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An argument for supervised injection sites

Published September 14. 2018 12:25PM

By Dr. David T. O’Gurek

Patients are and always will be my best teachers. Learning from so many of them on the significant stigma they suffer as a result of their substance-use disorder, I hear them yearn for new approaches, new ideas and innovative strategies to save the lives of those still actively using.

They lament losing friends daily to their battles with addiction and to the belief that this crisis is new as if it hasn’t been ongoing for decades without significant attention from policymakers other than to police their way out.

Not surprisingly, my patients have the insight to note that those making decisions regarding solutions are themselves so affected by bias that they perpetuate the stigma from which they suffer.

As a family physician who provides both primary as well as specialty care for individuals struggling with opioid-use disorder in Philadelphia, I am in strong support of the city’s establishment of supervised injection sites, an evidence-based strategy to address the growing opioid crisis.

Supervised, safe injection sites, or more appropriately named overdose prevention sites, exist worldwide. A biased approach chooses to focus on the fact that these are indeed controlled health care settings providing people who inject drugs with a safe location to use, equipped with trained staff in a hygienic environment to administer naloxone to reverse overdose.

They are, in fact, so much more, and as a result have been shown to not only decrease fatal overdose, but also prevent HIV and hepatitis C, prevent infections, reduce public injection and publicly discarded syringes, increase access to drug treatment, decrease crime and public disorder, and are cost effective. In fact, of all the strategies employed, they are the only intervention to demonstrate these outcomes.

While a recent meta-analysis study calls into question the outcomes, that study has significant limitations in describing the impact that these prevention sites have had on the communities where they exist.

Despite growing trends in our political schema, facts and evidence matter. On Aug. 31, state Rep. Jerry Knowles released a memorandum seeking co-sponsors for his legislation that would prohibit municipalities from receiving appropriations from the state if they approve policies to provide supervised injection sites. In his memorandum, he called this public health harm reduction intervention “ridiculous,” while at the same time saying he supports measures to assist those struggling with substance-use disorder.

He expressed concerns about “enabling users,” who more appropriately should be deemed individuals with substance-use disorder, through this strategy that has demonstrated to engage individuals in care who otherwise would not have sought such.

Such a response is not an unfamiliar one to my patients, as they have heard it all before as a mechanism of sweeping them by the wayside, feeling like they are not worth interventions that work.

As Philadelphia explores innovative and new strategies to address an ongoing crisis where more lives were lost last year than at the height of the AIDS epidemic, Knowles, in his announcement, chooses words to perpetuate stigma and fails to see that facts and evidence matter. While differences of opinion are acceptable, one cannot claim to be for solutions and perpetuate stigma at the same time. Harm-reduction strategies traditionally have been met with resistance, often out of fear as well as ignorance.

On behalf of my patients as well as residents of the commonwealth, I challenge our legislators to overcome this resistance and engage in conversations with those struggling and those informed on public health strategies.

My hope is that in doing so, they will see those struggling with addiction for the individuals they are as opposed to the activity that they do, and be committed to reducing stigma including considering innovative approaches like overdose prevention sites that save lives. Failing to do so is, in my opinion, ridiculous.

Dr. O’Gurek, practices comprehensive outpatient family medicine at Temple University Hospital, as well as coordinating an office-based opioid treatment program for patients who have opioid use disorder. He collaborates with Temple’s faculty practice and the Temple Center for Population Health on creative methods to address the university’s community health needs assessment. Notably, he has partnered with Philadelphia and its agencies to address the opioid crisis. He is the current president of the American Academy of Family Physicians.

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