Supervised Injection Sites: What You Need to Know

Introduction 

Injection drug abuse is a global public health concern. Injection drug abuse is responsible for one-third of HIV cases in America and high cases of hepatitis (Beletsky et al., 2006). Unsterile injections are responsible for a number of infections among drug users. Also, the ever-increasing cases of drug overdose-related deaths render this issue a public health concern. In an effort to curb such problems, government health agencies have established various strategies. Traditional intervention methods and programs work to a certain extent, but, they do not work for chronic drug abusers, hence the controversial solution- supervised injection sites. Supervised injection sites have medical staff to supervise drug use to ensure that drug users are in a sterile environment that will not expose them to infections. Supervised injection sites also minimize the risk of overdose-related deaths. While supervised injection sites is a socially controversial solution, chronic drug abuse is a public health problem; hence, unmerited political and social opinions should not be the basis of its evaluation. 

Background: SIS as a Public Health Issue 

Beletsky et al., (2006) state that supervised injection sites (SIS) have been operating in Europe since the 1980s. The first SIS was opened in Berne, Switzerland in June 1986 (Drugwarfacts.org, 2016). More facilities were established in Germany, Netherlands, and Spain among other European countries. Being the pioneers, Switzerland, Germany, Spain, and the Netherlands have the highest number of supervised injection sites. SIS has not gained much popularity outside Europe, only Australia and Canada have established supervised injection sites (Drugwarfacts.org, 2016). 

Despite the controversial nature of supervised injection sites, the above nations established them as a proactive way of reducing the health risks associated with injection drug abuse. Sharing of syringes and other drug paraphernalia is common among drug users, and it is responsible for the increased infections among drug users. Eventually, infectious diseases will spread rapidly in a community with high drug users, and even affecting other community members who do not use drugs. This explains why most HIV-positive individuals do not know how they were infected (Lingle, 2013). 

The only SIS in Canada was established to curb the spread of the AIDS pandemic in Vancouver. According to Aubin (2010), in 2002 Larry Campbell ran for the mayoral position in Vancouver and campaigned for the immediate opening of a safe injection site to help reduce Vancouver’s AIDS epidemic. After winning the election, Campbell did not establish the SIS forcing local activists to open a user-run SIS. This showed Vancouver leadership that the public was approving; hence, in 2003 a pilot SIS began in Vancouver. European nations that have SIS opened them to curb the high infection rates among drug users, part curly HIV and Hepatitis, to prevent overdose-related deaths, and to reduce public health menace caused by improper disposal of syringes. 

Aubin (2010) notes that SIS drastically reduces risk behavior among drug users; hence, it reduces the spread of infectious diseases such as HIV/AIDS among the affected population. SIS are usually established in places with high drug abuse with the main aim of reducing the spread of infectious diseases among users. Pilot studies and existing SIS also show that they play an important role in the reduction of overdose deaths, therefore, reducing the mortality rate of the affected population. 

Political Hurdles Related to SIS 

Political hurdles have prevented the establishment of SIS in many nations across the globe. Even with the number of supervised injection sites almost reaching 100, many nations are still apprehensive about this concept (drugpolicy.org, 2016). There are social, ethical, and political issues that plague this issue. Politicians have been very vocal against SIS, claiming that it is a waste of public resources. 

SIS is yet to be welcomed by conservative politicians and liberal politicians alike. According to Lunn (2016), SIS in Vancouver received extreme political backlash such that the case was fought all the way to the Supreme Court. Various politicians in other Canadian cities are yet to embrace this concept, which explains why there is only one SIS in Canada (Lunn, 2016). 

Many governments are still afraid of adopting SIS because of the fear associated with them. Governments and communities worry that SIS will increase drug abuse in the neighborhoods. SIS legitimize illegal drug abuse such that young people might be compelled to experiment on them since they are easily available in SIS. Some political leaders call SIS adoption an invitation to illicit drug use in the community (Lingle, 2013). With SIS increasing drug abuse in the neighborhoods, crime cases might also increase (Graham, 2008). 

Others argue that with SIS, the government will be facilitating drug abuse rather than creating better intervention plans to prevent drug addiction, which goes against the moral obligation of the government (Stueck, 2011). Individuals who use SIS are frequent drug users, and facilities such as SIS can be seen as an encouragement to such individuals. They can easily access more drugs from others at SIS when they want to. However, the most important political issue against SIS is that it costs a lot of money, which could have been put to better use. Aubin (2010) notes that Vancouver’s SIS received a lot of backlash from politicians. The center spent $3 million annually; this is a huge amount of money that could have been used to establish community rehab centers or other comprehensive drug programs. 

Though the adoption of SIS still faces political barriers, many are beginning to see the need for SIS among high-risk drug users. Certain drug users have no potential of quitting, and their drug use practices only endanger them and the community further. A number of politicians in the US have welcomed the idea of an SIS with the intention of reducing harm among high-risk drug abusers (Beekman, 2016). 

Potential Ways to Address the Issue 

Beletsky et al. (2006) note that SIS has a rocky path ahead. While the proponents of SIS have used evidence to show the effectiveness of such facilities, the opponents also have valid points that should be considered. Therefore, it should be carefully considered before implementation. 

SIS is an extremely polarizing issue, and to solve it, drug abuse should be treated purely as a health issue. Addiction is considered a health issue as it renders an individual vulnerable to drug abuse. According to Herbert (2014), a study by Pew Research Center showed that two-thirds of the public believe drug abuse is a health issue, and the government should focus more on treatment rather than prosecution of drug users. When treated as a health issue, SIS can be seen as any other form of drug abuse intervention aimed at reducing infectious diseases and overdose. According to Aubin (2010), injection drug users are part of society, and they deserve health equity. While drug abuse is considered a vice, it does not mean that drug abusers should not be given equal consideration to other members of society, especially when numerous studies have shown that SIS has no negative effects on society (Aubin, 2010). 

Many governments have syringe exchange programs for injection drug users (Beletsky et al., 2006). This syringe exchange program is not entirely different from SIS as it gives the drug users syringes to use, yet this program has not received political backlash. It is ironic that the government would give drug addicts syringes, and fail to provide them with a safe environment, and a medical professional to prevent them from a drug overdose. 

Lastly, political and moral concerns should not be used as the only deciding factors. Nations that have adopted SIS have shown tremendous progress in prevention of infectious disease and overdose related mortality. Additionally, SIS is known to serve individuals with further socio-economic problems. Most of the individuals using SIS are homeless, jobless, and some of them have mental and social conditions. These individuals lack social networks to assist them access alternative services, and their only escape is drug abuse, at least they deserve a clean kits and environment (Davies, 2007). 

As controversial as it is, SIS saves the government a lot of money indirectly (Aubin, 2010). The impact of drug-related infections and over dose related mortalities is very costly on the government. For instance, Canada’s SIS (Insite) saved the health care system approximately $14 million in reduction of drug related infections supporting the idea that government should fund more safe injection sites. 

To sum up, injection drug abuse will continue to exist, and society needs to adopt a more proactive way of dealing with it. While politics usually determine the adoption of such programs in society, there is a need to adopt a more liberal approach on this. SIS is not an answer to injection drug abuse, but it prevents spread of infection and often acts as a gateway for other drug intervention programs. While drug users are seen as a community menace, it does not mean they are not deserving of a life without HIV and other deadly infections. 

References 

Aubin, S. (2016). Safe Injection Sites and Needle Exchange Programs: An Important Part of Ensuring Health to Injection Drug Users.    Revue interdisciplinaire des sciences de la santé-Interdisciplinary Journal of Health Sciences , 1 (1), 17-22. 

Beekman, D. (2016). Heroin, cocaine users in Seattle may get country’s first safe-use site. The Seattle Times. Retrieved from: http://www.seattletimes.com/seattle-news/politics/heroin- other-drug-users-may-get-a-safe-use-site-in-seattle/ 

Beletsky, L., Davis, C. S., Anderson, E., & Burris, S. (2008). The law (and politics) of safe injection facilities in the United States.    American journal of public health ,    98 (2), 231- 237. 

Davies, G. (2007). A critical evaluation of the effects of safe injection facilities.    J Global Drug Policy Practice ,    1 (3). 

DrugPolicy.org. (2016). Supervised Injection Facilities. Retrieved from: http://www.drugpolicy.org/supervised-injection-facilities 

Drugwarfacts.org (2016). Supervised Consumption Facilities, Safe Injection Facilities, & Drug Consumption Rooms. Retrieved from: http://www.drugwarfacts.org/cms/Safe_Injection#sthash.1k6VG7jZ.Mwp6a26L.dpuf 

Graham, J. (2008). Supervised injection sites-a view from law enforcement. British Columbia Medical Journal ,    50 (3), 132. 

Hierbert, P. (2014). A Growing Number of Americans: Drug Abuse Is a Health Issue, Not a Crime. Pacific Standard . Retrieved from: https://psmag.com/a-growing-number-of- americans-drug-abuse-is-a-health-issue-not-a-crime-aff8b4cf7feb#.27suldo2s 

Lingle, C. A. (2013).    A Critical Review of the Effectiveness of Safe Injection Facilities as a Harm Reduction Strategy. (Doctoral dissertation, University of Pittsburgh). 

Lunn, S. (2016). Safe injection sites have potential to save lives, says Jane Philpott. CBC News. Retrieved from: http://www.cbc.ca/news/politics/save-injection-sites-toronto-1.3491134 

Stueck, W. (2011). The arguments for and against Vancouver's supervised injection site. The Globe and Mail. Retrieved from: http://www.theglobeandmail.com/news/british- columbia/the-arguments-for-and-against-vancouvers-supervised-injection- site/article596153/