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Enabling or a Lifeline? 

Controversy swirls around drug injection centers

To some, the concept of government sanctioned injection centers is akin to simply giving addicts a free pass to shoot up. To others, it's a proven safety net used around the world to combat a growing opioid crisis already taking lives at an alarming rate.

A controversial bill that would allow six California counties — including Humboldt — to voluntarily establish the so-called safe consumption sites has been shelved for the time being after a narrow defeat on the Senate floor last week.

But the author of Assembly Bill 186 says she's ready to try again next session, picking up right where the proposal to set up pilot programs left off after falling just two votes shy of the governor's desk.

"The opioid epidemic continues and new solutions are desperately needed," says Assemblymember Susan Eggman, a Stockton Democrat and former drug counselor who's carrying the bill, in a Sept. 15 statement.

She and other supporters see the centers, where illegal drugs could be used under medical supervision with onsite drug counselors there to guide people toward treatment, as a logical step in fighting opioid addiction.

"We have an opioid epidemic. We have a public health crisis," Eggman says. "We have traditionally treated addiction as a criminal issue and that has failed. We need to treat it as the public health issue that it is."

Modeled after a facility in Vancouver, Canada, the centers would have to provide clean needles and be staffed with healthcare workers offering first aid to prevent overdose and referrals to detox for addicts who want to quit. Visitors to the clinic would have to bring their own drugs and they would be shielded from criminal charges for using on site.

It's a radical response to the growing scourge of addiction and overdose that has swept the United States. Nationwide, overdoses kill more people than guns or car crashes. In California, 4,571 people died from drug overdoses in 2015, a 33 percent increase over a decade earlier.

Here in Humboldt County, the numbers are just as alarming — if not more so. There are more opioid prescriptions here than residents. Last year, 26 people died of opioid-related overdoses — an average of one death every 14 days. That's a rate four times higher than the state average.

"We need to look at different options for different people and this is only a small piece of the puzzle," says Eureka Councilmember Kim Bergel, who supports the legislation. "I think if we don't try we're never going to know."

Opponents, meanwhile, take a different view. While the legislative path may be paved with good intentions, they say, the result is simply enabling addicts whose actions are already wreaking havoc on local communities — from syringes left in public parks where children play to the crimes commited in order to feed a next fix.

"It's insane on its premise, that it's a safe injection site, because there no way to safely inject," says Eureka resident Judy Sousa, one of the more outspoken commenters on the Eureka Neighborhood Watch Facebook page, where the opinions flowed fast and furiously over the idea that a center could be set up in the city.  "We cannot enable people out of this."

Sousa and others also have concerns about the fact that the bill would also put the state in familiar territory — being in conflict with federal law under a drug warrior for an attorney general.

And then, there are the liability issues. What if someone hurts themself or someone else while on his or her way to the center or after leaving high on drugs? What about the people who live, work or own businesses nearby? Who's looking out for them?

Humboldt County is not alone in having a base of community opposition to opening safe consumption centers. In Seattle, where the mayor set up a task force that came up with two potential sites, opponents are collecting signatures to place an initiative on the county ballot to ban the facilities.

But Assembly Bill 186 — which could make California one of the first states in the nation to permit illegal drug use in designated places — has already defied the odds by making it as far as it did despite having the powerful law enforcement lobby in steadfast opposition.

A similar bill last year never even made it out of committee. But this year, the bill eked out of the Assembly with the bare number of votes needed and has already passed two committees in the Senate.

The approach has gained growing support in the medical field.

Research published in the Lancet medical journal shows that overdose deaths decreased by 35 percent in the neighborhood surrounding the Vancouver injection clinic and by 9 percent in the city overall. The New England Journal of Medicine recently published an article by a substance abuse specialist who teaches at Harvard's medical school making the case that supervised injection saves lives and improves health.

The American Medical Association, the official voice of the nation's doctors, voted in June to support the development of pilot projects where addicts can use their own intravenous drugs under medical supervision.

"Studies from other countries have shown that supervised injection facilities reduce the number of overdose deaths, reduce transmission rates of infectious disease, and increase the number of individuals initiating treatment for substance use disorders without increasing drug trafficking or crime in the areas where the facilities are located," the American Medical Association said in announcing its support.

Humboldt County Sheriff William Honsal says he appreciates that state legislators want to do something to address the opioid issue but believes AB 186 only "further blurs the line between what's criminal and what's not."

"If the state wants to decriminalize it, then fully decriminalize it and make it a public health issue is my personal view," he says.

Honsal says he spoke with a small group of recovering heroin addicts and all of them said they would not have used such a facility and don't think others would either for two main reasons: Addicts don't trust the government and heroin users don't think they're going to overdose.

Honsal says he'd rather see resources directed toward treatment programs and efforts to stem one of the main sources of the epidemic: the over-prescription of potent pain medications.

Heroin, he notes, is one of the most difficult drug addictions to overcome.

"I don't think providing a safe injection site is going to help people kick it," the sheriff says.

The bill is sponsored by the Drug Policy Alliance, an advocacy group that works to decriminalize drugs and is funded largely by billionaire George Soros. The group has pushed, thus far unsuccessfully, for similar legislation in New York, Maryland, Massachusetts and Vermont.

For supporters, the bill's purpose is simple: It's a way to save lives while also reducing syringe waste and encouraging those living on society's margins to reconsider their options through onsite counseling.

And, they emphasize, local government participation is voluntary and the programs would only be launched on a trial basis.

Brandie Wilson, executive director of the Humboldt Area Center for Harm Reduction, a local syringe exchange and overdose prevention program, points to the study on the Vancouver facility as a core reason why the local community should consider taking a similar step.

She says representatives with the Drug Policy Alliance, the Harm Reduction Coalition and the California Department of Public Health are planning a one-day seminar in the area in November to facilitate a community conversation on the general topic of harm reduction.

"We have drug use rate similar to big areas and we need to be able to use an approach that has been proven to work," Wilson says. "There are 110 (safe consumption sites worldwide) and they've been used for 20 years and they have been found to be one of the most successful ways into treatment."

She emphasizes that even if AB 186 were to pass, a center would not be set up overnight. The November seminar and a town hall in the works for January are just beginning steps for starting the conversation.

"First we have to talk about this as a community," Wilson says, adding that "there's a ton of work that needs to go on before any who, what, where and why would need to happen."

"This is just so we can talk about it," she stresses. "That's all it is."

Wilson notes that having a nonprofit, such as her organization, lead one of the centers would limit the potential liability of cities and the county while also conserving tax dollars.

Sousa is not convinced.

"It's being done by good people who have a good heart, who were taught to be kind, but they don't look forward to the consequence of those actions," she says of the legislation's backers.

That includes North Coast state Sen. Mike McGuire, who, after noting the fact that Humboldt County officials were not brought into the loop before being included in the legislation, voiced support for the bill on the Senate floor last week.

He also emphasized that AB 186 was an "opt-in" proposal.

"And, while it's not perfect, again, this is one of the tools that we need to combat this crisis here in the years to come," McGuire says.

One of the reasons Humboldt County made the AB 186 list is the region's high rate of drug use and overdose deaths, which McGuire also noted in his remarks.

Five of the counties singled out for potential safe injection centers line up with the ones previous selected to participate in trial programs to distribute naloxone, an emergency opioid overdose treatment, according to Eggman's office. The sixth is part of Eggman's district.  

For her part, Bergel says she supports AB 186 and would be willing to bring the idea of setting up a center before the Eureka City Council if the legislation is approved.

One of the most important tools in bringing people who are down back up, she says, is reestablishing connections with folks who have been living on the outer edge of society for too long.

These centers are one way of doing that, Bergel notes, with trained counselors on hand to offer options to those who may believe they no longer have any.

"I don't believe that treating people like human beings is enabling," she says.

Bergel says she recently put up a post about celebrities who are now sober on her Facebook page to drive that point home.

"People look at someone on street who OD'd on heroin and think, 'What a loser,' but look at John Belushi like he was some kind of rock star ... but he died the same way," she says. "Addiction doesn't care."

This story includes reporting from Laurel Rosenhall for CALmatters, a nonprofit, nonpartisan journalism venture committed to explaining how California's state Capitol works and why it matters. For more CALmatters stories, visit www.calmatters.org.

Kimberly Wear is the assistant editor and a staff writer at the Journal. Reach her at 441-1400, extension 323, or kim@northcoastjournal.com. Follow her on Twitter @kimberly_wear.

Editor's note: This story has been updated to clarify that the November seminar is about the general topic of harm reduction.


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About The Authors

Laurel Rosenhall

Kimberly Wear

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Kimberly Wear is the assistant editor of the North Coast Journal.

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