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.
This article appears in Rio Dell’s Hash Lab Murder Case.
Kim Bergel rocks
Portugal is held up as the gold standard for “decriminalizing” drugs and not “judging” the addict. Their programs has some success due to wrap-around services and is mandatory. Drug dealing is still illegal and dealt with harshly. Other EU countries tried to emulate the program. With the 2008 recession, their budgets were slashed for the addicts in program and caused overdoses, increased crime, and increased disease transmission, increased homelessness. Can you see us having an Injections Site AND wrap-around services? I don’t believe there will be funding for both. Why not use any proposed funding and increase needed detox/rehab facilities and sober living environments along with all the needed physical/mental health and social services. The way I see it, Injections Sites are prolonging the suffering and misery of the addict with the usual end result of death. Which would be more compassionate?
http://www.vancouversun.com/little+evidenc…
The four pillar approach only works when each pillar is properly funded. Prevention reduces the flow of people into addiction. Treatment reduces the number of addicts including those living in the DTES. Policing keeps a lid on the open drug dealing and the affects of the associated problems on the community. Only after these three pillars are properly funded can we afford to spend money on Harm Reduction initiatives that do not encourage abstinence. Putting HR first is like running up debt on your credit card and never paying more than your minimum payments.
http://www.globaldrugpolicy.org/Issues/Vol…
THE JOURNAL OF GLOBAL DRUG Policy AND PRACTICE
A Critical Evaluation of the Effects of Safe Injection Facilities
Garth Davies, Simon Fraser University
Conclusion: Taking Causality Seriously
On the subject of the effects of SIFs, the available research is overwhelmingly positive. Evidence can be found in support of SIFs achieving each of the goals listed at the beginning of the evaluation. In terms of our level of confidence in these studies,the assessment offered here is far less sanguine. In truth,none of the impacts attributed to SIFs can be unambiguously verified. As a result of the methodological and analytical problems identified above, all claims remain open to question.
http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites…
Vancouver’s INSITE service and other Supervised injection sites: What has been learned from research?
Final report of the Expert Advisory Committee
http://www.kiro7.com/news/local/councilwom…
“At the Vancouver site, the manager said since opening in 2003, the overdose death rate in the area around the clinic has dropped 35 percent. But the clinic also estimates 15 to 20 percent of people using the site come from other parts of the country specifically for it.”
http://www.seattletimes.com/seattle-news/h…
“Although research appears to bear that out, many of the studies that attest to Insites success are small and limited to the years after the center opened. For instance, a 2011 study published in the journal The Lancet found a 35 percent reduction in overdose deaths in the blocks surrounding Insite, versus 9 percent in the rest of Vancouver.
But that often-cited study looked only at the period two years before and two years after the center opened, not the ensuing decade.”
http://www.seattletimes.com/seattle-news/h…
“Although Insite is paired with a drug-treatment center, called Onsite, Berner and other critics point out that completion rates are low. Of the 6,500 people who visited Insite last year, 464 were referred to Onsites detox center. Of those, 252 finished treatment.”
The Vancouver Insite was placed in a crime-ridden, drug-ridden, low-income neighborhood. It only got worse.
http://www.seattletimes.com/seattle-news/h…
“Although the Insite center is a model, the Vancouver neighborhood surrounding it is nothing to emulate, advocates acknowledged.
If I came from a city like Seattle and I went to that Insite place, it would scare the hell out of me, Kral said. I would think, Are we going to create one of those?”
http://news.nationalpost.com/news/vancouve…
Vancouvers gulag: Canadas poorest neighbourhood refuses to get better despite $1M a day in social spending
What do you think would happen if this was placed in a middle-class neighborhood, or, ANY neighborhood?
https://www.youtube.com/watch?v=audzsuRMWB…
https://www.youtube.com/watch?v=wwJkqTZ5H_…
http://news.nationalpost.com/news/canada/b…
4/27/2016
Brian Hutchinson: Finding used drug needles in public spaces has become the new normal for Vancouver
http://www.huffingtonpost.ca/mark-hasiuk/i…
“Ten years later, despite any lofty claims, for most addicts, InSite’s just another place to get high.”
The 100% positive studies on Vancouver’s Insite (Safe Injection Facility) was done “Early last decade, Montaner and Kerr lobbied for an injection site. In 2003, the Chretien Liberals acquiesced, gave the greenlight to B.C.’s Ministry of Health, which, through Vancouver Coastal Health, gave nearly $1.5 million to the BC Centre (that’s Montaner and Kerr, you remember them) to evaluate a three-year injection site trial in Vancouver.
I asked him about the potential conflict of interest (lobbyists conducting research) and he ended the interview with a warning. “If you took that one step further you’d be accusing me of scientific misconduct, which I would take great offense to. And any allegation of that has been generally met with a letter from my lawyer.”
Was I being unfair? InSite is a radical experiment, new to North America and paid for by taxpayers. Kerr and company are obligated to explain their methods and defend their philosophy without issuing veiled threats of legal action.”
In the media, Kerr frequently mentions the “peer review” status of his studies, implying that studies published in medical journals are unassailable. Rubbish. Journals often publish controversial studies to attract readers — publication does not necessarily equal endorsement. The InSite study published in the New England Journal of Medicine, a favourite reference of InSite champions, appeared as a “letter to the editor” sandwiched between a letter about “crush injuries” in earthquakes and another on celiac disease.”
Really? What kind of “science” produces dozens of studies, within the realm of public health, a notoriously volatile research field, with positive outcomes 100 per cent of the time? Those results should raise the eyebrows of any first-year stats student.”
And who’s more likely to be swayed by personal bias? InSite opponents, questioning government-sanctioned hard drug abuse? Or Montaner, Kerr and their handful of acolytes who’ve staked their careers on InSite’s survival? From 2003 to 2011, the BC Centre received $2,610,000 from B.C. taxpayers to “study” InSite. How much money have InSite critics received?”
There has never been an independent analysis of InSite, yet, if you base your knowledge on Vancouver media reports, the case is closed. InSite is a success and should be copied nationwide for the benefit of humanity. Tangential links to declining overdose rates are swallowed whole. Kerr’s claims of reduced “public disorder” in the neighbourhood go unchallenged, despite other mitigating factors such as police activity and community initiative. Journalists note Onsite, the so-called “treatment program” above the injection site, ignoring Onsite’s reputation among neighbourhood residents as a spit-shined flophouse of momentary sobriety.”
http://www.hc-sc.gc.ca/ahc-asc/pubs/_sites…
Reducing the Transmission of Blood-Borne Viral Infections & Other Injection Related Infections
“Self-reports from users of the INSITE service and from users of SIS services in other countries indicate that needle sharing decreases with increased use of SISs. Mathematical modeling, based on assumptions about baseline rates of needle sharing, the risks of HIV transmission and other variables, generated very wide ranging estimates for the number of HIV cases that might have been prevented. The EAC were not convinced that these assumptions were entirely valid.
SISs do not typically have the capacity to accommodate all, or even most injections that might otherwise take place in public. Several limitations to existing research were identified including:
Caution should be exercised in using mathematical modelling for assessing cost benefit/effectiveness of INSITE, given that:
There was limited local data available regarding baseline frequency of injection, frequency of needle sharing and other key variables used in the analysis;
While some longitudinal studies have been conducted, the results have yet to be published and may never be published given the overlapping design of the cohorts;
No studies have compared INSITE with other methods that might be used to increase referrals to detoxification and treatment services, such as outreach, enhanced needle exchange service, or drug treatment courts.
Some user characteristics relevant to understanding their needs and monitoring change have not been reported including details of baseline treatment histories, frequency of injection and frequency of needle sharing.
User characteristics and reported changes in injection practices are based on self-reports and have not been validated in other ways. More objective evidence of sustained changes in risk behaviours and a comparison or control group study would be needed to confidently state that INSITE and SISs have a significant impact on needle sharing and other risk behaviours outside of the site where the vast majority of drug injections still take place.”
“It has been estimated that injection drug users inject an average six injections a day of cocaine and four injections a day of heroin. The street costs of this use are estimated at around $100 a day or $35,000 a year. Few injection drug users have sufficient income to pay for the habit out through employment. Some, mainly females get this money through prostitution and others through theft, break-ins and auto theft. If the theft is of property rather than cash, it is estimated that they must steal close to $350,000 in property a year to get $35,000 cash. Still others get the money they need by selling drugs.”
http://www.vancouversun.com/little+evidenc…
“In addition, the federal governments Advisory Committee on Drug Injection Sites report only five per cent of drug addicts use the injection site, three per cent were referred for treatment and there was no indication the crime rate has decreased, as well as no indication of a decrease in AIDS and hepatitis C since the injection site was opened.”
https://www.scientificamerican.com/article…
Massive Price Hike for Lifesaving Opioid Overdose Antidote
Suddenly in demand, naloxone injector goes from $690 to $4,500
Should we follow the money? Who would be profiting bigly from the increased use of naloxone?
https://www.bramptonguardian.com/community…
“Setting up free injection sites to deal with the recent spate of drug overdoses does not address the root of the opioid problem, says Ted Brown, executive director of Bramptons Regeneration Outreach Community.
Instead, Queens Park and other tiers of governments should consider investing resources and dollars toward rehabilitation programs to help those dealing with addiction and mental health issues, said Brown. “
http://www.bcmj.org/premise/supervised-inj…
Supervised injection sitesa view from law enforcement
Jamie Graham, former chief of Vancouver Police has outlined the successful model of dealing with an epidemic: Support, mandatory treatment, abstinence, and counseling as all part of the solution. My recover(ed)(ing) addict friends say they would agree.
https://mosaicscience.com/story/iceland-pr…
Iceland knows how to stop teen substance abuse but the rest of the world isnt listening
In Iceland, teenage smoking, drinking and drug use have been radically cut in the past 20 years. Emma Young finds out how they did it, and why other countries wont follow suit.
http://www.vancouversun.com/little+evidenc…
“The current campaign reports significant reductions in drug overdoses, yet the Government of British Columbia Selected Vital Statistics and Health Status Indicators show that the number of deaths from drug overdose in Vancouvers Downtown Eastside has increased each year (with one exception) since the site opened in 2003.”
https://www.usatoday.com/story/news/nation…
Pigeon nest of needles highlights Vancouver’s drug problem
Some graphs about how overdoses in Vancouver, BC have increased:
https://uploads.disquscdn.com/images/4937e…
One more: https://uploads.disquscdn.com/images/d2f8a…
In my opinion it is not a bad idea. No, it won’t cure anybody, but it will in effect warehouse them and keep their bad habits off the street at least for a percentage of the day. By their choices they have taken themselves out of our productive society, so the next best thing is to put them somewhere where they can’t hurt themselves or others. I know that sounds heartless, and I do have sympathy for folks addicted to drugs, and I wish them well. Keeping them safe and away from vulnerable members of our society is a bad solution to a worse problem. At least with clean needles and surroundings they will be less likely to act as a reservoir for diseases.