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Are Europe’s Heroin “Fix Rooms” in America’s Future?

“Some years ago, we surveyed over 1000 drug addicts in Scotland and asked them what they wanted to get from treatment, and less than 5% said they wanted help to inject more safely, and the overall majority said they wanted help to become drug-free…there is a real danger that were moving steadily away from a commitment for services to get addicts off drugs.” ~ Professor Neil McKeganey, the Centre for Substance Use Research In late 2016, the City Council, Health Board, and Police Department in Glasgow, Scotland, agreed to a controversial plan to designate areas of the city as “fix rooms” where local addicts can inject heroin safely. Under the plan, addicts will have access to medical-grade heroin and will be able to shoot up using provided clean needles. The entire process will be overseen by medical professionals.

“Shooting Galleries” for Heroin Addicts is Not a New Idea

Before city officials in Glasgow approved the plan, they looked at expert evidence and data from around the world. Dr. Emilia Crighton, who serves as the Vice-Chairwoman of the Glasgow City Alcohol and Drug Partnership, as well as the Director of Public Health at NHS Greater Glasgow and Clyde, said – “Nowadays, we see that actually that most of Europe is providing addiction services. There are safe consumption rooms – Switzerland has a model where there is heroin-assisted treatment and opiates replacement treatment that satisfies the needs of the population.” The plan was enacted in response to a spate of problems caused by the approximately 500 heroin addicts on the streets of Glasgow – crime, discarded needles and drugs, and infectious outbreaks of anthrax, botulism, and HIV. Although this would be the first state-approved “shooting gallery” in the United Kingdom, there are already an estimated 90 safe consumption rooms in at least 10 countries, including:

Even Canada, our neighbor to the north, provides safe heroin consumption zones. In 2011, a landmark decision by the Canadian Supreme Court determined that tax-funded injection sites could stay open, going against the expressed opinions of then-Prime Minister Stephen Harper. The judges ruled 9-0 in favor of the supervised injection sites, saying that the program “has been proven to save lives with no discernible negative impact on the public safety and health objectives of Canada.” Councilman Gord Perks, Chairman of the Toronto Drug Strategy, was very pleased with the ruling, saying, “The Supreme Court ruling is a game-changer. Now, it’s the law of the land that we have to provide equal access to medical services, including to people with drug addiction.”

Are Safe Consumption Zones for Heroin Examples of “Harm Reduction” or “Enabling”?

There are two schools of thought when it comes to safe drug consumption. Supporters say that fix rooms are for the public good, because they reduce crime, disease, overdose deaths, and the trained medical staff on-site are they are to provide education and referrals to any addicts who want to go to treatment for heroin addiction. They also say that supervised consumption rooms are just the next logical step after other efforts such as:

  • Needle exchange programs
  • Issuance and training in the use of naloxone, anti-opioid overdose drug
  • Opioid Replacement Therapy/Methadone Maintenance

Proponents are of the opinion that perhaps the goal should be to reduce the harm associated with drug use, rather than just expect people to stop using drugs. Vaughan Rees, an expert in addiction at the Harvard School of Public Health, says, “Short of being able to implement treatment, we need to think about how we can reduce the risk of drug use.” On the other side, opponents of the idea think that having supervised injection sites for heroin addicts sends the wrong message. Alternately, the concept is criticized as a misguided idea that will encourage drug use, a backdoor attempt to eventually legalize all drugs or state-sponsored tacit approval of dangerous and deadly behavior. In 2008, Tony Clement, then Canada’s Health Minister, made a pointed analogy, saying fix rooms are like “…a doctor holding a cigarette to make sure a smoker doesn’t burn his lips or watching a woman with cardiac problems eat fatty french fries to ensure she swallows them properly.” Barbara Herbert, the President of the American Society of Addiction Medicine’s Massachusetts chapter, understands both sides of the issue, saying, “The controversy, is, does it encourage people to keep using if we make their lives less dangerous and less miserable, or can we scare people into care?

What Does the Future Hold for Supervised Heroin Injection Sites in the United States?

Many addiction professionals are moving away from the idea that addiction treatment has to incorporate a “tough love” all-or-nothing, abstinence-only approach. The consensus that addiction is a chronic, relapsing disease of the brain has led to the acceptance of methadone maintenance, opioid replacement therapy, and anti-craving drugs for medication-assisted drug detoxification and rehabilitation. And, it’s hard to argue with success –since InSite, Canada’s supervised injection facility opened in 2003, they have safely overseen 2.6 MILLION injections with ZERO fatalities. When France inaugurated its first supervised injection site in October 2016, the country’s Health Minister, Marisol Touraine, weighed in, calling the program “… a pragmatic and responsible policy that brings high-risk people back toward the health system, rather than stigmatizing them.” As of yet, there are no legal supervised injection sites in the United States.