|Type of paper:||Research paper|
|Categories:||HIV Public health Drug abuse|
Across America, drug addiction hits hard, and its rate continues to rise rapidly. Opioid drugs, including pills to combat pain, heroin, and the potent fentanyl analgesic, have generated the deadliest overdose epidemic in history. More than 48,000 people died in the country in 2018, according to the most recent federal data. These occurrences have led to various public health officials to consider developing sites where drug addicts can use illegal drugs while under medical supervision. These sites are called Supervised Injection Sites. These Sites contain high hygienic standards and constant supervision from well-trained medical personnel. The main objectives are to reduce overdose instances, improve jab hygiene and provide better access to addiction treatment. SISs were first opened in Vancouver, Canada, in 2003 (DUCHARME). There are currently no authorized SISs opened in the United States of America, but serious consideration is in play to open them in Seattle, Denver, Ithaca, and San Francisco. This paper analyses whether these supervised Drug Injection Sites would be beneficial once erected in Seattle, Washington.
SISs in the US are a controversial issue, and the main inhibitor to the establishment of these sites is the legal perspective. States in America can authorize SISs within their territories, which is similar to their power to legalize marijuana usage (Leon). According to the Federal Controlled Substances Act, operating a facility that promotes or is used for drug abuse and the possession of narcotics are rendered illegal acts. These are the very elements of a SISs; hence, per federal law, SISs can be considered as illegal sites. Therefore, an SIS can be rendered illegal despite it being authorized within a certain state.
SISs cause numerous benefits to society. They include the following; the number of drug overdose deaths reduces, the number of public drug use is reduced, and the community's health improves as the transmission of bloodborne diseases such as HIV reduces (Kerr et al., 28). Frequent attendance at supervised drug-use rooms is also associated with lower use of injectable drugs in the public space, with a lower number of behaviors related to the risk of acquiring bacterial or viral infections (HIV, HCV) and with a lower level of unsafe removal of needles and injection kits (Kennedy et al., 166) It is an attitude that does not advocate abstinence every time. Surely, they will be better off if they do not take drugs, but they are treated despite consumption.
SISs act as addition service centers. They help drug addicts; these are often people who still like to consume, but who do not have any drugs. They have no money, no housing. They would still like to be able to control their consumption, but they no longer have control (Kennedy et al., 250). SISs move to reach drug addicts, and they act as welcoming homes. They are allowed to continue consuming their drugs but at controlled levels resulting in harm reduction.
Most supervised drug consumption rooms, regardless of location, share several features. First, access is usually permitted to only registered users of the service and provided they meet several conditions, such as minimum age and local residence (Lawrence 1774). They normally function as separate areas annexed to other services already provided to the homeless and drug users, among others, although some are independent units (Kral and Peter 920). The majority are aimed at drug users parenterally, although they mostly include drug users of various kinds.
Globally, in Europe, models of supervised drug injection sites are three: they include integrated SISs, specialized SISs, and mobile SISs. The vast majority of these rooms are integrated into basic care centers (Leon et al., 93). In this type of integrated room, drug use supervision is one more of the set of survival-oriented services that are provided in the same center, such as food distribution, the use of showers and laundries for those living in the streets, the distribution of prevention materials such as condoms and sharps containers, as well as addiction counseling and treatment.
Besides the provision of health-oriented counseling, the distribution of sterile injection equipment, and the referral of patients for treatment and specialized assistance, 60-70% of the rooms provide access to primary care provided by a professional nurse or doctor (McGowan et al., 34). Other services that are usually provided are the possibility of drinking coffee or tea, using the telephone, showering, and washing clothes.
Most drug sellers, especially those that sell crack, hide drugs inside a plastic. These small sachets camouflage in the mouth at the top of the gums. When one buys a dose, the seller spits it in the buyer's hand. Knowing that 80 to 90% of people living on the street are carriers of hepatitis C and that the drug is hidden in the mouth of the seller, this represents the first risk of contagion (Shaw et al., 49). Besides, the drug does not dilute properly in the body, causing problems in the veins and the heart.
A supervised injection site also saves taxpayers money. Hepatitis C, HIV, vein infections, heart attack, respiratory distress, and stroke, among others, are just some of the medical complications of street smoking (Kennedy et al., 174). Costs of running an SIS range around 3 million a year. However, lowering the cost of treatment and hospitalization saves even more money. For overdoses only, in 60% of cases, SIS manages to treat the person with a simple bottle of oxygen (Kral and Peter 921). The direct intervention of SIS saves the health care system ambulance and hospitalization.
The overdose mortality rate continued to increase before the arrival of SISs, exceeding a fatal overdose per day in Vancouver, translating to nearly 400 deaths a year. The Canadian Journal of Public Health published in 2006, three years after the opening of SISs, researched whether SISs had reduced mortality rates caused by drug overdoses (Kerr et al., 250). The results showed that the rate of overdose deaths had declined because of significant decreases in overdose cases in Vancouver (Kerr et al., 51). The decrease could be attributed to supervised drug injection sites.
Another benefit of SISs is that they result in less hospitalization. Besides these significant savings, more serious complications are avoided. Untreated infections often result in the amputation of an arm or leg (Leon et al., 94). By providing sterile equipment, allowing the user to heat the drug to dilute it better, and quickly treating infections on the spot, several amputations with high medical costs are avoided. It is also important to take into account the reality of the people affected (McGowan et al., 35). For infection in one arm, it is necessary to inject antibiotics, evening and morning, for two weeks. It is possible for SISs to manage this frequency, but the users would be quick to pick up if they had to go to the hospital, thus increasing the expenses of the hospital.
Past research has also shown that the use of SISs has increased by the administration of detoxification. It has also increased treatments related to drug dependence, especially the treatment of opioid substitution (Kennedy, Mohammad, and Thomas 166). A study conducted in Canada showed that the use of SISs in Canada led to an increase in referral rates to addiction treatment centers, an increase in the rates of acceptance of detoxification and maintenance treatment with methadone (Patterson et al., 583). The use of SISs has also resulted in a decrease of drugs being used in public places as well as decreasing the number of syringes being thrown away carelessly.
SIS also targets a population that has tried programs to stop using but has not been successful. Or people who are not ready to stop, but who need to inject themselves in a safe environment. In the Netherlands, in Switzerland and many European countries, it has proved successful (Young and Nadia 228). People will start injecting themselves more safely, they will be fewer overdoses, and there will be fewer needle exchanges. In the end, people will end up injecting themselves less.
Most SISs also allow the use of Naxolene. When treatment with oxygen is not enough, one needs to inject Naxolone. Naxolone suppresses the effects of opiates, such as opium and heroin (Kennedy et al., 170). This helps prevent respiratory depression in case of overdose. SISs are allowed to give 0.4 mg injections. If that is inconclusive, SISs can call the rescuers who can give injections up to 0.8 mg (Patterson et al., 584). The majority of overdoses will not require hospitalization.
The SISs in Vancouver have also resulted in fewer accidents. When the user has been served in the SIS, he/she goes through the last room to have a coffee. On most occasions, consumers who are high on drugs are easily found in the middle of the street, completely disoriented and wandering around, and they can easily be hit by vehicles resulting in accidents (Kerr et al., 28). It has been noted that by offering them coffee and allowing them to experience the beginning of their trip at the supervised injection site, this drastically reduces the number of users hit by an automobile.
In conclusion, it can be stated that a positive global impact has been observed in the communities where these rooms have been opened. However, as with syringe and needle distribution programs, it is essential that the main local agents be consulted to minimize community resistance or counterproductive policy responses. The support of the local community is essential in the success of addiction treatment centers that offer supervised drug-use rooms.
1033 Ducharme, Jamie. The Country's First Safe Injection Facility May Soon Open in Philadelphia. Here's What You Need to Know. 6 February 2018. 11 November 2019.
Kennedy, Mary Clare, Mohammad Karamouzian, and Thomas Kerr. "Public health and public order outcomes associated with supervised drug consumption facilities: a systematic review." Current HIV/AIDS Reports 14.5 (2017): 161-183.
Kennedy, Mary Clare, et al. "Willingness to use drug checking within future supervised injection services among people who inject drugs in a mid-sized Canadian city." Drug and alcohol dependence 185 (2018): 248-252.
Kerr, Thomas, et al. "Supervised injection facilities in Canada: past, present, and future." Harm reduction journal 14.1 (2017): 28.
Kral, Alex H., and Peter J. Davidson. "Addressing the nation's opioid epidemic: lessons from an unsanctioned supervised injection site in the US." American journal of preventive medicine 53.6 (2017): 919-922.
Lawrence, Thomas B. "High-stakes institutional translation: Establishing North America's first government-sanctioned supervised injection site." Academy of Management Journal 60.5 (2017): 1771-1800.
Leon, Casey, et al. "Changes in public order after the opening of an overdose monitoring facility for people who inject drugs." International Journal of Drug Policy (2018): 90-95.
McGowan, Catherine R., et al. "Fentanyl self-testing outside supervised injection settings to prevent an opioid overdose: Do we know enough to promote it?." International Journal of Drug Policy 58 (2018): 31-36.
Patterson, Tobie, et al. "Opening Canada's first Health Canada-approved supervised consumption sites." Canadian Journal of Public Health 109.4 (2018): 581-584.
Shaw, Ashley, et al. "Risk environments were facing potential users of a supervised injection site in Ottawa, Canada." Harm reduction journal 12.1 (2015): 49.
Young, Samantha, and Nadia Fairbairn. "Expanding supervised injection facilities across Canada: lessons from the Vancouver experience." Canadian Journal of Public Health 109.2 (2018): 227-230.
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