As heroin use continues to take an increasing toll on American lives, public health leaders are looking for novel ideas to address the epidemic. “Safe consumption sites” are medically-supervised venues where heroin users can inject heroin in clean, safe, and medically-supervised facilities, and where overdose prevention medication (naloxone) is ready for use if needed.
While not new in international settings (Vancouver utilizes this approach), to date there are no safe consumption sites in the United States. Seattle is currently considering such a program, and it has prompted much discussion and some opposition.
Those opposed to safe consumption sites typically voice concerns about these facilities increasing heroin use, with the assumption that safe places to use heroin will bring more users. Some feel that this approach validates heroin use, sending the message to users that it’s fine to keep using heroin. Other common concerns are that this approach will result in increased drug use in the vicinity of the sites, and that making heroin use easier will decrease the number of heroin users interested in seeking the care of opioid treatment programs.
A review of the literature shows little evidence supporting these concerns, and offers evidence that in Canada and Australia, safe consumption sites have not had the negative impacts cited. There also appears to be no reduction in admission to opioid treatment programs.
While in Seattle there appears to be wide-spread consensus among political and policy leaders about moving forward with these facilities, it remains to be seen whether such a consensus can trump the strongly held beliefs of citizens opposing this harm-reduction-based approach to the opioid use epidemic.
Jim Anderson, MPAS, PA-C, DFAAPA, is a physician assistant in Seattle.