After decades of failed zero-tolerance crackdowns, debates on drug policy are finally coming around to seeing drugs as a public-health issue. But that recognition hasn’t yet changed the fundamental aspects of drug dependence: There’s nowhere in the country where someone can use illegal drugs in a designated safe and humane setting. Instead, users resort to parking lots, abandoned stairwells, and public toilets, alienated by shame and exposed to illness and violence.
As the overdose-death toll swells nationwide—shattering once stable communities as opioid addiction grows more widespread and the drugs more powerful—some cities are trying to end the cycle of criminalization and alienation by moving an underground habit into public light. Through supervised injection facilities (SIFs), injection-drug users can seek a medically supervised safe space where they know they are protected from overdose and shielded from police. They are provided with clean facilities, sterile equipment, and, most importantly, trained health practitioners who can make sure users don’t become another statistic in the opioid crisis’s increasing body count.
In New York City, where overdose rates have soared—there were more than 1,370 overdose deaths in the city in 2016—and about 60 percent of surveyed intravenous-drug users said they had recently injected in “semi-public spaces,” like a public bathroom, public pressure to establish SIFs is rising. Though the stereotypes and stigma around inviting “junkies” into the neighborhood have impeded the process, the sheer scale of the crisis is clearing a way through the political impasse.
Advocates for harm reduction—the ethical framework centered on promoting public health and individual and community rights when it comes to substance use—are awaiting a long-overdue report commissioned by the city government to explore the feasibility of an SIF project. Nearly 100 such sites exist around the world—helping people cope with addiction in roughly 66 countries, primarily in Western Europe and Canada. Empirical research continually shows that SIFs have not resulted in increased drug use or drug-related crime in the surrounding community, but have led to “increased preventive healthcare and drug treatment utilization.” So the US lags behind, without a single official SIF. Despite making strides in other harm-reduction interventions such as needle exchanges, distribution of the OD-relief medication naloxone, and methadone clinics, the US has yet to establish a legal and infrastructural framework for safe consumption spaces.