Hey, there! Log in / Register

Giving addicts a safe place to shoot up a step too far?

Brianne Fitzgerald, an RN with a master's in public health explains why "harm reduction" efforts, such as an Albany Street facility where addicts can come down from a high under medical supervision, shouldn't be expanded to include "safe injection" sites:

It's essentially giving up hope on people who use IV drugs. One might even call this end-of-life or hospice care. The idea of such a facility takes away a person’s autonomy and essentially forces a social agenda that supports the normalization of IV drug use over active care and treatment.

Free tagging: 
Ad:

Comments

The normalization of IV drug use would be allowing folks to buy pharmacy-quality opioids for a rational price. The public health problem isn't that people are dependent on a drug, but that the dose, purity, and availability of the drug is inconsistent. Fix that problem, and they would still be drug users, but functional ones who could still contribute to society, and then we can worry about treatment.

up
Voting closed 1

That's the real value of requiring addicts to come in contact with treatment systems on a regular basis, even if incentivizing such regular contact means permitting certain behaviors in a secure setting. The more contact addicts have with people who can say "when you are ready, we will help you" and "nice to see you - are you okay", the easier it is to start treatment. It also makes society more secure if people have options for limiting their behavior to safe spaces away from playgrounds and doorways.

We need to think past prohibition and moralistic/moralizing blah blah because it obviously does not work, and think toward new ways to deal with an exploding problem.

up
Voting closed 0

The US is not the only place this approach has been tried. Portugal and Germany have also. As Swirly says, there's real value in keeping addicts in contact with the people who can steer them into recovery programs when the patient is ready, and it is essential that recovery programs can take the patient at that moment.

Clean needles to minimize health risk, drug therapy to replace heroin, even supervised heroin use to intervene in heroin or Fentanyl overdoses are life-saving services. The idea that by providing these services we're telling heroin addicts to stay on heroin is silly. If you know an addict you know the battle is won and lost in the patient's own head. As a society, we should say we want you to live and we want you to be able to live sober.

The Baker administration and Mass Dept of Public Health did a Friday news dump on President's Day weekend of heroin and Fentanyl related fatalities over the last year. What we're doing isn't working well enough. Let's look at what's worked elsewhere and why and decide if it'll help people reclaim their lives here.

up
Voting closed 0

"News dump" implies intent to minimize attention to some information. Why would a public health department do that?

up
Voting closed 0

Bad news always goes out late on Friday. At least it goes out, but there is no time for a buildup of news angst before the weekend starts - particularly a long weekend.

Public health does it, yes. So does just about any government agency, corporation, and even individuals.

up
Voting closed 0

Why would they want to keep bad news quiet?

Is it officials who don't want it to reflect on them?

Is it a desire to avoid pressure on politicians to meddle, when they think they have it under control?

up
Voting closed 0

Many of them asking for things that cannot be provided by the state agency (purview of local health, etc. or their health insurer).

Politicians have a hard time meddling unless they hold special sessions of just 5 of them to demand useless "studies" on weed. Even then, they have to come up with $$$. State Agencies are Executive Branch.

Nobody at DPH thinks this is under control. You can't try that.

up
Voting closed 0

Help as many addicts as we can while imposing stiff jail sentences for first time offenders caught selling drugs. Minimum mandatory 5 years for first offense. You're selling poison that kills people. If you were giving poisonous lollipops to school kids I assume the first time penalty would be stiff. They wouldn't wait until you're a habitual poison lollipop offender to finally put you away.

up
Voting closed 0

That's the current system

It doesn't work.

Please do some actual research on addiction and try again.

up
Voting closed 0

but to imply drug and alcohol dependency/abuse isn't a very serious public health and social problem is false.

up
Voting closed 0

Look they are shooting up regardless of where. She should study addiction in addition to public health. And what about the public's health regarding needles? I can't take my children to any park in the city without doing a needle sweep first. At least in a safe injection site there will be someone promoting safe sharps handling.
So instead addicts shoot up in hiding, dispose dangerous needles haphazardly and OD because they're in some alley or parking lot.
I watch it everyday in Dorchester. Opioid pain killers are what has "normalized" opioid addiction, not a solution to a public health crisis.

up
Voting closed 0

Isn't that better than finding needles in our playgrounds or down by Carson and Revere beach

up
Voting closed 0

....there were a lot more needles around before gentrification.

gentrification = fewer needles.

up
Voting closed 0

Not true in my neighborhood.

up
Voting closed 0

expensive condo rentals that an llc writes off as tax loss is not gentrification.

up
Voting closed 0

The Herald link isn't working for me, so I'm not sure of the specifics of her argument. I remember seeing something about the safe injection site in Vancouver a few years ago though and it seemed to do a lot of good in terms of curbing OD deaths and the transmission of HIV/AIDS. I'm not sure why opening a facility like this would be considered "giving up hope." It seems like a much better option than the sidewalk in Newmarket Square.

up
Voting closed 0

Empirical evidence suggests it's a good idea - the Vancouver statistics mentioned in the WaPo article are hopeful. But Fitzgerald's article doesn't address that at all, and is based on cheap moralizing: "When the consequences of actions are removed as in the environment of a safe injection facility, then the very concept of human agency evaporates."

up
Voting closed 0

Harley, please google East Hasting Street in Vancouver. It makes Methadone Mile look like an appealing place to raise a family.

up
Voting closed 0

No one wants to live in the neighborhood heroin addicts frequent when they're out and about, scoring and using.

Three people on my quiet street died of heroin overdoses in a one year; a girl who hadn't had her 20th birthday and two men in their 50s from different homes.

Its a nice street and people raise kids and take care of their yards. Clearly, that's not that same as having a clinic on the street but you also can't pretend that addicts come from nowhere.

Maybe Menino was just more thoughtful about placing recovery programs and homeless shelters than Marty Walsh is. Maybe there's a better solution than the one we have now,

up
Voting closed 0

There's no bridge to Long Island anymore.

up
Voting closed 0

It's not coming back for any treatment facilities. No bridge. No boat.

It will never be approved in a Boston budget nor by the City of Quincy. Although the property is owned by the City of Boston the property itself is part of the City of Quincy so they hold an enormous amount of influence.

I see a development with limited public access and concessions given to Q. for a new bridge. Squantum neighbors and Q. pols will be paid off and a bridge will be built but no more busses full of "bums."

Everybody wins, right? /bs

up
Voting closed 0

> Although the property is owned by the City of Boston the property itself is part
> of the City of Quincy

Is this correct. I was pretty sure Long Island and Moon Island were legally part of the city of Boston.

up
Voting closed 0

Long Island is in the City of Boston.

Moon Island is odd. It is in the City of Quincy, but owned by the City of Boston, who uses it as a shooting range and for fire training.

In the end, Quincy would need to sign off on a bridge, and judging by their stance over the decades on repairing the old bridge, don't hold your breath on that one.

up
Voting closed 0

Connected to the fancy solar trash cans throughout the city. Those who use them would be provided incentives to bring the full one to a central site and take an empty one back to the trash cans. We need to engage the population

up
Voting closed 0

Parts of East Hastings have been that way for much longer than Methadone Mile has worn its moniker.

Parts of East Hastings are perfectly fine - I stayed in an inn off of Denman and we rode down East Hastings on bikes and it wasn't much of an issue, even with kids. We are talking about a very long street by Boston Standards ... In fact, just take a street view tour and see for yourself that people live, work, and walk around the area.

There are areas of Seattle that also fit that description, made worse by all the fleabag motels that we don't have a lot of around here anymore.

up
Voting closed 0

It's essentially giving up hope on people who use IV drugs.

Bullshit. We don't have "hope" for them now, so there's nothing to "give up". We've already given up on them. As a society, we don't care if they shoot up in a back alley surrounded by filth with the 10th injection from the same syringe, only 3 of which were their own injections. If we did, then we would do something different than we do now, which is basically nothing.

Providing a clean, safe space for them to inject their drugs is something. It's not the best answer, but I'm not hearing anything better. There's no such thing as "active care and treatment" for someone who doesn't want to get clean. We have to convince them that they want and need to get clean first. And we're going to do that a lot better if we're seeing them more often and helping them out even while they continue to destroy themselves because they'll trust us more when we say "you really can't keep doing this to yourself" and "there's another way".

up
Voting closed 0

I've lived in both Boston and Seattle now. The debate on the west coast over injection sites is raging too. Google it and you'll find a ton of news articles. My personal take is that Boston should treat Seattle like a cautionary tale, particularly in one respect: drug use is MUCH more normalized here. From what I have seen, you can shoot up in broad daylight on ANY neighborhood sidewalk here and no one will say boo. Why? Because the attitude is that addicts have a "right" to be there. While compassion is needed, too much of it simply enables addicts to continue recklessly, endangering themselves and others. Property crime and some other crimes are much higher in Seattle, needles and trash everywhere, etc (in spite of the city providing garbage pickup and sharps containers). Legalized injection just normalizes drug use even further, and this is the key problem with the concept. I have to agree with the statement Fitzgerald makes. Furthermore, the evidence out of Vancouver is also simply not compelling enough - there's still a huge number of ODs (one of many articles here. Legalized injection sounds great from a compassionate, liberal standpoint... but the numbers do not indicate it is a solution on its own. Tread carefully, Boston... don't go down the same path towards normalization.

up
Voting closed 0

Increasing drug- and opioid-involved overdose deaths nationally and locally is not news. What continues to baffle me is the response here in Boston.

Our current treatment system for substance use disorders is far from equitable and effective. We throw whatever the latest and greatest idea is up against the wall and look to see if it sticks. Harm reduction is the new normal and I support the expansion of many of the harm-reduction initiatives — needle exchange, methadone, injectable naltrexone and buprenorphine. But I also feel strongly that recovery and genuine hope for an ordinary life has been forgotten.

Safe Site on Albany Street is a place where addicts who have used drugs may come in to ride out their high in a Barcalounger under the watchful eye of an RN armed with oxygen, Narcan and other medical supports to interrupt an overdose. There is strong lobbying now for a safe injection facility for the same neighborhood, where an addict could bring his drugs into the site and inject under the watchful eye of nurses and other medical personnel.

I am opposed to safe injection facilities as they may be one of the highest forms of enabling. It’s essentially giving up hope on people who use IV drugs. One might even call this end-of-life or hospice care. The idea of such a facility takes away a person’s autonomy and essentially forces a social agenda that supports the normalization of IV drug use over active care and treatment.

Safe sites and safe injection facilities provide no motivation for addicts to consider giving up substances. It is an aberration of the original harm-reduction principles which were “to meet the person where they were at and support that part of them that wanted to live.” Is the goal of safe injection sites to make IV drug use safe and desirable? If so, then it is true that “the emperor has no clothes.”

People need a motive to stop using. A safe site provides no reason to consider not using. Avoidance of death is not a motive as evidenced by a comment from one of my patients who told me, “I have been Narcan’d 17 times … ”

It is important to be kind, sensitive and empathetic, but there is a downside to this enabling and paternalistic attempt to reach addicts. There are no “quick fixes.” We have lied to people telling them that we can remove their pain. Addiction causes suffering everywhere. Sobriety is not for everyone; it requires hard work, commitment and time. When the consequences of actions are removed as in the environment of a safe injection facility, then the very concept of human agency evaporates. Life has become meaningless, a vacuum in which people bounce from boredom to oblivion. Just take a look at the neighborhood around Mass Ave. and Albany Street. There is nothing to hope for, nothing to fear.

up
Voting closed 0

I don't think anyone chooses addiction, but they do choose to use drugs and there is no way that they don't know the end result of that first time. Makes it difficult to be compassionate sometimes. If you continually walk in traffic, you're going to get hit by a car sooner or later.

up
Voting closed 0

The difference between harm reduction and safe sights is inject outside.

I don't have a masters in public health but I think the writer overestimates the impact of where the addict is when they inject heroin and or fentanyl.

up
Voting closed 0

And for voicing your opinion. I respect you just for stating it publicly.

God help these poor addicts is all I can say knowledgeably.

up
Voting closed 0

[citations needed]

up
Voting closed 0

I want to make clear that I support harm reduction and consider SPOT at Boston HealthCare for the Homeless as harm reduction. I miss identified it as Safe Place. The complexities of the opioid crisis are multifaceted and it is important to be available to all voices and efforts to make positive changes for those seeking help. As others have noted since Long Island closed we have been sticking our fingers in a dime with little success. The nightmare at Albany and Mass Ave is a public shame we must all take responsibility for.

up
Voting closed 0

I quit using heroin because I decided to. Addiction is a personality flaw. If you don't want to stop you never will. Let them die, don't use narcan, don't help them think they have a disease, don't help them think this is ok, shoot up all you want then drag yourself into a dumpster to die. Good riddance.

up
Voting closed 0

I get that we sometimes look the other at on certain laws: double parking to get a coffee, keeping our dogs on a leash at the park, maybe don't get the permits to a one day job on the house. These things are usually of no harm to anyone and sometimes it's more convenient for everyone to let it slide. But now we're using tax dollars to build a facility for people to break the law and possibly kill themselves? Whether we know it or not, using drugs is a crime. It's not just a victimless crime, but one that leads to theft, assaults, and murder. We want to create a safe space to allow them to shoot up without hurting anyone. The idea being, "They're going to do it anyway, we may as well control it.". This is the same as creating a safe place where gang members at war with each other can come and have their shootout without making innocent bystanders into unintended targets. "These kids are going to shoot each other anyway, right? We may as well control it.". And yes, it is the same thing. The end result is death. The shootout just kills a little quicker.

up
Voting closed 0

If the options are a shootout with innocent bystanders everywhere or a shootout with no innocents around and a controlled number of bullets and medics to carry away the injured, then why isn't the second one a much better option? You're not proposing there's a third way. I'm sure if it's better you could sell me on it instead of the second choice above.

up
Voting closed 0

Letting someone do what they want is "taking away their autonomy" and "forcing a social agenda" on someone? What kind of ass-backwards Orwellian speak is this?

up
Voting closed 0