The Rosenthal Report - August 2018

Rosenthal Reports

In the August issue of the Rosenthal Report, we look at renewed debate over safe injection sites for heroin and other opioid users and propose an experimental model for facilities that would provide a clear route into treatment rather than assistance for safe injection.

The Rosenthal Center proposes research to evaluate whether injection facilities can be designed to provide the essential bridge to treatment. Our model, Transition Treatment Centers, would include staffing by medical personnel and peer-based counselors, and be affiliated with a treatment network. They would offer a range of services, including medications and special assistance for safe injection. But most importantly, the Centers would provide an introduction to treatment on site, require participation by facility users, and limit the use of program facilities to no more than 60 days, in anticipation of a seamless passage to longer-term care by then. There are no easy solutions to the growing opioid epidemic. But sites that facilitate entry into life changing drug treatment - and not a surrender to a life of drug use – might prove to be a useful element of a comprehensive anti-opioid strategy.

Drug overdose deaths continue to climb in many U.S. cities, prompting politicians and policymakers in New York, Seattle, Philadelphia, San Francisco and elsewhere to advocate for the nation’s first safe injection sites. While many cities currently have needle exchange programs, where users receive a clean syringe, safe injection sites would allow addicts to shoot up under the supervision of health-care workers. Staff would not provide illegal drugs, but would administer overdose reversal medication and provide counseling and information about drug treatment options and programs.

Some 100 safe injection sites exist in Europe, Australia and Canada, but such facilities face legal and policy challenges in the U.S. Technically, they are illegal under federal law and there is ongoing controversy over their effectiveness. Supporters say supervised sites can prevent overdose deaths, reduce the transmission of HIV and hepatitis, and increase the number of people in treatment. But critics argue that by providing a safe space the sites encourage, rather than hinder, drug use and therefore perpetuate addiction. Moreover, they say that most addicts using the sites would be unlikely to enter treatment programs voluntarily.

In New York City, the plan recently unveiled by Mayor Bill de Blasio envisions four sites, called Overdose Prevention Centers, as pilot projects run by nonprofit groups and staffed by social workers and other trained professionals to administer medications and counsel addicts on treatment. Community outreach would precede the launch, encouraging public support for safe injections sites, which are generally opposed by their neighbors. A nationwide study in the June issue of Preventive Medicine found that among those surveyed only 29 percent supported legalized injection sites in their communities.

Some preliminary studies suggest that safe injections sites can reduce overdose deaths and increase the number of addicts in treatment. A report submitted by the New York City Health department with the mayor’s proposal estimated the four planned sites might prevent up to 130 overdose deaths a year (New York City had a record 1,441 last year). But more definitive, long-term studies are lacking, especially in the unique U.S. urban settings where sites are now being considered.

News briefs cover speculation about a possible Congressional slowdown on opioid legislation and an all too rosy view of pot.


With nearly 200 Americans dying every day from drug overdose, bi-partisan legislation to combat the opioid epidemic should be winging its way through Congress. But so far only the House has passed bills; the Senate is dragging its feet. The Washington Post speculates that the purported Republican-led slowdown might be due to election year politics. Approving legislation before the upcoming midterm elections would play well for vulnerable incumbent Democratic senators in states hit hardest by the drug crisis, including West Virginia, Indiana and Missouri. While the initiatives and funding in the proposed bills don’t go far enough to fight the epidemic, politics should not stand in the way of providing more help to those suffering and dying from substance abuse.


Americans have a much rosier view of marijuana than is backed up by science, according to a survey of more than 16,000 adults by the University of California, San Francisco. The study found that 36.9 percent of respondents believe that edible pot could prevent health problems, and 27.6 percent thought that driving under the influence of marijuana was safer than driving while drunk. The lead author of the study told Reuters that these relatively benign views of weed could be attributed to marijuana legalization – conflating legality and safety – as well as pot not being linked to the overdose deaths of the opioid epidemic.

1st August 2018
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