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Safer Consumption Spaces

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Gus Grannan of Project SAFE provided this overview of evidence regarding safer consumption spaces to the Prevention Committee on November 15, 2017.

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Safer Consumption Spaces

  1. 1. { Safer Consumption Spaces An evidence-based response to opioid use and overdose Gus Grannan, Project SAFE
  2. 2.  The City and/or partner organizations should further explore the possibility of implementing one or more comprehensive user engagement sites (CUES), on a pilot basis, in which essential services are provided to reduce substance use [my italics – g] and fatal overdose (including referral to treatment and social services, wound care, medically supervised drug consumption, and access to sterile injection equipment and naloxone) in a walk-in setting.  -From the report of the city’s Opioid Task Force 13 Further explore comprehensive user engagement site(s).
  3. 3.  In an effort to consider promising strategies that could reduce the health and societal problems associated with injection drug use, the AMA today voted to support the development of pilot facilities where people who use intravenous drugs can inject self- provided drugs under medical supervision. American Medical Assn.
  4. 4.  Studies from other countries have shown that supervised injection facilities reduce the number of overdose deaths, reduce transmission rates of infectious disease, and increase the number of individuals initiating treatment for substance use disorders without increasing drug trafficking or crime in the areas where the facilities are located. American Medical Assn.
  5. 5.  “State and local governments around the nation are currently involved in exploratory efforts to create supervised injection facilities to help reduce public health and societal impacts of illegal drug use,”…“Pilot facilities will help inform U.S . policymakers on the feasibility, effectiveness and legal aspects of supervised injection facilities in reducing harms and health care costs associated with injection drug use.” American Medical Assn.
  6. 6.  The examination of this issue by physicians at the AMA Annual Meeting was greatly assisted by the Massachusetts Medical Society and its recently completed comprehensive study of the literature associated with supervised injection facilities.  AMA Press Release, 6/12/2017 American Medical Assn.
  7. 7.  Jeremiah Daley, executive director of the Philadelphia- Camden High Intensity Drug Trafficking Area Program, a collaborative law enforcement effort, pointed out that heroin is illegal and has no medical use, so “we have that legal issue over our heads.”  “Where would this be placed?” Daley asked. "And does that doom that location to being a repository? We’re going to essentially redline a neighborhood.”  Daley challenged the portrait painted by the Vancouver site manager, who said that city's program, called Insite, made the host neighborhood a better place to live and do business. The area “has been at a dead stop,” he said. “It didn’t improve conditions in that neighborhood.”  Inquirer, Mayor's opioid task force sees huge obstacles to safe-injection sites in Philly, 3/22/17 Mayor’s Task Force
  8. 8.  Task force co-chair Thomas Farley, commissioner of the city’s Department of Public Health, asked Deputy Police Commissioner Myron Patterson for his opinion.  “I don’t see much good coming out of it,” Patterson responded. “Seattle is looking at it. Vancouver is up and running. But they aren’t Philadelphia.”  Inquirer, Mayor's opioid task force sees huge obstacles to safe-injection sites in Philly, 3/22/17 Mayor’s Task Force
  9. 9.  City Councilman David Oh said that Council would have to pass an ordinance to create a site where illegal drug activity was sanctioned. In that scenario, he said, the state legislature would likely respond by prohibiting such sites.  “We in City Council don’t have the power,” he said.  Inquirer, Mayor's opioid task force sees huge obstacles to safe-injection sites in Philly, 3/22/17 Mayor’s Task Force
  10. 10.  https://www.facebook.com/yestoscs/videos/vb. 320059568359474/495470480818381/?type=2&th eater King County [WA] Councilmember
  11. 11.  A few task force members spoke in favor of the idea, which is based on a strategy of “harm reduction” -- reducing the negative consequences of drug use while accepting that illicit drug use is a reality.  “We need radical change,” said the Rev. James P. Baker Jr., chair of the mayor’s drug and alcohol commission.  Inquirer, Mayor's opioid task force sees huge obstacles to safe-injection sites in Philly, 3/22/17 Mayor’s Task Force
  12. 12.  Meet people where they’re at  -Dan Bigg, Chicago Recovery Alliance  Center the knowledge of those at risk of harm  Encourage the self-efficacy of those at the foci of intersectional stigma and trauma  Recognize the source of harm and the locus of reduced harm Applied HR
  13. 13.  First in Frankfurt, Germany around 2003  98 sites in 66 cities  Now exist in [not exhaustive]  Germany  Switzerland  Netherlands  Norway  Australia  Canada Safer Consumption Sites
  14. 14. Kral/Davidson. Addressing the Nation’s Opioid Epidemic: Lessons from an Unsanctioned Supervised Injection Site in the U.S. American Journal of Preventive Medicine, In Press SIS Study
  15. 15.  Unsanctioned Safer Injection Site in unnamed American Metropolitan Area  Participants in agency approached ad-hoc as need for SIS services for person becomes apparent  No set exclusion criteria  Roughly 60 participants have privileges at any time  10-20 minutes per session SIS Study
  16. 16.  Staff and ancillary sterile injection supplies provided by agency  Staff trained in naloxone use/OD recognition  Users likely also trained and able to administer  One overdose per 1,278 injections in first 2 years of SIS operation  Similar to pre-fentanyl numbers at InSite in Vancouver BC SIS Study
  17. 17.  Reasons for success in reducing OD death  Supervision  Setting  Clean, well-lit, secure space with extra HR equipment  Injections hurried in over 80% of non-SIS use  All equipment used in SIS safely disposed of by site SIS Study
  18. 18.  Where would you have injected if not at site today? SIS Study Place of Injection Percent Public Restroom 34.9 Street, park or parking lot 57.3 Own Place 4.1 Friend's Place 1.8 Other 1.9
  19. 19. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Street or park Public bathroom Car Abandoned building Stairwell Bus, train, or subway Shooting Gallery Bathroom of a SEP Reported Locations of Public Drug Use (past 3 months) De facto drug policy [NJ]
  20. 20.  El Campemiento razed July-August 2017  SCS in Kensington church rousted, July 2017  807 OD deaths in 2016 De facto drug policy [Philly]
  21. 21.  From http://www.talkingdrugs.org/drug- consumption-rooms-benefit-people-who-dont-use- drugs  1. DCRs ensure safer streets  2. DCRs reduce the spread of disease  3. DCRs improve access to emergency services  4. DCRs can reduce crime  5. DCRs help people integrate into the legitimate economy Five Reasons Why DCRs Benefit People Who Don’t Use Drugs
  22. 22.  Although the title says ‘Five’, there is one last reason for why DCRs must be introduced that cannot be ignored.  6. DCRs save lives Five Reasons Why DCRs Benefit People Who Don’t Use Drugs
  23. 23.  If it were sanctioned, more people could be served, licensed clinicians could provide on-site healthcare services, other agencies could collaborate to provide co-located, wraparound services, and there would be more options for funding site activities and increasing operating hours. Although supervised injection sites may not substantially reduce the number of people who use opioids and other injection drugs, they do attenuate the serious medical sequelae of this epidemic, including preventable infections and deaths. It is time for local, state, and federal governments to consider removing legal barriers such that a comprehensive pilot of this innovative intervention can be implemented. SIS Study

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