Saving Lives Is the First Imperative in the Opioid Epidemic

[poledriver]

Saving Lives Is the First Imperative in the Opioid Epidemic

Formerly inconceivable ideas—like providing drug users a safe place to inject—are gaining traction.

America’s opioid problem has turned into a full-blown emergency now that illicit fentanyl and related synthetic drugs are turning up regularly on our streets. This fentanyl, made in China and trafficked through Mexico, is 25 to 50 times as potent as heroin. One derivation, carfentanil, is a tranquilizer for large animals that’s a staggering 1,000 to 5,000 times as powerful.

Adding synthetic opioids to heroin is a cheap way to make it stronger—and more deadly. A user can die with the needle still in his arm, the syringe partly full. Traffickers also press these drugs into pills that they sell as OxyContin and Xanax. Most victims of synthetic opioids don’t even realize what they are taking. But they are driving the soaring rate of overdose—a total of 33,091 deaths in 2015, according to the Centers for Disease Control and Prevention.

Hence the ascendance of a philosophy known as “harm reduction,” which puts first the goal of reducing opioid-related death and disease. Cutting drug use can come second, but only if the user desires it. As an addiction psychiatrist, I believe that harm reduction and outreach to addicts have a necessary place in addressing the opioid crisis. But as such policies proliferate—including some that used to be inconceivable, such as providing facilities where drug users can safely inject—Americans shouldn’t lose sight of the virtues of coerced treatment and accountability.

What does harm reduction look like? One example is Maryland’s Overdose Survivor Outreach Program. After an overdose survivor arrives in the emergency room, he is paired with a “recovery coach,” a specially trained former addict. Coaches try to link patients to treatment centers. Generally this means counseling along with one of three options: methadone; another opioid replacement called buprenorphine, which is less dangerous if taken in excess; or an opioid blocker called naltrexone. Overdose survivors who don’t want treatment are given naloxone, a fast-acting opioid antidote. Coaches also stay in touch after patients leave the ER, helping with court obligations and social services.

Similar programs operate across the country. In Chillicothe, Ohio, police try to connect addicts to treatment by visiting the home of each person in the county who overdoses. In Gloucester, Mass., heroin users can walk into the police station, hand over their drugs, and walk into treatment within hours, without arrest or charges. It’s called the Angel Program. Macomb County, Mich., has something similar called Hope Not Handcuffs.

Another idea gaining traction is to provide “safe consumption sites,” hygienic booths where people can inject their own drugs in the presence of nurses who can administer oxygen and naloxone if needed. No one who goes to a safe consumption site is forced into treatment to quit using, since the priority is reducing risk.

In Canada, staffers at Vancouver’s consumption site urge patrons to go into treatment, but they also distribute clean needles to reduce the spread of viruses such as HIV and hepatitis C. Naloxone kits are on hand in case of overdose. One study found that opening the site has reduced overdose deaths in the area, and more than one analysis showed reduced injection in places like public bathrooms, where someone can overdose undiscovered and die.

There are no consumption sites in the U.S., but in January the board of health in King County, Wash., endorsed the creation of two in the Seattle area. A bill in the California Assembly would allow cities to establish safe consumption sites. Politicians, physicians and public-health officials have called for them in Baltimore; Boston; Burlington, Vt.; Ithaca, N.Y.; New York City; Philadelphia and San Francisco. Drug-war-weary police officers and harm reductionists would rather see addicts opt for treatment and lasting recovery, but they’ll settle for fewer deaths.


When all else fails, handcuffs can help, too. A problem with treatment is that addicts often stay with the program only for brief periods. Dropout rates within 24 weeks of admission can run above 50%, according to the National Institute on Drug Abuse. Courts can provide unique leverage. Many drug users are involved in addiction-related crime such as shoplifting, prescription forgery and burglary. Shielding them from the criminal-justice system often is not in society’s best interests—or theirs.

CONT -

https://www.wsj.com/articles/saving-lives-is-the-first-imperative-in-the-opioid-epidemic-1491768767

 

[cj]

I posted a long reply but it got lost somehow. I was agreeing with the guy until he started advocating for arrests and coerced treatment. That's just more of the same policy that havent worked in 40 years. In fact coerced treatment through drug court is the norm today in most places. Yet the bodies still pile up in ever growing numbers.

This article would of been OK 3 years ago. But the time for debate is over. It's a simple choice you let a bunch of people die from overdoses and other preventable ways or you rapidly implement observed shooting galleries. Free methadone and siboxone clinics for any addict who wants it no questions asked just a dirty drug screen or other obvious signs of addiction.

I pay 17 dollars a day for methadone. That is insane and out of reach for most people. It's also time to make clear that drug rehab has an extremely low success rate for opiates addicts espec u ally IV users. These people need to be funneled into free or affirdable methadone clinics.

I'm sick of watching my friends die. The time for debate is over. If there is not a serious change in policy top down this year then it will be too late. A part of me wonders oif the government simply want us all to die.

 

[herbavore]

I just found out that if the California bill passes my city will be one of those chosen for the experiment (safe injection sites). I hope it passes but tbh I don't have high hopes.

 

[Jabberwocky]

It's funny how people in the mainstream conceptualize harm reduction, how it is almost always frames as somehow essentially "different" from recovery. I'm not sure I'll ever understand quite frankly. Well, I have an idea.

It probably has something to do with the common misconception that recovery can only begin with abstinence, and that abstinence is somehow mutually exclusive to harm reduction. And this probably has something to do with confabulating attempts at moderation with the (much) larger scope of harm reduction policies; likewise abstinence with recovery. I find it depression when I feel a need to point out something as basic as "recovery" only being a possible if you're still breathing.

And speaking of recovery, it always irks me a bit when I read or hear how most people talk about recovery, about recovery like it is some monolithic entity, well understood or even with basic standardized elements is likewise bothersome: http://www.ijdp.org/article/S0955-3959(15)00100-0/abstract (and this paper only touches on the issue).

Recovery is ultimately about quality of life, a topic so subjective and diverse that it is impossible to effectively discuss when you don't have all the stake holders present for the conversation (and the war on drug ensures that all the stakeholders' voices will not be heard, at least not nearly at comparable volumes).

Regarding compulsory "treatment:" http://www.ijdp.org/article/S0955-3959(15)00358-8/abstract

 

[alpha_centauri]

I just found out that if the California bill passes my city will be one of those chosen for the experiment (safe injection sites). I hope it passes but tbh I don't have high hopes.

Even if they have those places lots junkies will still share needles, overdose, and die as they will always put the drug and getting high on it even if it kills them over being safe and not using the drug or getting high. Personally if my city wanted a place like this opened up I would vote against it as it would cause an increase in crime rate, lower property values, and we don't live in a slum or ghetto, and it would be as bad as a methadone clinic for attracting criminals and junkies.

 

[poledriver]

The Medically Supervised Injection Centre has not had a negative impact on robbery, property crime or drug offences in Kings Cross LAC, according to the latest monitoring report by the NSW Bureau of Crime Statistics and Research.

The Medically Supervised Injecting Centre (MSIC) opened in Kings Cross in May 2001.

The Bureau examined trends in robbery, property crime and drug offences recorded by NSW Police crime between January 1999 and March 2010 to determine whether there had been increases in the volume of robbery, property crime and drug offences in Kings Cross Local Area Command. The results were compared to the corresponding trends for the rest of Sydney SD.

Spatial analyses were used to determine whether drug arrests were concentrated around the MSIC site. Police recorded incidents of possession and dealing of narcotics, cocaine and amphetamines were geocoded and mapped with the results inferred by descriptive statistics and visual inspection.

With a few minor exceptions the incidence of robbery and property offences have fallen in the Kings Cross Local Area Command since 2001. This pattern is consistent with the rest of Sydney.

Of the six drug offences considered, five have been stable in Kings Cross since 2001. The exception was cocaine possession which increased in both Kings Cross and the rest of Sydney.

The spatial analyses showed no pattern of increased drug offences around the MSIC.

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Fact Sheet: Supervised Injecting Facilities
According to Harm Reduction International, globally there are sixty cities that have one or more Supervised Injecting Facilities (SIFs). Many have been operating successfully for over twenty years.

SIFs improve public amenity through reductions in public injecting and inappropriate disposal of needles and syringes in public places.
SIFs have an important role to play in providing access to AOD treatment for Injecting Drug Users (IDU) as well as access to other health and social programs that support PWID, their children, families and friends.
More importantly SIFs save lives by reducing the risk of overdose by allowing the IDU using the facility to access an emergency response (resuscitation) when necessary.
SIF staff are able to observe and provide advice to users to rectify poor injecting practices thus preventing the spread of blood borne viruses ( HIV and Hepatitis B and C) and reduce other adverse events such as Injecting Related Injury and Disease (IRID) i.e. abscess, thrombosis, endocarditis
In the National Drug Household Survey in 2004 and 2007, community participants were asked about their support for measures relating to the use of heroin. In 2007, 50% supported regulated injecting rooms, which was an increase from 2004 (40%) (AIHW, 2008).
Attitudes of local businesses near the SIF in Kings Cross, Sydney were evaluated by the National Centre in HIV Epidemiology and Clinical Research (NCHECR), and in 2005, nearly 70% agreed with the establishment of the centre which was an increase from 63% in 2002 and 58% in 2000 (NCHECR, 2006).
Another of the many evaluations on the SIF in Sydney carried out by NCHECR in 2007 investigating Client Referral and Health Issues at this SIF found that between:
May 2001 to April 2006, 8,743 individuals made 309,529 visits to inject at the Sydney SIF.
Heroin (69%) and cocaine (13%) were the drugs most commonly injected
Most of the registered clients were male (74%) with an average age of 32 years who had been injecting for an average of 13 years.
Nearly 40% reported injecting at least daily, and 43% had injected in public in the month prior to registration at the SIF. Just over 50% mainly injected heroin and nearly 40% of clients reported a history of drug overdose.
Over 40% had engaged in methadone maintenance treatment (MMT) at some time and 13% were currently enrolled in MMT, and 6% of clients reported having used a needle and syringe after another IDU in the month prior to registration.
Of particular note is the fact that between May 2001 to April 2006:
SIF staff provided 42,193 other occasions of service (i.e. wound care, brief interventions) to 4,433 clients (51% of all clients) at a rate of 136 per 1,000 visits.
AOD information was provided on 4,777 occasions and advice on alcohol and other drug (AOD) treatment was given on 2,837 occasions.
A total of 5,380 referrals for AOD treatment, health care and social welfare services were provided to 1,461 clients (17% of all clients) at a rate of 17 per 1,000 visits.
Of these referrals 44% were made to AOD treatment (7.6 per 1,000 visits), most frequently to pharmacotherapy treatment.
Health care and social welfare referrals were provided at rates of approximately 5 per 1,000 visits.
AOD treatment referrals were less likely to have been received by clients who had been injecting for more than six years and who mainly injected methamphetamines compared to heroin.
A third of clients who received an AOD treatment referral had not previously accessed any form of drug treatment.
A brokerage program for referrals to AOD treatment is also provided at the SIF in Sydney and as a result:
Financial assistance was provided to the treatment services to facilitate treatment, via a brokerage referral program for 66 clients between Jan 2006 and June 2006.
Clients who were living in unstable accommodation and who were Hepatitis C positive were almost twice as likely to receive a brokerage referral to AOD treatment.
Outcome data for those brokered treatment referrals provided in the first 6-months of 2006 indicate that 84% of the clients presented to the treatment referred service which compares favourably to the 20% presentation rate reported in the Phase 1 Evaluation Report.
After a Case Referral Coordinator was employed to enhance referral capacity referrals increased from 5.3 per 1,000 visits to 10.2 per 1,000 visits. In the 12-months before (n=376) and after (n=725) this position was established an almost two-fold, increase in referrals to AOD treatment occurred
Ambulance services in NSW have reported reduced calls to attend overdoses in the vicinity of the SIF thereby saving ambulance time and resources.
Evaluations of SIF’s in Sydney and Vancouver, Canada, showed that drug dealing and drug-related crime i.e. robbery, property have not increased as a result of this facility opening.
A point to remember: SIFs should not be thought of as a panacea, rather as part of a continuum of services which includes peer-based and social interventions (Rhodes et al., 2006; Wright et al., 2004). SIFs cannot be expected to solve all of the drug-related problems within a particular area, but can contribute to their reduction or minimisation.
Legal reviews indicate that SIFs do not breach international obligations under various UN Conventions on drugs.

 

[poledriver]

I'm pretty sure property prices around the kings cross site have only increased over the years it has been operating. I dont have proof of that but most places here in Aus seem to just keep on rising, I doubt that area is any different.

I have never used needles to take drugs but I support the Safe injection centre in Sydney, I think it's great that they have reduced virus's and there has never been an OD death in there afaik and they have been operating a long time now.

Sure there will always be addicts that dont use it but the ones who do are able to use clean equipment and be supervised by trained medical staff.

 

[Felonious Monk]

I just found out that if the California bill passes my city will be one of those chosen for the experiment (safe injection sites). I hope it passes but tbh I don't have high hopes.

My county would be as well. I think it's coming up for a vote tomorrow. Seems like it has a fair chance.

 

[Jabberwocky]

Even if they have those places lots junkies will still share needles, overdose, and die as they will always put the drug and getting high on it even if it kills them over being safe and not using the drug or getting high. Personally if my city wanted a place like this opened up I would vote against it as it would cause an increase in crime rate, lower property values, and we don't live in a slum or ghetto, and it would be as bad as a methadone clinic for attracting criminals and junkies.

Opinions like yours are what is keeping America in the dark ages when it comes to our drug policy.

Too bad this is the opposite of the trends in every city that has ever studied the actual effects of safe injection sites (such as in Canada and Switzerland). The Canadian conservative party really pushed hard to get Insight shut down, but they were able to keep it open precisely because ALL the research indicated it did exactly the opposite of what you are insinuating results in such a program or fear would happen.

Of course, as long as there are drugs one could possibly overdose on, you will have some people who end up over dosing. But that absolutely doesn't mean that overdoses are inevitable when it comes to substance use, even with potent, potentially very dangerous substances like heroin. How is the fact that there will always be drugs that get people high and kill them a reason for policies that are proven to reduce people from dying from overdoses? I take it you're against good sam laws and policies that make Narcan more accessible too? Keep trolling.

Do you have any evidence whatsoever other than your bigoted opinions highlighted by your post to support any of your claims? I didn't think so. Please don't troll DiTM (or any other forums).

 

[neversickanymore]

Even if they have those places lots junkies will still share needles, overdose, and die as they will always put the drug and getting high on it even if it kills them over being safe and not using the drug or getting high. Personally if my city wanted a place like this opened up I would vote against it as it would cause an increase in crime rate, lower property values, and we don't live in a slum or ghetto, and it would be as bad as a methadone clinic for attracting criminals and junkies.

nonsense8(