Thinking about the unthinkable - supervised injection facilities for those addicted to opioids

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On Wednesday afternoon, Chittenden County State's Attorney Sara George said she would support state legislation to provide safe injection sites for heroin users. "People in our community are committing countless crimes, losing their jobs, losing custody of their children, and even dying, because of their addiction to opioids," said George. "I have an obligation to examine all potential solutions that could reduce overdoses and deaths, and keep our community safe."

George is a member of a Chittenden County commission tasked in March with evaluating the concept and whether it might be an effective way to combat the opioid crisis. The commission was made up of law enforcement officials and community health professionals, people who see every day the toll the opioid crisis is having on the state.

It's no surprise that people around the country are looking at nontraditional methods to help cope with the epidemic. Brattleboro Police Chief Michael Fitzgerald told the Reformer that many in the law enforcement and public health communities are "at wit's end" in dealing with heroin use. "We're working diligently at it, but traditional law enforcement methods are ineffective," he said. "We have to try something new and innovative."

Becca Balint, the Senate Majority Leader in the Vermont Senate, agreed. "The state needs to look at all nontraditional methods," said Balint, who emphasized she was commenting as a senator from Windham County and not a spokeswoman for the Vermont Democratic Party. "We are not making much headway. We need to be creative and we need to consider alternative approaches."

And Sue Avery, a local mom whose daughter has been struggling with addiction for the past two decades, said she would also consider supporting safe injection facilities if only to keep injection drug users from contracting infectious diseases such as hepatitis and HIV. "From my reading, this is going on all over Europe and the injection sites seem to be a very safe place for people who have this disease are able to go with confidence," said Avery.

Not everyone, however, is ready to open the doors of supervised injection facilities in the Green Mountain State.

"Before Vermont considers opening a Supervised Injection Facility — a state sponsored and funded heroin injection site — there should be a full examination of the costs and benefits of such a program," stated Thomas D. Anderson, the Commissioner of Public Safety, in response to George's announcement. "Questions that need to be fully answered include whether such facilities would lead to greater drug use, additional crime, a deterioration of community life, the cost to taxpayers, and whether they aid in getting drug addicts into treatment or simply perpetuate the cycle of addiction."

In his statement, Anderson referenced facilities in Vancouver that have been in operation since 2003: "[O]verdose deaths continue to rise dramatically. In addition, there are reports of significant negative impacts associated with the SIF on the Vancouver community. It is also not clear that SIFs aid in getting drug addicts to end their addiction."

But, as Anderson fails to note, perhaps deliberately, according to a September report by News 1130, a radio station in Vancouver, the supervised injection facilities were established to combat an earlier epidemic, not this current one, which is made more dangerous by the introduction of fentanyl, a synthetic opioid that can be deadly in minute doses.

"We managed to meet the last crisis [in the late 1990s and early 2000s]," Patricia Daly, chief medical health officer for Vancouver Coastal Health, told News 1130. "But this one is different. It's the contamination of the entire drug supply. And the past one-and-a-half years into this new crisis shows us that supervised injection sites are not sufficient to manage it."

"It is also not clear that a SIF in Vermont would bring us closer to our ultimate goal: reducing the number of Vermonters addicted to opioids, including heroin," stated Anderson, and this is obviously true. But what SIFs do is decrease is the number of overdose deaths related to opioid abuse. News 1130 noted that since the opening of SIFs in Vancouver, there have been 6,440 overdose "interventions" on the premises and 1,781 in 2016, but no one has died of an overdose at an SIF. If you talk to anyone with a junkie in their family, or anyone who has successfully recovered from opioid addiction, that fact might be enough for them to support supervised injection facilities in Vermont. We agree. When someone dies from an overdose, they leave behind mothers, fathers, sisters, brothers and, worst of all, children.

"It has been very clear to me as a prosecutor, in general, the opioid crisis has just gotten worse and worse and regardless of all these great efforts we're making and programs we're implementing, it just doesn't seem to be making a dent," George said.

During the Wednesday news conference, George also said that SIFs could be a second chance for people who want to be productive members of the community. "These individuals do not want to be committing crimes, they don't want to be sitting in jail, they don't want to be getting felony convictions and they certainly don't want to end up another fatal overdose statistic," George said.

And, as Balint told the Reformer, addicts in communities around the state, including Brattleboro, are shooting up wherever they can find a spot. "Speaking as a senator from Windham County who talks to business owners in Brattleboro, we have people injecting in bathrooms in local businesses. This is a reality we are struggling with. We need to be honest in discussing alternatives."

Windham County State's Attorney Tracy Shriver said she is also open to discussing programs that have been implemented around the world. "This is a public health crisis."

It's true that SIFs are expensive to operate, in the millions of dollars, but how much are we, as local communities and the state, spending to police and lock up addicts? And what kind of return are we getting on the traditional model. That argument seems to be lost on those in the state and around the country who choose to ignore the obvious failures of the current method.

"The better strategy is for Vermont to focus its limited resources on preventing the use of opioids and heroin in the first place, treating those who seek and want treatment for this disease, and supporting those in recovery," stated Anderson, which we agree with. But where will the state find the money to fully implement the programs? Surely not from the current administration, which seems intent on filling our prisons with even more drug abusers.

"People are not getting the help they need. People who are suffering from addiction don't belong in the criminal system," Fitzgerald told the Reformer, adding that the jails should be reserved for people selling the drugs, not for those struggling with addiction.

We, as a community and a state, need to consider options that were unthinkable just a few years ago. We urge our legislators to continue the discussion around supervised injection facilities and other options to combat the epidemic when they convene for the 2018 session. We also urge them to consider legislation, co-sponsored by State Rep. Selene Colburn, P-Chittenden, that would remove criminal liability for anyone who wanted to establish this type of site in the state.

Editor's Note: Sue Avery facilitates Nar-Anon groups in Brattleboro and Keene, N.H., for families with loved ones who are struggling with addiction,. The group meets at 7 p.m. Tuesdays at Brattleboro Memorial Hospital and at 7 p.m. in Keene at St. James Episcopal Church.

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