Dead patients can’t recover: Why we need Safe Injection Facilities now

According to the CDC, about 91 Americans die of an opioid overdose every day. That number is too high, and new data has revealed a promising treatment approach–but are we as a society brave enough to accept it?

As a practicing physician and Vice President of Clinical Integration at the Massachusetts Health & Hospital Association (MHA), I serve on the Task Force on Opioid Therapy and Physician Communication at Massachusetts Medical Society (MMS), as well as the MHA’s Substance Use Disorder Prevention and Treatment Task Force.

After careful consideration of the scientific evidence, the multidisciplinary experts of both committees unanimously recognized the merits of a pilot Safe Injection Facility (SIF) project in Massachusetts. Subsequently, this position was ratified by the entire House of Delegates of MMS and unanimously endorsed by the Board of Trustees of MHA.

The end result of opioid Substance Use Disorder (SUD) is recovery, incarceration or death. It turns out most patients with SUD do trend toward recovery, however dead patients can no longer choose to recover. It is up to us to help patients remain alive and healthy until they can choose recovery. SIFs accomplish this by reducing or eliminating the risk of overdose death, as well as the risk of contracting viral diseases such as HIV and hepatitis or bacterial disease such heart infections through contaminated or non-sterile injection practices.

At first, harm reduction strategies such as clean needle exchanges or safe injection facilities may seem counter-intuitive or even counterproductive to the casual observer, bereft of the benefit of the scientific evidence. Yet experience and data informs us of the merits of such strategies.

Not all patients with substance use disorder are ready to choose recovery today. Yet such patients are often amenable to other cost-effective treatments to reduce harm, such as clean needle exchange, access to the opioid reversal agent Naloxone, medical monitoring during intoxication, education and SIFs for safer drug consumption. All of these harm reduction strategies have been proven to reduce the terrible suffering and mortality of this disease and to reduce the expense of treating it.

Benefits of SIFs include:

1. Department of Public Health can sample local heroin and check for contamination.
2. Sterile technique is taught, eliminating infectious disease transmission.
3. If overdose occurs, SIF staff can safely resuscitate the patient.
4. Counseling regarding recovery options is available.
5. SIF patients are more likely to choose recovery.
6. Food, clothing, showers and first aid are available.
7. SIFs save lives until patients choose recovery.

Observing people after they inject drugs has become critical as recently, heroin has been increasingly laced with the deadly drug fentanyl, a narcotic 50 times as potent as heroin. More recently carfentanil laced heroin has appeared on our streets, killing groups of patients in its wake. Carfentanil was originally developed as an elephant tranquilizer. It is 5000 times as potent as heroin. Given the strength of fentanyl, the need for safe injection facilities is even more imperative, as fentanyl and carfentanil overdose victims are more likely to die suddenly. Patients with SUD cannot tell if their heroin is laced with fentanyl.

Perhaps most importantly, SIFs have demonstrated a 30% increase in the rate of patients choosing recovery rather than persistent drug use, as every time a patient utilize an SIF, it’s a touch point for a compassionate healthcare worker to make a personal connection. These touch points increase the client’s awareness of their treatment options.

I can’t emphasize enough the fact that SIF utilization increases the chances that a patient who suffers from SUD will accept referral for treatment, thus taking the first step on the road to recovery rather than their next stride towards an early grave.

This isn’t a question of why spend the money. Safe Injection Facilities save money. A recent Baltimore study predicted that, at an annual cost of $1.8 million, a single SIF would generate $7.8 million in healthcare savings and also prevent untold overdose deaths, HIV and hepatitis infections, hospitalizations for skin and soft-tissue infection and overdose-related ambulance calls and emergency room visits, all while bringing an additional 121 people into addiction treatment.

Another beneficial side effect is that SIFs improve the quality of life within the neighborhoods where they are located, as there is reduced injection related litter, reduced public injecting of drugs and reduced dangerous discarded needles.

We need an all hands on deck strategy to fight this public health epidemic. Harm reduction strategies such as SIFs are one such weapon to combat this crisis. Over half a dozen states are considering legalizing a pilot SIF program. You can save lives, prevent infections and improve communities by supporting SIFs.

Why is it imperative that we pass enabling legislation to pilot SIFs? To paraphrase the report of the bipartisan presidential task force upon which former Democratic Congressman Patrick Kennedy and current Republican Governor Charlie Baker just recently served:

Every American should awaken to this simple fact: if this scourge has not yet found you or your family, without bold action by everyone, it soon will.

I ask you to support this cost-effective and life-saving proposal by emailing your elected state and federal senators and representative and express your support for SIFs.