Many people still don’t know that a single facility that looks like an oversized hair salon—common in Europe but nonexistent in the US—has the power to prevent life-threatening infections and drug-related deaths. Fewer still appreciate that far from costing a community money, such a facility would save the community millions of dollars per year.
Many people who currently use heroin have already attempted to quit but not yet succeeded. In most US states they can obtain a sterile needle from a syringe exchange, and in some states from pharmacies. But then they head home, or to a gas station bathroom or into a nearby alley, to avoid arrest or robbery while shooting up. Too often, they inject a dose that is contaminated or unexpectedly strong, and—especially if they are injecting alone—they die.
Sixty-seven cities across the world have confronted this problem by opening a place for people to inject drugs safely: a supervised injection facility (SIF). SIFs provide medical staff, clean injection equipment, and a dozen booths where people can inject previously obtained drugs. SIF nurses provide education and intervene directly to stop overdoses, prevent HIV, hepatitis C and skin infection, and give referrals to social services. In the process they build trust with SIF clients, which in many cases is crucial to helping them rebuild their lives.
Over the past year, I worked with researchers in California and Vancouver to produce a cost-benefit analysis of a potential SIF in San Francisco, California. Our research was published by Sage Journals’ Journal of Drug Issues last week.
We found that each year, a single 13-booth facility in San Francisco would prevent 19 hepatitis C infections, three HIV infections and 0.24 overdose deaths; it would reduce skin and soft tissue infection hospital stays by 415 days, and it would bring 110 new patients into various kinds of treatment. These benefits would save the city $6.1 million per year. If the SIF cost $2.6 million per year, it would save $2.33 for every dollar spent.
Many are surprised to see that preventing 19 hepatitis C infections and three HIV infections is worth $2.6 million. But these conditions require lifelong medical care—a single hepatitis C case carries a lifetime treatment cost of roughly $70,000, while one HIV case costs an astounding $400,000.
And the fact that a single 13-booth facility could keep more than one person per day out of the hospital for skin and soft tissue infection (SSTI)? That’s a surprise to almost anyone who doesn’t work in an emergency room. Yet it is so common for people who inject drugs to contract these little-known but life-threatening bacterial infections that in many urban hospitals, they are the one of the top reasons for admission. At a hospital cost of $4,000 per day, those 415 days saved would reduce costs by $1.7 million.
Drug treatment can save large sums of money, too. When patients start medication-assisted treatment with methadone or buprenorphine, for example, they are less likely to steal or commit other crimes to obtain money. Their risks of HIV, bacterial infection and overdose are vastly reduced. Researchers estimate the savings to society at $18,000 per person—so when a SIF brings 110 patients into treatment, it saves a staggering $1.5 million.
But why do I advertise SIFs as preventing overdose if we estimate the SIF would stop only one death every four years? A SIF wouldn’t prevent many overdose deaths in San Francisco because there aren’t many. Thanks largely to wide distribution of the overdose reversal drug naloxone, the city had only 13 overdose deaths in 2012. In most American cities—like in Baltimore, which experienced 192 overdose deaths in 2014—a SIF would prevent numerous overdose deaths every year.
While the health and cost benefits of SIFs are undeniable, many other significant benefits cannot be easily quantified.
SIFs benefit their immediate community by reducing syringe littering and public drug use. They enable social service providers to reach people who inject drugs, normally an extremely difficult group to track down. And they enable researchers to study this population, improving the quality of work like ours and advancing reforms that work.
But wait, some people still say—won’t giving people a place to inject drugs encourage them to keep using? Perhaps forcing them to inject in unsanitary and unsafe hiding places will stop them from using?
In fact, the opposite is true: The more we degrade and ostracize people who inject drugs, the harder it is for them either to quit using their painkiller or to use it in a less risky way. When marginalized drug users walk through the doors of a supervised injection facility, the medical staff often become the only people in their lives who believe in them.
SIF staff may administer naloxone to stop clients from dying, but it is the human connections they forge that may give their clients the will to live.
