There’s a Good Way to Fight Heroin Overdoses, but You’re Going to Hate It

A legal self-injection site for drug users in Kensington would help fight the string of deadly overdoses. (See?)

Insite - vancouver

The injecting room at Vancouver’s Insite, North America’s first legal self-injection drug site. | Courtesy Insite

The news from last weekend was grim. Nine people, ranging in age from 20 to 40, died of drug overdoses. They included Victor Colon, a man the Daily News described having a “heart of gold.” There would have been more deaths, per Action News, but police revived four people with the overdose-reversing drug Narcan.

The weekend was part of a harrowing stretch of 35 fatal drug overdoses between December 1st and December 5th. The news for this entire year is grim, too: The medical examiner’s office says there could be as many as 900 fatal drug overdoses in 2016, and police have used Narcan to save 125 people. According to a report from the Philadelphia Department of Public Health in June, heroin overdose deaths spiked in 2011 and have remained high ever since.

Headlines (like ours) tend to term these incidents heroin overdoses, but in reality they are usually polydrug ODs: Between 2003 and 2011, “benzodiazepines and cocaine were detected in combination with opioids in approximately 90% and 70% of deaths, respectively,” says the health department report. (Benzodiazepines include Xanax, Valium, Klonopin and Rohypnol.) Increasingly, many heroin batches sold in the city are spiked with the synthetic narcotic fentanyl.

There may be no lasting solution to the drug problem. But district attorney Seth Williams thinks the strategy right now is to crack down. Action News says Williams “is vowing to tackle the problem head on, one drug dealer at a time.” He told the station: “We are going to do all that we can, with the use of undercover officers, people giving us information, to prosecute people spreading this poison in our community.” Local journalist Christopher Moraff, who has written extensively on the Kensington drug scene, reports that police activity has been hot in what are called “the Badlands.” A police source told him cops have lifted OT restrictions in order to make busts in Kensington.

On cue, the police have released mugshots of 41 alleged drug dealers they’ve arrested in recent weeks. This has been our strategy for fighting drug abuse for decades. It will not end any time soon. But we can look north to a unique strategy that has been proven to cut heroin overdose deaths. A warning: You’re probably not going to like it. But Philadelphia could cut its death rate from overdose by simply giving heroin users a supervised injection facility — like Vancouver does.

Injecting rig at Insite

Courtesy Insite

Insite opened in Vancouver, British Columbia, in 2003. It does not give out drugs, but it does provide a safe environment in which drug users can self-inject with their own drugs. It is popular: Anna Marie D’Angelo, a spokesperson for Insite, says users line up and wait outside for a spot in one of the 13 booths. No teenagers and no first-time drug users are allowed; you can’t pass drugs or money there. Dealers are shooed away from the outside, and people have come to “respect” the site. Police now tell addicts to go to Insite. The site provides a place for users to exchange dirty needles for clean ones, similar to Prevention Point Philly.

The idea of a self-injection site is simple: A half-century (or more) of treating the drug issue like a criminal-justice problem has shown that some people are going to use heroin and other drugs no matter what the law is. When it opened, Insite got an exemption from Health Canada to legalize the possession and use of heroin within its walls. There, nurses watch users inject heroin — and revive them if there is an overdose. In 2015, there were 768 overdoses at Insite — and not one death. Insite users are 30 percent more likely to access detox services than those who do not visit.

But the idea is to eventually get users help. Last year there were also 5,368 referrals to other social and health services — the vast majority for addiction treatment — and 464 referrals to a detox center at the same location called Onsite. “You want to reduce the harm that somebody’s doing to themselves and you try to connect them to health care,” D’Angelo says. “You want to connect them to abstinence eventually.”

Almost all studies show Insite to be a success — it increases the number of addicts attempting to quit while not increasing overall drug use totals. The surrounding community has grown to support the site, as it’s gotten addicts off the streets. “In the years leading up to the opening of the site, there were cries of protest from Chinatown and Gastown merchants,” The Globe and Mail wrote in 2006, “but now it is difficult to find anyone in the city urging that Insite be closed down.” People in the city have marched for the program’s expansion.

It’s also relatively cheap. Insite is part of Vancouver Coastal Health, and took up $2.9 million of the health authority’s $231 million budget last year. Much of that $1.9 million was directed, D’Angelo says, toward detox and addiction services. Compare that to the money spent in Philadelphia to suspend police overtime rules to arrest dealers: Moraff says cops spent $64 million in OT last year, which was $15 million over budget.

Though Seattle is moving toward opening its own self-injection facility, it’s obvious there isn’t the political will for such a site in Philadelphia. The only comments from law enforcement and elected officials on the drug overdose problem in Philadelphia vow to continue the strategy we’ve been using for decades: Arrest drug dealers and users, and hope that fixes the problem.

Perhaps you think that’s the strategy we should continue. But all that seems to do is clog the courts, lead drug users to riskier behavior, and cost taxpayers money. Prevention Point has done much admirable work toward preventing heroin overdoses. But maybe we could do more. It would be complicated. It would rely on buy-in from courts, police and health professionals in Philadelphia. But a legal self-injection site in Kensington would do more to help the heroin overdose problem than any amount of arrests we could make.