Somewhere in a U.S. city, a small nonprofit organization has been hosting a secret site where users can inject drugs under the supervision of trained staff who provide clean needles and guard against overdoses, researchers said Tuesday.
The site, which is illegal under federal law, has been operating for three years, according to a paper published in the American Journal of Preventive Medicine. It is part of the “harm reduction” strategy adopted by 98 facilities in 10 other countries where supervised injection sites operate legally.
The controversial approach has been debated in the United States for many years, but it is gaining popularity in some places as the number of overdose deaths from illegal drugs continues to skyrocket. California, New York City, Boston and Ithaca, N.Y., are exploring the idea. The county that includes Seattle has approved opening two locations.
“The whole country knows this is a crisis. We need some new solutions,” said Alex Kral, an epidemiologist for RTI International who revealed the program in a commentary Tuesday. “We need innovation at this point. This is not innovation out of thin air. This is innovation that’s been proven.”
More than 52,000 people died of drug overdoses in the United States in 2015, according to the Centers for Disease Control and Prevention. Data released Tuesday by the National Center for Health Statistics show that number may rise sharply, to about 60,000, when final totals are available for 2016.
Kral, who has published research on substance use for many years, said he was approached by the organization and asked to collect data on the site's operation. He and co-author Peter J. Davidson, of the University of California at San Diego, did not reveal the site's location in their article. Kral said the peer-reviewed journal did not ask for proof that it existed, and the university's panel that supervised the research did not require that he reveal its location.
The article's data, taken from the first two years of the site's operation, provide a sobering glimpse at the hardcore addicts who use the facility. More than 100 users who gave themselves 2,574 injections there were surveyed. Eighty percent are homeless, 91 percent are men and 80 percent are white. The vast majority injected heroin, but some used methamphetamine, cocaine or prescription opioids. On average, they injected drugs about 114 times per month.
Four people have been revived at the site with the antidote naloxone after overdoses during the first three years of operation, Kral said.
The program, Kral said, is open by invitation only to drug users who are known to the staff members of the nonprofit organization. Many other supervised injection sites around the world are open to anyone who walks in and wants to inject drugs. The clandestine U.S. program operates four to six hours a day, five days a week and is staffed by people trained to respond to overdoses and to provide advice on safe and hygienic injection. It has five small spaces where users can inject drugs and a second room with couches where they can remain afterward.
Canadian and U.S. law enforcement groups opposed the opening of the first site in North America, in Vancouver, B.C., in 2003, and many communities have raised objections about the impact that opening such a facility would have on their neighborhoods.
Research has shown that supervised injection sites reduce deaths from overdoses, cut the risk of HIV and hepatitis transmission by eliminating needle-sharing and provide users with access to health and social services, Kral and Davidson wrote in their paper. For the surrounding community, they reduce public injections, improper disposal of syringes and drug-related crime, they wrote.
The sites also help get some users into treatment by offering them care and a chance to talk with staff in a safe, relaxed place, said Taeko Frost, western regional director of the Harm Reduction Coalition, who has studied supervised injection sites. “It's really hard to create any space or time for anyone to focus on anything else when they're worried about not getting arrested or dying alone,” she said. In Kral's paper, more than 92 percent of users said they would inject drugs in a public restroom, park or parking lot, or on the street if the site didn't exist.
“We really applaud the work they’re doing,” Frost said of the unsanctioned injection site. “It's extremely courageous to operate a lifesaving service like this.”