An unsanctioned safe injection site in the United States saw just one overdose and no deaths per 1,287 injections, according to a study of the site published in the American Journal of Preventive Medicine.
The study, approved by University of California, San Diego, involved an anonymous social services agency working in an unnamed urban area. Alex Kral, an epidemiologist and Peter Davidson, a medical sociologist, monitored the site and asked participants to fill out a survey. Safe injection sites refer to areas where drugs addicts can openly use illicit substances under the supervision of public health professionals trained.
In two years, the site oversaw 2,574 injections by more than 100 users. During that time, two overdoses occurred at the site, both of which were reversed with naloxone by supervisors. More than 90 percent of participants stated that, if not for the unsanctioned injection site, they would have used in a public place. Accordingly, the study says the site prevented more than 2,300 instances of public consumption of illicit substances. The study also suggests that the site prevented needles from getting littered in the street, with 67 percent of participants saying they disposed syringes in public places within 30 days of using at the site.
While unsanctioned, the injection site consisted of one room for injection and one room for monitoring after a drug user consumes an illicit substance, similar to sites that may be coming to King County. A staff member, trained in overdose prevention and the use of naloxone and rescue breathing, was present at all times. To use the space, which was open four to six hours a day, five days a week, users must receive an invite. Less than 60 people generally have access at one time. Due to ventilation limitations, the site did not allow for users to smoke drugs.
Kral and Davidson conclude that safe injection sites could save lives, though it is impossible to know the “full benefits” of the site they studied because it is unsanctioned. Should the officials legalize the site, it could serve more users, invite licensed clinicians to provide healthcare and invite other agencies to bring more services, they say.
“Although supervised injection sites may not substantially reduce the number of people who use opioids and other injection drugs, they do attenuate the serious medical sequelae of this epidemic, including preventable infections and deaths,” the authors write. “It is time for local, state, and federal governments to consider removing legal barriers such that a comprehensive pilot of this innovative intervention can be implemented.”
Davidson told The Stranger that, alongside saving lives, such sites could also bring drug use out of the streets and into controlled environments. “Safe consumption sites are associated with a reduction in public nuisance, such as injection in bathrooms or in the street,” he said in a phone interview. He added that studying a site with permission from city officials would lead to better study results.
“The most useful thing would be there for there to be an authorized site. It’s very difficult to study something underground like this, because by necessity it must be small. There are some distortions that come with that,” he said.
The study, released today, comes amid a regional debate over safe consumption sites. King County and Seattle in January approved a plan to open the first two safe consumption sites in the United States. The backlash was swift. Lawmaker in Bellevue and Auburn voted preemptively to ban injection sites in their jurisdictions. Federal Way will take a similar vote today. A well-funded initiative to ban legal consumption centers across countywide reportedly received enough signatures to appear on a ballot.
A spokesperson for Initiative 27, the push to ban injection sites in King County, did not respond to The Stranger’s request for comment.
Patricia Sully, Staff Attorney for the Public Defender Association’s Racial Disparity Project, said the study refutes some of the concerns of safe injection site opponents.
“One can only imagine how much more effective an above ground, sanctioned, funded model would be,” Sully said. “It is time to listen to the evidence. Promises don’t save lives and every day that passes without action is another day someone dies a preventable death alone.”
Most of the participants in the study were white, homeless men using heroin. Roughly 76 percent of users have had contact with police. About 80 percent of the time, the participant used heroin. Methamphetamine was the second most commonly used drug, at 16 percent, followed by drug mixes (13 percent), cocaine or crack (9 percent) and opiate pills (5 percent).
Seattle and King County’s plan to open a safe injection site is partly inspired by existing sites in Vancouver, which have reportedly prevented 5,000 overdoses.
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