Heroin overdoses don’t need to be fatal

As public health officials continue searching for solutions to combat a deadly amalgam of heroin that is creeping through the streets of New England, one Canadian city recently defeated 31 heroin overdoses in two days through the use of a harm-reduction strategy it implemented over a decade ago. 

Across the nation, opioid overdoses are surging. Fatal overdoses have already rocketed 55 percent since 2000 and are now the leading cause of injury death in the United States. From 2010 to 2012, the number of heroin overdose deaths doubled in over half of the states. Now, New England has begun to see a sharp spike in overdoses. 

{mosads}With two months of the year remaining, overdose deaths in New Hampshire have nearly matched 2013 levels, and an additional 70 possible overdose deaths remain unconfirmed by toxicology tests. In Connecticut, 151 people this year died from opioid overdoses between January 2 and June 17, a 60 percent increase from the first six months of last year. 

Recent studies of local drug samples have found substantial amounts of fentanyl, an opiate much stronger than heroin in the illicit heroin supply, leading some law enforcement officials to ascribe the adulterated drug to the rise in overdoses. Meanwhile, a medical facility located just 30 miles north of the US border has already found a viable solution to reducing fatalities associated with opioid overdose. 

In 2003, Vancouver welcomed to the city its first supervised injection facility, InSite. Similar to the 91 other facilities operating in 60 cities worldwide, InSite has sought to provide drug users with a sterile, controlled environment in which to inject their own intravenous drugs while under the supervision of trained medical professionals. Shortly after its inception, the city saw an immediate impact on the welfare of its citizens: the number of city-wide fatal overdoses decreased nine percent while fatal overdoses occurring within 500 meters of InSite plummeted 35 percent. InSite’s doors have continued to remain open, similar trends have ensued. 

Several weeks ago, 31 InSite clients overdosed on fentanyl-laced heroin over the course of two days. By promptly providing clients with oxygen and the opioid-reversal drug Naloxone, the facility’s staff successfully saved the life of each client. Elsewhere in the city, where this life-saving support system does not exist, one woman died after reportedly overdosing on the same batch of heroin. 

Due to the heighten presence of fentanyl this year, InSite has seen a larger amount of overall overdoses, around 10 to 12 each week. However, there has not been a single fatal overdose at the facility in the eleven years it has been open due to the presence of medical staff who are equipped to effectively treat opioid overdoses post-haste. 

Moreover, the benefits offered by InSite transcend fatal overdose prevention. In particular, InSite has succeeded in significantly reducing the number of publicly discarded syringes and injection-related litter in the city by offering drug users a place to inject. Further, disease transmission rates have decreased as those who frequent the facility no longer share syringes. As a result, the program has yielded some economic factors as well; one cost-benefit analysis estimated that InSite provides a societal benefit of more than $6 million per year as a result of decreased medical costs normally associated with drug abuse and HIV transmission. 

Harm-reduction strategies sustain the notion that drug addiction is an illness which requires medical treatment, and thus, they are able to offer more pragmatic solutions to those battling drug addiction. Indeed, the advent of supervised injection facilities has even impacted the use of drug cessation services. The year after InSite opened, the use of detoxification services rose 33 percent among local heroin users. Further, those who enrolled as clients at InSite developed a greater likelihood to stopping injection drug use completely, in comparison to those who did not attend InSite. 

It is evident that harm-reduction approaches can provide safer, alternative solutions to drug users than can the current U.S. policy. In 2010 alone, 268,700 people were arrested in the US for possession of heroin, cocaine, and other derivatives. Rather than medically treating these people to overcome their addictions, the War on Drugs forces punitive measures on those suffering from illness. Many overdose victims avoid calling emergency services in fear of incarceration. Shifting towards a harm reduction policy would allow those suffering from drug addiction to safely convalesce and reenter the workforce without the burden of a criminal record. 

Supervised injection facilities provide a new paradigm to follow when searching for solutions to end the heroin epidemic. While these facilities remain prohibited under federal drug laws, it is imperative that health and law enforcement officials acknowledge the ways that these pioneering facilities have reduced drug harm and begin to openly explore solutions which may be applied domestically. Until new ideas can be discussed without reproach, the War on Drugs will continue to claim casualties. 

Gargano is a Young Voices Advocate and freelance writer based in Connecticut.