Across the United States, heroin and other drug users have died in alleys behind convenience stores, on city sidewalks and in the bathrooms of fast-food joints — because no one was around to save them when they overdosed.
An alarming 47,000 American overdose deaths in 2014 has pushed elected leaders from coast to coast to consider government-sanctioned sites where heroin users can shoot up under the supervision of a doctor or nurse who can administer an antidote if necessary.
“Things are getting out of control. We have to find things we can do for people who are addicted now,” said New York state Assemblywoman Linda Rosenthal, who is working on legislation to allow supervised injection sites that would also include space for treatment services. “The idea shouldn’t be dismissed out of hand.”
Critics of the war on drugs have long talked about the need for a new approach to addiction, but the idea for supervised injection sites is now coming from state lawmakers in New York, Maryland and California, and city officials in Seattle, San Francisco and Ithaca, New York.
While such sites have operated for years in places such as Canada, the Netherlands and Australia, they face legal and political challenges in the U.S.
“It’s a dangerous idea,” said John Walters, drug czar under President George W. Bush. “It’s advocated by people who seem to think that the way we should help sick people is by keeping them sick, but comfortably sick.”
At Sydney’s Medically Supervised Injecting Centre, more than 5,900 people have overdosed since it opened in 2001. No one has died. It’s the same at Insite in Vancouver, British Columbia. About 20 overdoses happen there every week, but the facility has yet to record a death.
Sydney’s facility is tucked between a hostel and a Chinese restaurant in the red-light district. Up to 16 users can shoot up in the injection room, which resembles a doctor’s office. Staffers are not allowed to administer drugs, though clean needles are provided.
After users get their fix, clients head to a second room with a warmer feel. Colored Christmas lights hang from the ceiling; books and magazines line the shelves. Clients can relax with coffee or tea or talk to staff. Some stay for 15 minutes; others spend hours. They leave through a back door to protect their privacy.
An Amsterdam clinic — one of three in the Dutch capital — goes even further, distributing free, government-paid heroin to long-term addicts so they don’t have to commit a crime to pay for their fix.
In Vancouver, Insite offers patients treatment services just up the stairs from where they shoot up.
Rhea Jean spoke to the AP after recently injecting herself there. She felt nauseous and ran outside to the curb to vomit. Her face covered with scabs, the longtime heroin user looks far older than her 33 years.
“It’s a great place for active users in full-blown addiction. It links you up to other programs,” said Jean, who hasn’t sought treatment through Insite.
The Vancouver facility was targeted for closure by Canadian Prime Minister Stephen Harper and his Conservative Party. The case went to the Supreme Court of Canada, which in 2011 told the government to issue an exemption to the drug laws allowing Insite to operate.
In the U.S., which for decades has treated addiction as a law enforcement issue, the biggest hurdle remains federal law, which makes such facilities illegal. Supporters say officials in the nation’s capital could grant an exemption or adopt a hands-off approach similar to the federal government’s response to state medical marijuana programs.
Kevin Sabet, a former drug policy adviser to the Obama administration, put the chances of injection sites getting approval anytime soon at zero.
“These facilities send a message that there is a safe use, and I don’t think there is any safe use of heroin,” said California state Assemblyman Tom Lackey, who spent 28 years as a California Highway Patrolman. He opposes legislation there to allow state and local health departments to allow supervised clinics.
In Maryland, state House of Delegates member Dan Morhaim is an emergency physician who has administered the overdose antidote Narcan “many, many times.” He sees his bill for supervised injection sites as just one of many creative approaches.
“It’s not going to cure everyone. I’m not unrealistic,” he said. “But moving people from more dangerous behavior to less dangerous behavior is progress.”