Over the last few years, I have watched with a blend of amazement and grave concern as an odd phenomenon has unfolded against the backdrop of our nation’s opioid crisis: Despite the clear need to battle this ongoing epidemic with all of the tools at our disposal, one evidence-proven option — supervised injection facilities — is being overlooked, and even disparaged.
Back in the spring, the Massachusetts Medical Society began advocating for the establishment of a pilot supervised injection facility in the commonwealth of Massachusetts. It was not an easy decision because physicians don’t want to condone, or to be seen as condoning, the use of illicit drugs. Yet after close review and thorough debate, it was clear that the data supported their use.
A supervised injection facility is a safe, clean space where individuals can inject drugs they already possess under the supervision of trained medical staff. The facilities also offer sterile injection equipment. The advantage is that medical expertise is immediately present in case an emergency occurs. At the same time, these on-site clinicians can facilitate pathways to treatment and rehabilitation from the chronic disease of opioid abuse disorder.
Such sites provide an alternative to dangerous injection tactics like syringe sharing, syringe reuse, and improper disposal of soiled injection materials, all of which can lead to infection with HIV and hepatitis C, as well as other painful and hard-to-treat infections that can attack the heart, bones, and other organs.
As a physician and president of the Massachusetts Medical Society, I was initially inclined to oppose the concept of supervised injection facilities. How, I thought, could a health care professional, someone grounded in ethics and an oath to “do no harm,” stand by and watch as individuals inject street drugs into their veins?
Yet the opioid crisis and the frightening rate at which it has accelerated doesn’t allow for the outright dismissal of this idea — or any others — that could have prevented even one of the more than 60,000 deaths caused by drug overdoses in the United States last year.
As a health care professional, I can’t stand idly by with the knowledge that a better way exists for reaching and caring for those suffering from the disease of addiction. We can’t allow individuals to die cruel deaths alone in alleyways or under the cover of darkness in public parks.
The concept of supervised injection facilities fits well with the overarching and proven public health philosophy of harm reduction: meeting patients where they are in their disease to eliminate existing barriers to rehabilitation.
With lives being lost each day from all segments of our society, dealing in theoretical solutions can be counterproductive. Fortunately, supervised injection facilities operating in other parts of the world have yielded substantial and evidence-backed reductions of death, disease, and expenditures.
To better understand the utility of these facilities, the Massachusetts Medical Society created a task force to examine the evidence for and against supervised injection facilities. This group produced a report that reviewed all available data regarding the use of supervised injection facilities around the world.
The report clearly showed that these facilities save lives. For example, after the Insite facility opened in Vancouver, British Columbia — the first supervised injection facility in North America — researchers reported a 35 percent decrease in the number of lethal overdoses in that area.
Of utmost importance is the fact that since Insite’s doors opened in 2003, not a single fatal overdose has occurred on premises.
In addition to providing a safe environment for using injection drugs, Insite encourages users to seek entry into treatment for drug addiction. This effort has yielded a 30 percent increase in detoxification and an increase in methadone maintenance initiation among those using the facility.
Supervised injection facilities are not a cure-all and they aren’t for everyone. In fact, they are designed to target the most vulnerable of our population — people, often homeless, who inject drugs publicly. But they work.
Shortly after our medical society overwhelmingly voted to adopt a policy in support of a pilot supervised injection facility program in Massachusetts, the American Medical Association adopted a similar policy.
The supervised injection facility concept is not the only approach we need to confront the opioid crisis. From improving opioid-prescribing guidelines to instituting partial-fill laws and prescription monitoring systems, it’s time for an all-hands-on-deck approach to reducing the use of illicit opioids. Still, supervised injection facilities are one of many tools that can be implemented and, with the “fentanyl era” snatching lives at a sad and frightening rate, piloting a supervised injection facility now is more prudent than ever before.
Establishment of supervised injection facilities managed by individuals with the experience and resources to safely oversee the injection of illicit drugs can help reduce the harm caused by opioid abuse disorder, make clearer the path to recovery, and save lives. As we continue to look for ways to increase access to recovery programs for those with opioid use disorder, we must remember that in order to get people into recovery, they must first stay alive.
Henry L. Dorkin, M.D., is the president of the Massachusetts Medical Society.