Despite California’s progress in preventing opioid overdose deaths, over 2,400 Californians still die each year due to opioid overdoses, a number that is expected to increase due to COVID-19. This Substance Abuse Prevention Month, as lawmakers and state advocates consider policies to reduce drug overdoses, they should consider supervised consumption services.
Supervised consumption services (also called safe injection sites, drug consumption rooms, or overdose prevention programs) are programs which allow people to consume pre-obtained drugs in certain locations under the supervision of trained staff. Staff in these facilities, including medical professionals, provide sterile injection supplies, answer questions, and are available to provide emergency medical aid, such as administering the overdose-reversal medication naloxone, when necessary.
Supervised consumption services have been shown to reduce overdoses and the overall burden of substance use disorders, connect people who use drugs with rehabilitation services, and improve outcomes for the community at large. If California is serious about reducing substance use-related deaths, it should enact laws to allow for supervised consumption sites and lead the way for the establishment of more of these life-saving interventions across the country.
Supervised consumption services have a proven track record of helping people who use drugs.
Over 120 supervised consumption programs exist in ten countries around the world, providing ample research on their effectiveness. First and foremost, such programs have been shown to work: supervised consumption services are successful at both reducing overdose deaths and connecting people who use drugs with care and treatment.
In Canada, people who used a safe injection facility were more likely to enter treatment and more likely to stop using drugs afterwards. Similarly, in Sydney, Australia, researchers found that paramedic and emergency room use was reduced when supervised injection facilities were established, and that the strongest reduction occurred during the hours the sites were open. In addition, research shows supervised consumption sites promote safer injection practices and reduce sharing of injection equipment which could otherwise be contaminated, thus reducing the incidence of HIV and hepatitis infection.
In addition to the research from international programs, a recent study of an unsanctioned safe consumption site in the United States found similar results. Over a period of two years, the site saw only two overdoses, both of which were reversed by naloxone administered by staff. In addition, the site facilitated the reduction of injection-related injury and disease, with 80 percent of users reporting they typically had to rush injections and 90 percent stating that, if not for the site, they would have been injecting in public.
Supervised consumption services are good for the community.
In addition to the benefits to people who use drugs, supervised consumption sites have a record of reducing community disorder and drug-related crime. Studies show that safe consumption spaces do not increase drug-related crime in surrounding areas. Supervised injection facilities are associated with reduced rates of public drug use and publically-discarded syringes, in part because such programs are effective at reaching the most marginalized individuals who would otherwise inject in public spaces.
Supervised consumption services also reduce costs associated with the opioid epidemic. The U.S. Centers for Disease Control and Prevention (“CDC”) estimates that opioid use disorders cost the U.S. $78.5 billion per year between the costs of health care, lost productivity, treatment, and involvement in the criminal justice system. In contrast, according to one recent study, it is estimated that opening a supervised injection site in a U.S. city would save $3.5 million per year.
Supervised consumption services will contribute to health equity and racial justice.
California finds itself at a unique and critical moment in which people across the country are calling on their elected officials to enact policies that promote racial justice and to reconsider the use of traditional law enforcement tactics to respond to health issues; simultaneously, the COVID-19 pandemic is increasing rates of behavioral health problems, including substance use disorders. Safe consumption programs provide California with an evidence-based option to heed these calls and invest in services that better serve the needs of people who use drugs and their communities.
While people of all ages, sexes, races, and classes use drugs and experience problems with substance and opioid use disorders, the most severe harms fall on low-income and underserved individuals, including Black, Indigenous, and People of Color (“BIPOC”), the same communities which are disproportionately affected by the COVID-19 pandemic. In recent years, Black people have experienced the greatest increase in opioid-involved and synthetic opioid-related overdose deaths, specifically Black individuals between the ages of 45 and 64 living in large metropolitan areas. Further, individuals experiencing housing instability are often at highest risk of both overdose and development of abscesses, infections, and other harms that result from rushed or unhygienic injection. Supervised consumption services provide an opportunity to serve these communities in particular, thus contributing to both racial justice and health equity.
What can California do?
In recent years, the California legislature has twice considered a bill which would allow for pilot programs for supervised consumption services. In 2018, the legislature passed Assembly Bill 186, which would have authorized the City and County of San Francisco to establish overdose prevention programs, including supervised consumption facilities, but it was vetoed by then-Governor Jerry Brown. This past legislative session, a similar bill, AB 362, was introduced to allow for facilities in both San Francisco and Oakland. Despite passing in the Assembly, the bill was ultimately shelved.
If California wants to take serious and effective action to prevent substance use overdoses and deaths — particularly in light of increased rates of both due to the pandemic — it should enact this legislation and also enable any city or town across the State to establish a supervised consumption facility. As examples from around the world make clear, supervised consumption services have a proven record of reducing overdoses and deaths, and their implementation in the United States is essential to fighting the opioid epidemic ravaging our state and country.