We have a powerful weapon to fight the opioid epidemic. Let's use it.
I have a patient fighting the opioid epidemic in a way I cannot. He surprised me by obtaining a prescription for naloxone, the life-saving opioid overdose reversal agent. As a resident physician in New Haven, I frequently prescribe this medication to individuals living with addiction, but I never thought to do so for this man because he does not use drugs. I had never considered that he lives in shared housing with many people who inject heroin.
He gave me a reality check: If his housemates get into trouble, they will not be able to save themselves. Rather, hope lies in having him as their ally — someone nearby whom they trust when they inject and who is reliable to intervene because he does not use drugs. I realized that he was describing the structure of a supervised injection facility, a powerful tool for preventing overdoses and improving the health of people with addiction. Connecticut legislators need to place this weapon in the state's arsenal if they are truly committed to stopping the tragedies of addiction.
A supervised injection facility is just what it sounds like. It is a place where people safely inject drugs, which they obtain elsewhere, using sterile needles and under the watch of trained medical personnel carrying naloxone in case of an overdose. These facilities systematize my patient's philosophy of protecting his friends from finding themselves alone after inadvertently injecting too high a dose or a supply cut with the far more powerful fentanyl. There are already 90 supervised injection facilities operating in Canada, Australia and Europe. Now, policymakers in San Francisco, Seattle, New York and Boston are considering bringing supervised injection facilities to the U.S.
The lawmakers' reasoning is straightforward: Supervised injection facilities save lives and provide numerous health benefits beyond overdose prevention. In Vancouver, the opening of the world's first supervised injection facility was associated with a 35 percent decrease in mortality due to drug overdose in the surrounding neighborhood (compared to a 9.5 mortality decrease in the rest of the city). Around the world, such facilities have been shown to decrease public injecting, connect clients to rehabilitation services and cut health care costs by preventing HIV and Hepatitis C infections. Accepting that addiction is a chronic and persistent medical condition opens doors to meaningful help for people living with that affliction.
Anyone who finds supervised injection facilities excessive or dramatic should skim the headlines of any recent newspaper. In Connecticut, fatal opioid overdoses have risen persistently since 2012 at some of the steepest rates in the country, with this year's death count expected to exceed 1,000. Existing needle exchange programs are not enough: They cannot control the conditions under which people inject. Dramatic times call for bold policy. The longer we allow squeamishness or denial to blind us to an effective solution, the more death and suffering we will see in our streets.
A fair concern about authorizing supervised injection facilities in Connecticut is whether federal laws, such as the Controlled Substances Act, might preclude such an effort. However, we cannot let fear of one battle stop us when we have the capacity to win the war. State policy in Connecticut and elsewhere is shaking the delusion that drug use can be willed away by punitive force or control of the supply chain. We have reason to hope that national policies will adapt to better reflect this understanding. Until then, Connecticut legislators ought to have the courage to enact supervised injection facilities and defend the law against federal challenge.
If we truly wish to treat addiction not as a crime but as a disease, we ought to take advantage of any safe, evidence-based treatment for that disease. Supervised injection facilities are a model treatment. By preventing people from injecting potentially fatal substances while alone, they target the common denominator of many tragic overdose deaths. Furthermore, they create opportunities to engage people with addiction in health care by increasing face time with medical personnel. Rather than let a ravaging public health crisis stay one step ahead of us, we should adopt this scientifically validated and compassionate approach to help people living with addiction.
Jasleen Salwan, M.D., MPH, of New Haven is a resident physician in primary care at Yale New Haven Hospital.