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  • Alina Kahn

Feeling Safe in the World: A Small American Shift to Harm Reduction for Drug Addiction



“I was a 17 year old girl with no hope for the future. I had resigned to the fact that I was going to live and die as a drug addict.” Rather than stressing over homework assignments, friends, and college applications, Courtney Lovell’s mind was occupied by a crippling addiction at only 17.

The opioid crisis is often overlooked or ignored. However, almost half a million people died from opioid overdoses between 1999 and 2019. In 2020, for the first time ever, 100,000 people died of an opioid overdose in a single year. The opioid epidemic has taken different forms over time, starting as an issue of misuse of prescription drugs, to heroin, to the current drug of choice: fentanyl.


As fentanyl becomes more prevalent, people are becoming addicted to it at increasing rates. Fentanyl is incredibly potent in small doses, meaning a small miscalculation could lead to death. But, because it is very cheap and easy to produce, it is an appealing additive to drug distributors. White Americans have been at the forefront of the discussion surrounding opioid addiction because they were disproportionately affected by the earlier stages of the epidemic. However, the new addition of fentanyl into heroin and other drugs has caused a large increase in overdose deaths among Black Americans, one that is beginning to exceed that of white Americans.


The United States has a history of oppressive policies regarding drug misuse and abuse – focusing more on punishment than rehabilitation.


One alternative to this approach has recently begun to be adopted in the US: safe or supervised injection sites (SISs). These are locations where people with drug dependence are provided a safe space where they can consume drugs under the supervision of medical professionals who are trained to administer naloxone to prevent fatal overdoses. In addition, professionals demonstrate how to correctly inject substances and provide a clean environment with clean needles, preventing not only drug overdose but also decreasing the prevalence of other diseases, such as Hepatitis C and HIV, that are spread through dirty needles and needle sharing. They also provide resources on how people can get rehabilitation.


As the use of fentanyl increases, SISs are becoming increasingly important because fentanyl overdose onset is very sudden and ambulances often cannot respond quickly enough to prevent a fatality. The SISs could also have equipment to check the contents of the drugs that people bring into them to ensure they do not contain excessively high levels of fentanyl or other dangerous additives.

One of the key arguments against safe injection sites is that they will encourage or increase drug use. However, there has been no evidence of this in any SISs. Drug addiction creates a physical need, one that people will alleviate whether a safe space is available or not. SISs do not increase drug use but instead provide a safe space to reduce danger.


The current criminalization of drug users and lack of policy to help those suffering from addiction is leading to more harmful situations for everyone. People reported injecting drugs while driving, using a seatbelt to tie off their arm; others inject in abandoned buildings; and some in rural areas for fear of being arrested if they used drugs in a public place. Those who are alone may never have the time to call for help and even if they do, ambulances often take too long to reach isolated places. Others will consume drugs in public places where they cannot or do not dispose of needles properly and leave them in places that can harm others.

Because of these situations, many countries have adopted SISs: Australia was the first in 2000, followed by Canada and, later, many European countries, for a total of over 100 sites worldwide. One of the leading sites, Vancouver’s Insite has been operational since 2003 and has facilitated 3.6 million injections. Insite has seen more than 6,000 overdoses with no deaths reported. In fact, no one has ever died at an SIS.


The US has been slow to adopt this type of care. The Controlled Substances Act, a piece of legislation created to deal with “crack houses” in the 1980s that “bans the operation of a facility for the purpose of using illegal drugs,” was applied to a Third Circuit Court case and blocked the opening of an SIS in Philadelphia. The Supreme Court did not take this case, paving the way for New York City, a location outside the jurisdiction of the Third Circuit Court, to establish two SISs at the end of 2021. On their first day of operation, two deaths were prevented. NYC will likely face lawsuits with their new SISs. However, for now, NYC is providing hope for a future that focuses on a harm reduction approach, one where people with drug dependencies are not ostracized, but rather met where they are.


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