Safe-injection sites for heroin users should be available

Open discussion of safe heroin use, possible injection risks could save lives, open path to recovery

This article is not a how-to, an endorsement, nor a judgment. But I am about to give you a crash course in heroin, and yes, you need to know this. 

A safe-injection site (also called safe-consumption sites) is a controlled environment for drug users to inject the intravenous drug of their choosing with clean equipment. Safe-injection sites employ trained staff who can intervene in the event of an emergency. Many overdoses are reversible with the aid of drugs like naloxone (commonly referred to by the brand name Narcan), and help with safe dosing and injection. 

Following the principles of community harm reduction, the purpose of these facilities is to make sure those in active addiction are supported and safe. They will not stop anyone from doing drugs, although many offer access to counseling, community services and treatment drugs like methadone. 

The Department of Justice (DOJ) has indicated a willingness to relax its stance on safe-injection sites, reversing the Trump administration’s aggressive action that it took against such institutions. While prosecutors successfully blocked Philadelphia’s proposed safe injection sites last year, two clinics opened in New York last November to a far more open reception. The DOJ is in communication with experts to decide what guidelines could be put in place to allow their operation. 

Privately run safe-injection sites have existed for years, but state-funded sites (which exist in Canada, Europe and Australia) are still not a reality. Hopefully, they will become more common in the coming years. They are life-saving places which actively contribute to lowering deaths to addiction and overdose. They are integral to a real fight against addictions rather than a criminalization-focused war on drugs. According to the Centers for Disease Control and Prevention, between April 2020 and April 2021 over 100,000 people died from drug overdose. 

So, you may ask as a non-injection drug user, why does this matter? Lots of people do inject themselves with heroin, cocaine and/or amphetamines. In order to prioritize their safety and offer a chance to recover, information should be as widely accessible and understood as possible. 

Let us unpack that deceptively simple answer, and focus on heroin. Heroin is the third most commonly-used substance in the Portland area, behind cannabis and methamphetamine, and the most likely to be consumed via injection. The National Institute on Drug Abuse places the number of American heroin users in 2021 at 1.1 million people, and 13,165 of them died of an overdose in 2020. 

Oregon in particular saw trends of drug usage in 2020 that followed the rest of the country, which have seen heroin users dying at increasing rates, particularly from supplies cut with the synthetic opioid fentanyl. But the National Drug Intelligence Center, which is part of the DOJ, reported that the rates of treatment-seeking for heroin abuse have declined, even though it is still the top narcotic that treatment-seekers report using. 

One of the chief dangers of heroin is its basic chemistry, since even the purest heroin can easily lead to overdose, which inhibits breathing and cardiac function, as well as disrupting one’s self-preservation ability and brain function. Adulteration of heroin with synthetic opioids, unexpected stimulants or even house cleaning powders greatly increases the likelihood of overdosing. Most overdoses are reversible, provided someone can act in time, but an impaired user will quickly lose their ability to safely measure a dose and shortly thereafter their ability to react when something goes wrong. 

Beyond the likelihood of overdosing, with its status as a predominantly injected drug, accidents with the intravenous injection of the drug are common. If a user hits an artery, they will likely bleed profusely, or accidentally inject air bubbles which cause severe cardiac complications, unlike when air is injected into a vein. Hitting a nerve can cause paralysis and result in amputation. 

The process of shooting is painful, and an addict who injects in the same part of their body too often can lose the ability to successfully find veins — the stereotypical injection site of the inner forearm may have to be forgone for the neck, toes or groin, increasing or retaining the dangers to one’s arteries. Many of us have gotten a blood draw from a phlebotomist who has stabbed us multiple times trying to hit a vein. Imagine doing that with a dirty, dull needle while suffering withdrawals, or having that “phlebotomist” be high themselves.

Finally, the equipment and environment an addict uses can be incredibly dangerous. Users who are forced to inject illicitly often have to share needles or other supplies that transmit disease and risk infections, including HIV. Used needles are not sharp, rendering them difficult to inject with, resulting in higher chances of injury in an already risky activity. Users could be in unsafe situations with people who would take advantage of their incapacitation, or injecting with other addicts who may be unable or unwilling to call for help in the event of an overdose. This already-struggling group is being forced to suffer further pain, rather than receive support as people with a disease. 

In short, heroin is a deadly, often adulterated substance with a high rate of addiction and a falling rate of users seeking treatment. Psychologists, doctors, politicians, social workers and anyone else with a platform can argue all day about what causes addiction, but the fact of the matter is that it exists, and real human beings live with it every day. 

If we hope for decriminalization to be a successful community measure, addicts need active support. Simply not policing addicts will not make addiction go away. It merely lowers arrest numbers. Medically-guided support systems lower death rates, overdose rates, rates of HIV and rates of other infections. Treating addiction the same as a mental or physical illness succeeds more often than decrying drug users as criminals or failures, which has been the United States’ approach for generations. It treats addicts like people. Addicts have the potential to recover, and deserve the best possible chance to do so. 

This requires freeing them from the threat of incarceration, but also as best as we are able, from the threat of overdose. These sites are sparse in the Portland area, but with the recent decriminalization pushes on Multnomah County ballots (possession now merits only a $100 fine or a call to a counseling service), the fight against addiction deaths cannot be left halfway fought.

So why do you need to know about heroin? You may have never used it or have no intention of using it in the future, but you do not exist in a vacuum. You exist in a community, and the addict on the Portland sidewalk is part of that community too. Understanding the struggles and dangers your fellow community members face is integral to understanding how to help. The lifesaving presence of safe-consumption sites allow for cleaner, less painful, controlled injection of drugs to ease the pain of withdrawal. 

No one deserves the suffering we have allowed addicts to endure for generations. Allowing safe-injection sites, a first step on the way to recovery, is our first step to righting the wrongs of the War on Drugs that have destroyed so many lives.