken.

It’s an enormous difference in perspective from what many in the U.S. are used to. But when you look at rates of fatal overdoses, poverty, and homelessness in the U.S. because of drug abuse, perhaps it’s worth taking a look into this new way of viewing drug addicts.

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Jenna Richer

Executive Director - Colorado
Jenna, MSW, LCSW, has worked extensively with individuals experiencing homelessness, severe and persistent mental illness, & co-occurring substance use disorders. She oversaw several intensive, field-based programs providing services to these individuals through the LA County Dept. of Mental Health & Veterans Administration. Jenna worked with the Colorado Office of Behavioral Health to secure SAMHSA grants for mental health & housing services providers. Prior to her current role, Jenna served as the Division Director for Housing and Homelessness programs through Family Tree, working with local officials, leaders, housing developers, & grants on “Housing First” programming with mental health services for people experiencing homelessness, addiction, & mental illness.

Benefits of Harm Reduction

In addition to the benefits already described above, there are other supervised injection site pros, including that they:

  • Reduce overdose deaths and rates of HIV
  • Reduce public drug-taking
  • Reduce the number of needles in public
  • Reduce needle sharing
  • Provide better management and regulation of substance abuse
  • Make it easier for people to get referrals to rehab programs, social services, and other health services
  • Reduce crimes involving drug possession and use
  • Reduce the prison population
  • May increase participation in treatment, having met drug users where they are and reducing stigma
  • Reduce the cost of hospitalizations, emergency services, etc. to taxpayers

Concerns About Harm Reduction

There are supervised injection site pros and cons. Now that we’ve covered the potential benefits in harm reduction programs, here the common concerns associated with these facilities:

  • Normalization of drug abuse
  • Allows those who use drugs to continue to abuse them
  • Possibly less motivation to quit using substances
  • Possibly fewer people in substance abuse treatment due to fewer drug-related legal problems
  • Removal of resources from hospitals, clinics, etc. to staff SCS facilities

It’s understandable and valid to have these concerns. For the people who visit harm reduction sites, there certainly are still risks of negative outcomes, like long-term health problems and difficulty keeping employment and housing. The issue is one of safety and empowerment. Supervised injection sites represent a shift in perspective—away from “They cannot be helped” toward “They can learn to help themselves.”

Should People Advocate for Harm Reduction Services?

Harm reduction services will continue to be controversial. Some people will see them as lifesaving, while others will see them as enabling. It’s worth looking at the research. Studies show that the presence of supervised injection sites decrease fatal overdoses and improve access to drug treatment. While people may never completely agree on where—or if—there should be limits on these services, many can agree that more respect and empathy should be given toward those in active addiction.

Harm reduction allows a holistic approach to substance abuse. When we respond to and care for drug addicts as people, we can take into consideration what led them to using drugs. Factors like family, socioeconomic status, racial inequities, and others become more apparent when we stop making it a priority to shame and criminalize. By the same token, we’re able to more easily imagine what a future without drugs could be like.

References

  1. http://www.vch.ca/locations-services/result?res_id=964
  2. https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865876/
  4. http://www.massmed.org/advocacy/state-advocacy/sif-report-2017/

Jenna Richer

Executive Director - Colorado
Jenna, MSW, LCSW, has worked extensively with individuals experiencing homelessness, severe and persistent mental illness, & co-occurring substance use disorders. She oversaw several intensive, field-based programs providing services to these individuals through the LA County Dept. of Mental Health & Veterans Administration. Jenna worked with the Colorado Office of Behavioral Health to secure SAMHSA grants for mental health & housing services providers. Prior to her current role, Jenna served as the Division Director for Housing and Homelessness programs through Family Tree, working with local officials, leaders, housing developers, & grants on “Housing First” programming with mental health services for people experiencing homelessness, addiction, & mental illness.

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