Dr. Mitch Rosenthal Proposes Changes to Safe Injection Sites
The Rosenthal Report - November 2019
Supervised injection sites for drug users must focus on facilitating movement to treatment
Supervised injection sites providing a controlled and safe environment for drug use are again on the national agenda. A federal court ruling last month removed a legal obstacle to opening the first such U.S. facility, in Philadelphia, which is struggling with the opioid epidemic and a skyrocketing rate of overdose, as are other American cities. While it’s not certain when this might happen, questions remain regarding how such sites will help move users into drug treatment.
These sites do not provide drugs to addicts, but rather offer access to clean needles, and health professionals are on hand to administer anti-overdose drugs as well as provide counseling. Supervised sites have operated for years in Canada, Australia and Europe and some studies show they can reduce overdose fatalities as well as the transmission of infectious diseases through injection and drug-related criminality.
Yet, while the goal is to save lives, such harm-reduction strategies fall short when it comes to ensuring that users opt for treatment. My experience suggests that after a user injects drugs or is rescued from an overdose at a safe site, there is insufficient engagement to end the cycle of drug abuse.
Safehouse, the Philadelphia nonprofit sponsoring the supervised site, would do this by counseling users and promoting medication-assisted treatment (MAT), which combines withdrawal drugs and behavioral therapy. But it leaves the final decision up to the patient, believing that by establishing a trusting relationship with the user, he or she will more likely agree to give treatment a try.
As noted in a previous Rosenthal Report (August, 2018), what is missing from this approach is a mindset that all patients can be helped to enter treatment. We also propose to limit the time and access to the facility to 60 days to discourage continued drug use without agreeing to treatment. By the end of this time, and after extensive interaction with peer-based counselors and addiction professionals, there would be an expectation that the patient is ready to enter treatment to become drug free.
We encourage the safehouse project in Philadelphia, but it must have a research protocol. And at the same time, they should also run a pilot project along the lines I have suggested that can transform a supervised injection center into a treatment induction center. We need to know which will work better and prove to be more beneficial as part of a comprehensive anti-opioid strategy.