Rhode Island plans to create supervised spaces for illicit drug users, in a big test of the idea that harm reduction to drug users is more effective than criminalization.
The two-year pilot, a first for a state, would establish sites where users could also get drugs tested for life-threatening doses of fentanyl, the potent synthetic opioid that led overdose deaths to a national record in 2020.
States like Massachusetts and California are considering similar sites. Some cities have attempted to legalize supervised injection sites, including Philadelphia, where one was prevented from opening due to a court challenge from the Trump administration.
Such injection sites allow people to use drugs, including heroin and methamphetamine, under the supervision of qualified personnel. In the event of an overdose, staff can administer the antidote naloxone. Advocates say the sites prevent overdose deaths and provide a point of access to other services that can help prevent harm to users, such as housing, medical care and treatment.
Critics say there is no evidence that the sites significantly reduce illegal drug use or addiction. Rhode Island State Representative Arthur Corvese, a Democrat, said it doesn’t make sense to set rules for most people and then create space for some to break them. âThere is almost like a moral oxymoron going on here,â he said.
The operators of the Philadelphia cream site, called Safehouse, is asking a federal judge in the Eastern District of Pennsylvania to reconsider the case for opening it. The Justice Department would not say whether the Biden administration would oppose Safehouse’s request.
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Planned safe use sites in Rhode Island may face a federal challenge better, as states have more authority than cities to set drug policy, according to legal experts. Advocates of so-called harm reduction policies say Rhode Island law is the most direct test yet of the idea that legal consumption sites can reduce overdose deaths and harm to consumers from drug.
âWe’ve always been a country that treats a health problem with punishment,â said Suzanne Carlberg-Racich, associate professor of public health at DePaul University in Chicago.
Rhode Island State Representative Edith Ajello, a Democrat, said the death of her best friend’s son from an overdose during the pandemic had helped her convince her that safe-to-use sites would help prevent deaths statewide.
âSupervised consumption sites can help reduce these losses,â she said.
Overdose deaths are the leading cause of accidental death in the country, killing more people than car crashes. These deaths increased by nearly 30% in 2020 due to a deadlier drug supply and the destabilizing effect of the Covid-19 pandemic, according to federal data and public health officials.
A potential user of the planned sites in Rhode Island, Lee McDaniel, 51, said he has been using drugs intermittently for more than a decade. He said he found himself in dangerous, abusive and potentially fatal situations to hide his drug use.
“We are forced to put ourselves in positions where the choices we have to make degrade, degrade and degrade our human dignity,” he said.
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Countries like Canada and the Netherlands have established similar safe use sites. In Toronto, Shaun Hopkins said the site she helps run has helped users get treatment, housing and medical care. She said some users come to the site up to four times a day.
Critics, including some Rhode Island lawmakers, say the sites allow drug use. Proponents say ending drug addiction does not follow a linear pattern and point to an increase in drug addiction program registrations in places where they are supervised. injection sites have been set up.
Under the Biden administration, the Office of National Drug Control Policy, which under previous administrations focused on the criminalization of drugs, made harm reduction a priority for the first time.
âLanguage is the first step. But real investment and real support is actually what is needed,â said Ellen Glover, campaign manager for drug policy, harm reduction and criminal justice at People’s Action, a collective of around 40 organizations, some of which are working to reduce overdose deaths. .
The Substance Abuse and Mental Health Services Administration this year added $ 30 million in federal support for harm reduction services, and the Drug Enforcement Administration lifted a decade-long moratorium on mobile opioid treatment programs. The administration also proposed that Congress remove mandatory minimum sentences for possession of fentanyl-related substances.
Meanwhile, harm reduction advocates criticize the Biden administration’s support for a Trump-era policy that applied the toughest criminal penalties for fentanyl-related substance drug offenses. The number of people convicted of trafficking in fentanyl-related drugs has increased by 160% since the adoption of tougher penalties in 2018, according to the US Sentencing Commission.
Some 40% of illegal drugs tested for fentanyl contained a potentially fatal dose of at least 2 milligrams, the DEA said. The synthetic opioid can produce an effect similar to that of morphine, but can be up to 100 times more potent, according to the DEA.
Rhode Island is preparing to codify the rules for operating its supervised injection sites in January and aims to have locally agreed locations by March. Some public health advocates in Rhode Island are concerned about how safe use sites will operate without public funding. A Medicaid spokesperson said the program does not pay for the administration of controlled substances illegal under federal law.
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Amy Nunn, executive director of the Rhode Island Public Health Institute, the nonprofit that is working to open a safe consumption site in Providence, said it was not clear how the site would get a malpractice insurance or whether Medicaid would cover the costs of treating users there. She said her group would seek private donations and other sources of funding for the site.
âPeople will put up a lot of roadblocks,â she said. “There is so much stigma associated with drug use.”