Seattle is on track to become the first place in the country where heroin addicts can legally shoot up at a supervised healthcare facility, hoping that the controversial move can reduce the number of overdose deaths and decrease the spread of disease through dirty needles.
An outgrowth of needle exchange programs found throughout the U.S., the two "supervised injection facilities" would assign drug users to a small cubicle where they could shoot up. Medical personnel monitor each person's response to the drug and, if he or she overdoses, is immediately treated with an overdose-reversing medication such as naloxone.
The facilities are intended to bring users out from the alleys and into safe places where overdoses can be treated immediately and addicts can be encouraged to get into a treatment program. Ninety-one people a day die in the U.S. from an opioid overdose, including heroin and painkillers, according to the Centers for Disease Control and Prevention. In Seattle's home of King County, that included 229 deaths in 2015.
Although the concept is new to the U.S., more than 90 such facilities exist in Europe, Australia and Canada. The Vancouver, British Columbia, facility saves between 1.9 and 11.7 lives annually by using drugs that reverse overdoses, according to a report.
Seattle created a 40-member task force last year to develop strategies for thwarting the drug problem. Seattle Mayor Ed Murray and King County Executive Dow Constantine announced in late January that they were looking at where to create the facilities and what it would take to build them.
The Seattle-King County Public Health Department is looking into funding the two projects, but one state senator is hoping to block the endeavor before money is allocated.
"Toleration is not compassionate, it is a signal of defeat. We cannot give up on drug users. In the end, these sites will only distract us from getting resources into real, medically proven treatment options," Miloscia said.
John P. Walters, director of drug control policy in George W. Bush's administration, agreed the only safe approach to heroin is not to take it.
"Supporting addicts' heroin use maintains their disease, administering the poison that causes their illness and diminishes their lives. A government-approved place for unlimited heroin injection creates the conditions for never-ending addiction and gives government a drug dealer's power over the addicted," Walters wrote in an op-ed. "We do not protect addicts by reviving them from overdose death only to return them to death's front door, perpetuating the self-destructive cycle of addiction."
Advocates argue that the safe spots not only would cut down on the number of deaths, but also would dramatically cut down the transmission of HIV and hepatitis C.
Dr. Nora Volkow, director of the National Institute on Drug Abuse, part of the National Institutes of Health, said not taking action to reduce the spread of those diseases would be irresponsible from a public health perspective. Cutting even one HIV infection would save $379,668 in lifetime costs, according to NIDA data.
King County spends $1.2 million annually on its needle exchange program, allowing the program to essentially pay for itself if three infections are prevented per year. Cutting infections by 1 percent in King County would save more than $70 million in HIV-related medical costs, the county's website states.
San Francisco and Massachusetts officials also are studying the pros and cons of safe injection clinics. San Francisco commissioned a study that found one facility would prevent 3.3 cases of HIV and 19 cases of hepatitis C per year and bring 110 people to enter medication-assisted treatment.
A San Francisco facility is estimated to cost $2.6 million per year, but when adding in the $6.1 million savings in healthcare costs, the city believes it would save $3.5 million annually.