A woman prepares to use heroin at an “injection site” in Vancouver. (Courtesy of Insite.)

Svante Myrick was on the phone with a reporter from a big New York newspaper when he realized people’s assumptions about the heroin epidemic don’t match the reality. The journalist asked the 29-year-old mayor of Ithaca for a “gritty” picture that would represent the damage heroin has wrought in his community. Ithaca, a town of 30,000 residents that’s home to Cornell University and Ithaca College, isn’t a very gritty place. But heroin has hammered it nonetheless.

“Mothers would come in carrying needles that their daughters had found playing outside,” said Myrick, who took office in 2012, at the age of 24. “…Businesses would come in and say, ‘Someone overdosed in our bathroom.’ ”

Heroin, he said, is now woven into the nation’s social fabric. Fewer than 6,000 Americans died of an opioid overdose in 2001. In 2014, nearly 20,000 did. That trend has been especially pronounced in places like New York state, where the number heroin has killed increased from 215 in 2008 to 478 in 2012. In Tompkins County, which Ithaca anchors, heroin overdoses have tripled in less than decade. And in the city itself, three people died from heroin overdoses in one 10-day span in 2014.

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“It’s everyday America now,” Myrick said. “And I was sick of not having any answers.”

So he proposed one that, in the heart of America’s heroin epidemic, could change everything. Tucked into what he calls the Ithaca Plan, it’s a method that has had success in other parts of the world, but is untested in the United States. The idea is to prevent fatal overdoses by providing supervised injection sites where addicts can use the illegal narcotic under the watch of medical professionals. Then, if they start to overdose, workers can administer naloxone to reverse the process. The addicts would also receive services and counseling to help them kick addiction.

With the availability of a tool like naloxone, no one should die because of heroin, Myrick said. Not anymore — not when society has so much at stake.

Persuading others, however, won’t be easy. The state Legislature — and possibly even federal authorities — would first need to approve the plan. And some lawmakers have already come out against it. “It is an absolute, total misguided approach on how we’re going to eradicate this heroin addiction problem we have in this state,” state Sen. George Amedore told the Albany Times Union

Myrick’s proposal nonetheless marks the latest departure from the zero-tolerance orthodoxy that has for years governed the drug war. In California, voters passed a proposition that reclassified some drug violations as misdemeanors. In Massachusetts, where the governor just declared a state of emergency over opiate-related deaths, a small town police chief now offers amnesty to addicts seeking help. But to some degree, Myrick’s proposal is more radical than these.

He doesn’t just want to mitigate punishment. He wants to give addicts permission to break the law.


Ithaca Mayor Svante Myrick wants to bring the first injection site to the United States (Associated Press).

‘It sounded crazy’

Few people have had more experience with how needles can destroy lives than Lilian Fan. For years, she has worked with an Ithaca non-profit providing addicts with clean needles. She says she often sees “severe infections, that were avoidable, because they didn’t have a safe place to inject.” So when she got word two years ago that the young mayor was looking for solutions to quell overdoses, she told Myrick that was what the city needed. Bring addicts out of hiding. Give them a place to use safely.

“I thought it sounded crazy,” Myrick said. “I had the same reaction that everyone had — injecting heroin is bad.” Why make it easier for people to use, he thought. Myrick, after all, was familiar with drugs. His dad, a veteran of the Navy who later drove garbage trucks, did crack cocaine. Myrick was six when his dad ditched town for the last time. His mother sat him down.

“My mom explained to me he couldn’t take care of us or himself, and that there was something in the way” his father couldn’t control, said Myrick, who went decades before speaking with his father again. “You have to explain that to children, because what’s more important than taking care of yourself? But the drugs are so powerful that it defies logic. Anyone who knows an addict knows that.”

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Myrick nonetheless went home and started researching Fan’s idea. He learned that injection sites have been around for decades. Germany, Switzerland and the Netherlands have all used them, placing them in locations where addicts congregated. One reverend opened a site near the Rotterdam Central Station in the Netherlands, and later expanded to a church that still provides those services today.

The community concerns that surrounded the facilities aren’t surprising. Neighbors fretted over crime and public disturbances. Others thought it would socialize the community to drug abuse, attracting narcotics like never before. What if someone died at an injection site? Who would be liable?

Social scientists swooped in to study the phenomenon. “Findings, however, have been encouraging,” found a study published in the Drug and Alcohol Review, published in 2000. “In some areas public nuisance has been minimized, the number of overdose deaths and complications from non-fatal overdoses have decreased, risk behavior has decreased and health and social functioning of clients have improved.”

That same year, the battered neighborhood of Downtown Eastside in Vancouver was in the throes of simultaneous heroin and AIDS crises. The language now used to describe America’s heroin problem — “states of emergency;” “epidemic” — were then used to describe Vancouver’s. One study said the community was “among the highest HIV infection rates of any community in the Western world.”

“It was pretty bad,” said Patricia Daly, chief medical health officer at Vancouver Coastal Health. “…Our hospital beds were being filled with people with AIDS.” So soon, she said, a team of medical officials flew to Europe to analyze the continent’s injection sites and determine whether they could work in North America.


What Vancouver’s Insite looks like on the inside (Courtesy of Insite).

Treating a diseased neighborhood

Day remembers the first weeks at the injection site named Insite. It was 2003. And Vancouver, with cooperation with local authorities, had just given the community’s addicts permission to come to the facility and use drugs. People swarmed the system. More than 800 injections occurred every day. Sometimes, it was more than 1,000.

But then something unexpected happened. Rather than encouraging more drug abuse, the environs surrounding the site suddenly emptied of it. “As soon as it opened, the public order improved,” Daly recalled. “Fewer discarded needles and a reduction in overdoses … and open drug use.”

But anecdotes are one thing; statistical evidence is another. So several years later, researchers set out to discern whether this perception was warranted. Social scientists, who later published their findings in Lancet, sketched a 1,600-foot radius around the facility. Then they studied the rest of the city, and found that overdoses across the city had dropped by 9 percent in the two years since Insite opened in 2003. And within the radius? Overdoses had actually decreased by 35 percent.

“One of the things that happened after we opened is that we learned very marginalized people weren’t even accessing health services,” Daly said, estimating it has saved “hundreds of lives.”

“This [facility] is engaging marginalized people in our community,” she added. “Bringing them out of the shadows.” And connecting them with resources that can help them to recovery — resources they wouldn’t have encountered otherwise. Facility officials, who say the number of daily injections has dropped to around 600, call it the “first rung on the ladder from chronic drug addiction to possible recovery.”

What happened in Vancouver and elsewhere sold Myrick on the idea. One of the keys, he contends, to defeating addiction is liberating it from stigma. “So many of us who have been touched by addiction believe that we are alone and carry this as a private shame … [that] we’ve never proposed real solutions because we’ve lived in the closet,” he said.

More roadblocks, however, lay before Myrick’s proposal than that. Some experts call it a pathway to legalization. Others think it would provide a service no one wants. But perhaps the most pervasive criticism is that it would acculturate the public to addiction.

But what, Myrick asked, if the inverse is true? What if it could acculturate addicts to medical care? What if it’s not a pathway to legalization, but a “pathway to treatment”?

Now he just needs to convince everyone else.

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