Safe Injection Site for Dutchess County in 2018-- Save Opioid Overdose Deaths Now

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Sign this petition if you agree that Dutchess County should have a safe, supervised drug injection facility to save lives here locally.

The Poughkeepsie Journal reported Apr. 24, 2017 that: "Amid the rise in heroin use and drug-related deaths in New York, Dutchess County frequently saw the highest rates of death in the state from 2010 to 2015, a new report found. While Dutchess County did not see a huge spike in drug-related deaths, in the six years analyzed, Dutchess County had the highest drug-related death rate of any New York county in three of those years: 2010, 2012 and 2013. Dutchess County's per-capita drug-related death rate hit a high of 24.2 per 100,000 people in 2013, but fell to a rate of 16.9 in 2014, yet went back up to 22 deaths per 100,000 people in 2015."
http://www.poughkeepsiejournal.com/story/news/local/new-york/2017/04/24/drug-deaths-spiked-dutchess-ulster/100850314/

Fact: "The American Medical Association is in support trying of these sites, as is the Massachusetts Medical Society. Elizabeth Warren has spoken about them, and Nora Volkow, director of the National Institute on Drug Abuse, has asked for local data," according to Alex Kral, PhD of UC San Diego.

Elected officials across the U.S.-- in Ithaca here in New York, along with Philadelphia, Seattle, Denver, and Chittenden County in Vermont-- have all expressed serious interest in launching safe, supervised drug injection facilities in their communities; click on these links for more on this:  http://www.ithaca.com/news/ithaca/ithaca-gets-first-look-at-supervised-injection-site-model/article_211dd07a-2f68-11e7-a11e-9f09d4c093c3.html http://www.philly.com/philly/columnists/mike_newall/safe-injection-sites-heroin-opioid-crisis-1250-20171215.html http://www.phillymag.com/news/2017/09/14/krasner-safe-injection-sites/ http://www.foxnews.com/politics/2017/10/18/washington-state-judge-rules-in-favor-supervised-injection-sites.html                    https://www.usnews.com/news/best-states/washington/articles/2017-11-21/seattle-budget-includes-money-for-safe-injection-site https://www.theatlantic.com/health/archive/2017/11/why-cant-addicts-just-quit/545552/                                         https://www.denverpost.com/2017/11/05/denver-heroin-drug-users-supervised-injection-site-proposal/ http://www.burlingtonfreepress.com/story/news/local/2017/03/22/vermont-considers-safe-injection-space-drug-users/99468280/ http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-drug-injection-1505265354-htmlstory.html https://www.nytimes.com/2017/01/18/opinion/injecting-drugs-under-a-watchful-eye.html                                    https://www.nytimes.com/2016/03/23/nyregion/fighting-heroin-ithaca-looks-to-injection-centers.html

Fact: "Ten countries currently allow legal operation of such sites (Australia, Canada, Denmark, France, Germany, Luxembourg, the Netherlands, Norway, Spain, and Switzerland), with approximately 98 facilities operating in 66 cities worldwide. Implementation of supervised injection sites has been shown to improve individual health, such as overdose mortality rates, drug use and enrollment in drug treatment, HIV and viral hepatitis risk, and access to health and social services. Improvements in community health and safety are also noted in neighborhoods with supervised injection sites, including reductions in public injection and improperly disposed of syringes, drug related crime, violence in the neighborhoods surrounding the site, and in the demand for ambulance services for opioid-related overdoses. Once implemented, these sites have been found to have high community support, which increases over time. A recent study estimated that placing a supervised injection site in a U.S. city would net cost savings of $3.5 million (U.S.) per year."  [from Peter Davidson, PhD. and Alex Kral, PhD of UC San Diego: http://www.ajpmonline.org/article/S0749-3797(17)30316-1/fulltext ]

Recall as well this Janet Burns gem from Forbes magazine Aug. 10, 2017: "Opioid Activists Are Going Rogue To Prove That Safe Injection Sites Save Lives" https://www.forbes.com/sites/janetwburns/2017/08/10/opioid-experts-are-going-rogue-to-prove-that-safe-injection-sites-save-lives/#388df89f6b86 

Email countyexec@dutchessny.gov and countylegislators@dutchessny.gov too!

Please also call Governor Cuomo and state legislators to make sure state law allows this here in Dutchess County and across New York: 877-255-9417.

[pass it on]

Joel Tyner, Dutchess County Legislator (Clinton/Rhinebeck), 324 Browns Pond Road, Staatsburg, NY 12580, joeltyner@earthlink.net 845-464-2245 http://www.DutchessDemocracy.blogspot.com Host of "Working Class Dutchess" on Facebook and Saturday mornings on http://www.WHVW.com 950 AM

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https://www.forbes.com/sites/janetwburns/2018/01/02/research-finds-signs-of-recovery-community-at-underground-safe-injection-site/#1ad003c45d23

Underground Safe Injection Site Offers Healing, Community For US Addicts: Study
 
Janet Burns , WOMEN@FORBES Opinions expressed by Forbes Contributors are their own.

JAN 2, 2018 @ 10:00 AM

According to the Deputy Attorney General, drug overdose is now the leading cause of death for Americans under the age of 50. 

According to researchers, models for supervised drug injection facilities that have shown results abroad could also make a big difference at home, where the opioid crisis continues to overwhelm current medical resources. 

A study published last week in the International Journal of Drug Policy revealed that patients at an unsanctioned U.S. safe injection site reported numerous benefits from using the small facility (including unexpected ones), and which American health officials would do well to consider.

Opened in late 2014, the unsanctioned facility offers supervision and clean needles for drug injection, safe disposal for needles, and various forms of outreach and health referrals in an unofficial capacity. The small private space is located in an undisclosed U.S. urban area with a high concentration of drug abuse, and is operated by trained volunteers and a handful of employees from an adjacent social services nonprofit.

After more than two years of observation, veteran addiction researchers Alex Kral and Peter Davidson found that patrons were able to meaningfully reduce the personal and social risks of their drug use, and even take steps toward recovery--all thanks, in effect, to the significant risks the site's organizers are taking.

As the researchers explained in a first-of-its-kind study of the same site earlier this year, U.S. medical experts and support groups have hit a wall in exploring the possibilities of safe injection sites for reducing drug overdose, infectious disease, and other addiction-related conditions among high risk populations.

In the past ten years, such sites have grown in number, size, and success across Europe, Canada, and other countries, offering access to everything from on-site medical care to coordinated recovery options and key social services.

In the U.S., however, safe injection sites have yet to receive federal approval, keeping would-be pilot projects by researchers and health officials from even opening their doors. And in at least one case, Kral and Davidson point out, Americans' procedural and perceptual block on leveraging safe injection facilities have driven on-the-ground experts to go rogue.

By phone, Davidson commented that the nonprofit group who launched the unsanctioned facility spent far more time debating take that career-imperiling plunge than they did setting up the site once the decision was made.

"It took operators about a year of very careful thought to decide to do it," Davidson said. "But it only took about two weeks to go from that decision to actually providing care, and now they've been in continuous operation since September 2014."

Equipping the facility as an off-the-record side project has proved to be cheap, even with the small nonprofit's total budget of under $150,000 a year. Mostly manned by volunteers, the site contains five stainless steel injection stations, a room for clients to rest and observe the effects after drugs are administered, and a small area for staff to perform client outreach and unofficial referrals.

Before they inject, users can anonymously provide information on their experiences with the site and life outside through a tablet-computer survey. Since the site opened, dozens of addicts have provided feedback on the project this way, reflecting on how it's allowed them to use and dispose of needles indoors, the impact it's had on their health, and even the sense of community this 'underground' operation has created.

Davidson explained that while many survey respondents gladly reported feeling less rushed, more socially responsible, and seeing less injury and infection at injection sites--results sanctioned sites have shown in other countries--the study also revealed "some unexpected positive effects" of the site's gray-area legal status.

"The fact that it was unsanctioned and had to be kept under the radar seemed to create an improved sense of community, given that injecting the drug is a crime," Davidson said. "Users were very aware of the risks operators were taking, and were enormously grateful."

Davidson pointed out that while the site saw some benefits from operating under the table, expecting further nonprofits to take that risk is clearly no kind of solution. "It was interesting to see how addicts were able to feel camaraderie with each other and with staff because it was unsanctioned, but a legal facility would still be vastly preferable for a number of reasons, aside from practical points." 

"For one thing, [unsanctioned status] severely limits the number and types of people you can serve. Facility operators are nervous about opening up their services people with severe mental health issues, for example, because they're more likely to disclose information about it," he said. "And that's obviously a population that needs access to this highly supportive space, and operators are frustrated to feel like they can't serve this population."

In general, Davidson said, the concentrated groups of addicts in many American cities are high-priority populations whom operators would love to easily link with other social services. At present, site volunteers can only tell users where to find certain services, rather than connecting them directly, and have often needed to walk users over to a nearby recovery center or drive users to the hospital themselves.

"If you authorize a pilot center in the U.S., you could have those services right in the same building," Davidson said. "Even having a doctor or nurse practitioner on the premises would be great--someone who can treat abscess injuries or prescribe buprenorphine right there."

This latest study continues the work the researchers began with their earlier paper, Davidson said, adding data on qualitative life impacts from a U.S. safe injection operation to the evidence surrounding this issue. In the past, critics of safe injection sites have argued that while such programs may work abroad, they wouldn't work in the U.S., with its unique population and needs.

As Davidson noted, "The [new study] also provides preliminary evidence that this is not the case--that in the U.S., the model seems to be working similarly to the ways it's working in other countries, from public health impacts to social impacts."

The study authors believe urban pilot projects and the funding required could get rolling pretty quickly across the country once federal health officials finally give approval for such programs.

If the National Institute of Health were willing to permit safe injection sites but not fund them, Davidson said, he suspects that a number of foundations would "come out of the woodwork" to make projects happen. "If they were successful, then cities would fund these sites the way they do regular intervention programs," he said. In the mean time, local governments in several cities have chosen to tackle the task themselves.

Of course, safe injection sites will never be a whole or one-size-fits-all solution for Americans' opioid abuse and other drug problems. Davidson noted that many U.S. users are in rural and suburban areas, as is the case in his native Australia, and such users are unlikely to drive or find transport for a fair distance to visit a centralized site serving a large region.

"It'd be great if there was a silver bullet that worked absolutely everywhere, but there will be parts of country where safe injection sites wouldn't make much sense, such as areas where people are mostly housed," he said. "Out in the suburbs, this may or may not work--and we'd either need to find something that does, or invent something new."

"But the U.S. has a lot of large urban areas with concentrated populations of drug users, who tend to be the poorest, with the most mental health issues, and the most prone to overdose," Davidson continued. "They should be a priority, which is not to say we shouldn't be working on treatment methods for housed people, too."

Davidson, who has been studying overdose and how to reduce overdose deaths for close to two decades, said his awareness of the urgency of Americans' heroin and opioid program has changed a lot since he arrived in California in the early '00s.

"Back then, I thought of overdose as a crisis, and it's just gotten worse and worse since then" he said. "Somewhere around 2008, it overtook motor vehicle death as the leading cause of accidental death in the United States, hasn't stopped rising."And the sooner we connect those suffering from drug abuse with services to address their addiction and the issues underlying it, the better, Davidson said.

"Right now, we've kind got a political moment where we can try these things, perhaps, and implement the ones that are shown to be successful," he said. "Part of that is the number of people in crisis, but we're also to the point where almost everyone knows someone who's affected by it."

While he was in Sacramento talking about naloxone availability at California's state capitol last year, Davidson recalled, legislators would approach him and say that that a friend or relative's loved one had overdosed, and ask how they could help. "A few years ago, they would have said, 'You want what?'"

Researchers like Davidson and a wide range of social service experts hope lawmakers will similarly come around on safe injection sites once they've taken an honest look at the data. "The main argument I hear against them is that if you open one of these, it is the government condoning drug injection, and people will think using drugs is okay," Davidson noted. 

"These sites have not increased drug use, nor made drugs more attractive to anyone else, but have had all these positive effects, including keeping users from doing drugs in front of you and your kids on the street," he said. Such ideas are part of a seriously and scientifically flawed way of thinking about drugs, and particularly drug users, that goes back decades, Davidson said.

"We've been saying that drugs are bad since Nixon, and 40 years later, more Americans are dying from drug overdose and abuse than ever in our history."

Regarding his latest findings in this closely followed field of study, Davidson added, "My overall takeaway from this piece of research is that it serves as more evidence that doing a full trial in the U.S. makes sense."

Whether addiction experts will soon find the government support they need to (legally) begin testing safe injection sites on U.S. soil remains to be seen. As the opioid crisis continues to soar, however, state and federal lawmakers will no doubt find themselves put to the test regarding the public benefit, at least--including their ability to serve it.

Janet Burns covers tech, culture, and other fun stuff from Brooklyn, NY. She also hosts the cannabis news podcast The Toke.

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https://www.forbes.com/sites/janetwburns/2017/08/10/opioid-experts-are-going-rogue-to-prove-that-safe-injection-sites-save-lives/#388df89f6b86

Opioid Activists Are Going Rogue To Prove That Safe Injection Sites Save Lives
 
Janet Burns , WOMEN@FORBES Opinions expressed by Forbes Contributors are their own.

AUG 10, 2017 @ 02:51 PM 

One of the most promising tools for combating opioid abuse has been passed over in the U.S. so far, but research surrounding an unsanctioned program suggests that it's time for lawmakers to think again.

An article published this week in the American Journal of Preventive Medicine addresses the massive scope of opioid addiction in the United States, and discusses numerous benefits of giving drug users a supervised place to inject--something other countries have put into practice all over the world. Because U.S. law still prohibits such spaces, some advocates are choosing to take pilot projects 'underground' in order to start serving communities, and to prove the efficacy of safe injection sites, before it's too late for millions more addicts.

In their article, UC San Diego medical sociologist Peter Davidson and RTI International epidemiologist Alex Kral describe the methods and outcomes of one unsanctioned site that's been serving patients in an undisclosed urban area for nearly three years. Operated by an organization that provides other social services, the site offers intravenous drug users identified through its programs a clean, safe place to administer drugs while under supervision of staff trained in overdose prevention, resuscitation using naloxone and rescue breathing, injection technique, and harm reduction principles.

 Opened in September 2014 after a year of preparation, the small, completely supervised facility is simple: it contains five stainless steel injection stations, a room for clients to pause in after drugs are administered, and an area where staff can perform client outreach and recommend other services, such as medical and addiction treatment. It also provides clean needles and sanitary disposal for used ones, aimed to help stop the spread of illness among users and the community, and gathers anonymous information from users by tablet-computer survey before they inject.

Once the program was underway, organizers reached out to Davidson and Kral, who are unaffiliated with the project or larger social organization, for the researchers' assessment. In its first two years of operation, the facility served around 100 clients, with close to 60 having privileges to visit the center at any given time, so as to minimize lines. By its second year of operation, the facility was open to clients five days a week, for between four and six hours a day.

And in those two years, the study authors found, this tiny operation managed to supervise 2,574 injections, safely dispose of an estimated 1,725 syringes, and be on hand to reverse a total of two overdoses--all of which would almost certainly have otherwise occurred in public. 

In a phone interview Monday, Kral explained that more than 90% of drug users who used the site reported that they would otherwise have been injecting in a parking lot, street, public restroom, or park, while 67% said they would have disposed of their equipment unsafely if not for the site. As a result, the site is responsible for having averted an estimated 2,300 instances of public injection and 1,725 cases of public syringe disposal by those 100 users in a two-year period.

Another 9% of site users said they had used unsanitary injection equipment in the past month, putting them at risk for HIV, Hepatitis C, and other blood-borne illness. Because the operation offers free sanitary ancillary equipment, Kral said, the site brings the percentage of users injecting with used equipment "down to zero."

Kral also noted that more than 80% of the mostly white, male, and homeless visitors to the site reported having to "always, often, or sometimes" rush the process of injecting drugs otherwise--in most cases, heroin. This fact highlights a major issue in the opioid epidemic, according to Kral, with which the general public (and even government) likely isn't familiar.

"Imagine that you are somebody who is injecting drugs: you’re homeless, on the street someplace. Obviously, you’re going to try to do that injection as quickly as possible in case police walk by, in which case you might get arrested, or kids and other passers by might see you, which is embarrassing at best," Kral said.

"So what happens is, people really rush their shots. They draw them up as quickly as possible, inject as quickly as possible, and that's important for two reasons: first, you might miss your [injection] site and have to poke around a few times, which can lead to abscesses and infection."

"But it's also really important in this day and age, especially with so much fentanyl around and present in heroin, for people to be able to get a taste of their drugs first before injecting the full amount--people in public health are really pushing for this, but it's not something you can do if you're rushing," Kral said. "If you don't know [your drugs] contain fentanyl, you're highly at risk for taking something too potent, and might overdose. But if you're inside with people monitoring you, and can sit down and take your time away from the chaos outside, you can do it right."

Kral said visitors to the site usually spend between 10 and 20 minutes there, allowing them to inject a small amount of drugs as a test run before the entire dose while under supervision. During the two years for which Kral and Davidson examined data from the site, only two overdoses occurred, or one per 1,287--close to the rate of a busy supervised injection site in Vancouver, BC during "the pre-fentanyl era"--and both of which were reversed on site by staff using naloxone.

Beyond protecting users from overdose and the public from associated risks, such sites also "facilitate constructive discussions about how to mitigate the negative consequences of drug use, and allow for conversations about entering treatment programs," Kral said. "The full benefits of the study site aren't actualized because it's unsanctioned," he added, but anecdotes from the site help illustrate the outreach benefits of safe injection zones.

He recalled hearing from site staff about times they had walked with users over to drug treatment intake centers, or encouraged users to seek medical attention for other apparent health concerns, reducing the need to call 911. In at least one case, Kral said, a staff member personally drove a site user to the hospital after observing a potentially urgent medical problem in order to ensure that person would be okay.

"The program can't officially co-locate those services because it's an unsanctioned project. Staff members can't make referrals directly--it has to be, 'By the way, we met this person, who's interested in this treatment,'" he said. For the same reason, professional doctors and nurses are currently unable to participate in this or similar programs, as such participation would put them at serious risk of losing their licenses.

Given the scope of our nation's opioid crisis, the few thousand safe injections facilitated by the site may not seem like a lot, Kral noted, but the success of the small project may speak to the bigger picture.

"I think there’s a thirst for information on this, but it’s a little bit of a catch 22: a lot of organizations which are interested in opening sites won't do so until this is legal, and it won't be legal until there is research showing that it works," Kral said. "The American Medical Association is in support trying of these sites, as is the Massachusetts Medical Society. Elizabeth Warren has spoken about them, and Nora Volkow, director of the National Institute on Drug Abuse, has asked for local data." 

In the absence of sanctioned pilot projects, this under-the-radar case offers some of the insights needed for regulators to take real steps, according to Kral. "This unsanctioned study shows us a little bit of data on how safe injection sites function and can save lives here in the U.S.," he said.

In light of such unsanctioned programs, which have also popped up in other nations prior to their official acceptance, Kral and Davidson say the U.S. is "in the beginning phases of similar civil disobedience and activism related to supervised injection sites."

"In my mind, these people are heroes," Kral said. "They're personally risking a lot to provide services they care deeply about because of all the deaths in their communities. It's that important to them."

And with any luck, the risks they're taking to help curb opioid addiction will pay off if this locally derived data, and that of similar programs around the world, can make safe injection sites important to legislators, too.

Janet Burns covers tech, culture, and other fun stuff from Brooklyn, NY. She also hosts the cannabis news podcast The Toke.

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http://www.ajpmonline.org/article/S0749-3797(17)30316-1/fulltext

December 2017 Volume 53, Issue 6, Pages 919–922

Addressing the Nation’s Opioid Epidemic: Lessons from an Unsanctioned Supervised Injection Site in the U.S.
Alex H. Kral, PhD, Peter J. Davidson, PhD

Over half a million people have died of overdose in the U.S. since 2000. As of 2014, an estimated 774,434 people inject drugs in the U.S., the majority of whom inject opioids including prescription opioids and heroin. The prevalence of HIV and hepatitis C virus among people who inject drugs in the U.S. is 2% and 43%, respectively. With the U.S. in the midst of an opioid epidemic causing morbidity and mortality at unprecedented levels, policymakers and public health practitioners are in need of innovative solutions.

Illicit drug use has been treated in the U.S. primarily as a criminal activity and only secondarily as a public health concern. When HIV/AIDS emerged in the early 1980s, activists and public health practitioners adopted and advocated for a more pragmatic approach to drug use—harm reduction—which consists of “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.” Prominent examples of harm reduction programs include access to sterile syringes for injection of illicit drugs through syringe access programs and expanding provision of naloxone, a lifesaving opioid overdose-reversal medication, to lay persons, law enforcement, and other first responders. Although these strategies have been shown to reduce viral transmission risk and decrease opioid overdose mortality, respectively, more needs to be done. Supervised injection sites are the next evidence-based harm reduction strategy that should be considered for implementation in the U.S.

Supervised injection sites (also called safer injection facilities or safer consumption services) are legally sanctioned locations that provide a hygienic space for people to inject pre-obtained drugs while observed by trained staff. These sites have the dual aims of increasing the safety of people who inject drugs and reducing the public nuisance of having people injecting drugs in public spaces, including on the street or in public restrooms. These locations provide a non-judgmental environment; protected time and space for injecting; appropriate guidance and equipment (e.g., clean needles, naloxone) to reduce harms; proper disposal of used equipment; and onsite or linkage to medical care, substance use treatment, and social services. Ten countries currently allow legal operation of such sites (Australia, Canada, Denmark, France, Germany, Luxembourg, the Netherlands, Norway, Spain, and Switzerland), with approximately 98 facilities operating in 66 cities worldwide. Implementation of supervised injection sites has been shown to improve individual health, such as overdose mortality rates, drug use and enrollment in drug treatment, HIV and viral hepatitis risk, and access to health and social services. Improvements in community health and safety are also noted in neighborhoods with supervised injection sites, including reductions in public injection and improperly disposed of syringes, drug related crime, violence in the neighborhoods surrounding the site, and in the demand for ambulance services for opioid-related overdoses. Once implemented, these sites have been found to have high community support, which increases over time.  A recent study estimated that placing a supervised injection site in a U.S. city would net cost savings of $3.5 million (U.S.) per year.

The legal status of supervised injection sites in the U.S. is unclear, but laws such as the federal Controlled Substances Act could potentially be used to shut them down. In response to legal obstacles to syringe access programs in the 1980s and 1990s, community activists engaged in civil disobedience and grassroots activism to implement this intervention, which had evidentiary support from other countries, but was initially illegal in many parts of the U.S. The country is currently in the beginning phases of similar civil disobedience and activism related to supervised injection sites.

After a year of planning and preparation, a social service agency located in an undisclosed urban area in the U.S. opened an unsanctioned supervised injection site in September 2014. The agency developed a quantitative survey to evaluate the impact of the site. The service is confidential and the survey is anonymous. The authors were approached by the agency, with whom they are not affiliated, to help evaluate their program. All evaluation activities were approved by the IRB of the University of California, San Diego.

The unsanctioned supervised injection site has one large room dedicated solely to injection and an adjoining room that provides post-injection monitoring/supervision. The injection room has five stainless steel stations with mirrors and stools (Figure 1). It is open 4–6 hours per day, 5 days per week. Use of the space is by invitation only, and the total number of people with active privileges is generally <60 in order to avoid lines. The agency provides other social services that are open to the general public. Once a person comes to the agency a few times, and appears to need supervised injection services, they are invited to use the supervised injection room. There are no formal exclusion criteria. Participants generally spend between 10 and 20 minutes in the injection room. Because the rooms are not adequately ventilated, smoking of drugs is not allowed. A staff person is stationed in the injection room at all times. Ancillary sterile injection equipment is provided by the agency, which also safely disposes of all used equipment. The staff person observing the injections has been trained in overdose prevention, resuscitation using naloxone and rescue breathing, injecting technique, and harm reduction principles. 

Before each time a program participant injects drugs at the site, the staff person asks 12 questions, and the answers are recorded into an encrypted survey software package via a tablet computer. In the first 2 years of operation, there were 2,574 injections by over 100 participants (the exact number of participants is unknown because the survey is anonymous and the validity of the data linked by unique identifiers cannot be verified). Most participants are white, male, and homeless. Heroin is the most commonly injected drug at the site. There have been two overdoses on site, both of which were reversed by staff using naloxone (one overdose per 1,287 injections). This rate is very similar to the overdose rate in the pre-fentanyl era at the main Vancouver supervised injection site, which had a rate of one overdose per 1,310 injections. No incidents of violence have occurred at the site.

This proof-of-concept evaluation has brought up a number of potential benefits for people who use the site and the surrounding community. Supervision of injections by trained staff ensures that overdoses are identified and responded to immediately. It also provides opportunities for real-time education about safer injection practice, potentially reducing the future incidence of soft tissue infection and other injection-related morbidities. Being able to inject in a clean, well-lit space equipped with sterile equipment, where there is no need to rush due to fear of detection, may also reduce injection-related injury and disease. By contrast, more than 80% of people who used the site reported having to always, often, or sometimes rush injections when injecting outside the site. More than 90% of people using the site reported that, if not for the site, they would have been injecting in a public restroom, street, park, or parking lot. As such, this site has averted over 2,300 instances of public injection in the neighborhood during a 2-year period. The proportion (67%) reporting recent unsafe disposal of used equipment is very high. In contrast, all syringes from injections at the supervised injection site were safely disposed, representing an estimated 1,725 (67% of 2,574) episodes of averted public disposal of injection equipment. The site facilitates constructive discussions about how to mitigate negative consequences of their drug use, and allows for conversations related to entering substance use treatment programs.

The full benefits of a supervised injection site are not actualized in this U.S. site because it is unsanctioned. If it were sanctioned, more people could be served, licensed clinicians could provide on-site healthcare services, other agencies could collaborate to provide co-located, wrap-around services, and there would be more options for funding site activities and increasing operating hours. Although supervised injection sites may not substantially reduce the number of people who use opioids and other injection drugs, they do attenuate the serious medical sequelae of this epidemic, including preventable infections and deaths. It is time for local, state, and federal governments to consider removing legal barriers such that a comprehensive pilot of this innovative intervention can be implemented.



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