Nurses to Supervise Heroin, Cocaine Injections

Here's an article I got over at nurselink about the proposal to start a safe injection site in San Francisco. My response on the site is also reposted here below the news article. Head on over to nursingling to check out all of the naysayers too.

ASSOCIATED PRESS Oct 19, 2007
City health officials took steps Thursday toward opening the nation’s first legal safe-injection room, where addicts could shoot up heroin, cocaine and other drugs under the supervision of nurses.

Hoping to reduce San Francisco’s high rate of fatal drug overdoses, the public health department co-sponsored a symposium on the only such facility in North America, a four-year-old Vancouver site where an estimated 700 intravenous users a day self-administer narcotics under the supervision of nurses.

“Having the conversation today will help us figure out whether this is a way to reduce the harms and improve the health of our community,” said Grant Colfax, director of HIV prevention for the San Francisco Department of Public Health.

Organizers of the daylong forum, which also included a coalition of nonprofit health and social-service groups, acknowledge that it could take years to get an injection center up and running. Along with legal hurdles at the state and federal level, such an effort would be almost sure to face political opposition.

Bertha Madras, deputy director of demand reduction for the White House Office of National Drug Control Policy, called San Francisco’s consideration of such a facility “disconcerting” and “poor public policy.”

“The underlying philosophy is, ‘We accept drug addiction, we accept the state of affairs as acceptable,’” Madras said. “This is a form of giving up.”

Sixty-five similar facilities exist in 27 cities in eight countries, but no other U.S. cities have considered creating one, according to Hilary McQuie, Western director for the Harm Reduction Coalition, a nonprofit that promotes alternative drug treatment methods.

“If it happens anywhere in the U.S., it will most likely start in San Francisco,” McQuie said. “It really just depends on if there is a political will here. How long it takes for that political will to develop is the main factor.”

Drug overdoses represented about one of every seven emergency calls handled by city paramedics between July 2006 and July 2007, according to San Francisco Fire Department Capt. Niels Tangherlini. At the same time, the number of deaths linked to overdoses has declined from a high of about 160 in 1995 to 40 in 2004, he said.

Colfax estimated that there are between 11,000 and 15,000 intravenous drug users in San Francisco, most of them homeless men. Like many large U.S. cities, the city operates a clean-needle exchange program to reduce HIV and hepatitis C infections.

Advocates plan to work on building community support for a safe-injection center, including backing from Mayor Gavin Newsom and the Board of Supervisors.

The mayor’s spokesman, Nathan Ballard, said Thursday that although he does not want to discourage debate, he “is not inclined to support this program because, quite frankly, it may create more problems than it supposedly addresses.”

In Switzerland, Spain and other European countries with such programs, the sites have been placed in existing public health clinics and created as stand-alone centers, said Andrew Reynolds, a program coordinator with San Francisco’s city-run sexually transmitted diseases clinic.

Possible locations for opening one in the city include homeless shelters, AIDS clinics or drug treatment centers, he said.

“They aren’t these hedonistic dens of iniquity,” Reynolds said. “There is no buying or selling of drugs on the premises. Staff do not assist in injections.”

While it’s too early to tell what the room in San Francisco would look like, Vancouver’s InSite program is on the upper floor of a low-rise building in a downtown neighborhood where drug users shoot up in the open.

The site, exempt from federal drug laws so users can visit without fear of arrest, has 12 private booths where addicts inject drugs such as heroin, cocaine or crystal. They can use equipment and techniques provided by the staff, and then relax with a cup of coffee or get medical attention in the “chill out” room where they are observed, said program coordinator Sarah
Evans.

“It looks kind of like a hair salon,” Evans said of the bustling space. “If we were a restaurant, we would be making a profit.”

While 800 overdoses have occurred on the premises, none resulted in death because of the medical supervision provided at InSite, said Thomas Kerr, a University of British Columbia researcher who has extensively studied the program. His research also has shown an increase in addicts seeking drug treatment and a decrease in abandoned syringes, needle-sharing, drug-related crime and other problems since the clinic opened, he said.

The results indicate the idea is worth replicating, despite the criticism it may attract, Kerr said. “I prefer the approach of the Vancouver Police Department, which was: ‘We don’t like the idea of this, but let’s look at the evidence and at the end of three years we will tell you either this
is something we can support or it’s something we can’t support,’” he said.

Temple University law professor Scott Burris told the audience at Thursday’s forum that a supervised injection room would seem to run afoul of federal drug possession laws and a state statute that makes it illegal to operate a crack house or any place where drugs are used, but only if the police and federal agents enforce them.

He cited as an example California’s medical marijuana law, which has allowed pot dispensaries to flourish but at the risk of being raided by federal authorities.

“The law isn’t a barrier,” Burris said. “The issue of whether it’s legal doesn’t come up until somebody is arrested.”

My response:
There are so many reasons that this is a good idea: The first point of contact for many street-living addicts is the ER, either for an overdose or an infected abcess. Both of these are costly to the taxpayer/HMO system. If nurses can catch infections early, teach people how to inject safely, spread the word about the necessity of clean needles and clean water AND save the system money AND direct people to resources & services AND direct them to treatment, AND save their lives then the "it's illegal" argument falls a bit flat in the face of that.

It's still illegal outside of the clinic environment. By entering the clinic the user has made an
(either overt or tacit) agreement to use clean gear & stick around afterwards (at least that's the arrangement at the Vancouver InSite). Chronic drug users no longer get high from heroin or
cocaine, they need the drugs simply to remain functional and not go into withdrawl. Users then can get information on treatment programs or be put in contact with other resources while in a frame of mind where they can actually take the information in rather than while they are "jonesing" for a hit.

Just in case anyone envisoning addicts to be "merely" the homeless (although they're the ones to benefit most from this type of frontline care), 13.1% of employed Americans in 1999 were substance abusers and it's suspected that 10% of the nursing population of the US uses drugs and/or alcohol, 6-8% to the point of impairing their clinical judgement (Dunn, Substance Abuse Among Nurses, AORN Journal, Oct 2005)