Ithaca Considers A New Approach To Getting Users Off Heroin: First Give Them A Safe Place To Use
Ithaca, New York, population 30,000, is a small city with a big plan to counter heroin addiction, announced by mayor Svante Myrick Wednesday. The strategy includes a 24-hour crisis center, a new office of drug policy, and something that’s never been tried before in the United States: a medically supervised site where drug users could inject heroin.
It sounds counterintuitive: fight a heroin epidemic by providing a safe place to inject heroin. But it’s had success: after a supervised injection site opened in Vancouver, in 2003, overdose deaths in the neighborhood declined by 35 percent in its first two years, and staff have connected thousands of users to treatment and social services.
If a site opens in Ithaca, it would be modeled after the program in Vancouver. It’s a big “if” though: Congress would have to change federal law to make it legal or the state of New York would have to declare a public health emergency. Side Effects reporter Michelle Faust spoke with Daniel Raymond, policy director at the Harm Reduction Coalition, an advocacy group working to reduce negative consequences of drug use. He shares his point of view on the value of such programs and why they’re worth considering in the United States.
Michelle Faust: In my reading of what has happened in the facility in Vancouver, it's not without problems, but the idea behind it is for staff to build a rapport with the person before anything else.
Daniel Raymond: Yeah, exactly. It's not just a safe environment to inject drugs. It’s a safe environment to say ‘These are the problems that I'm having, these are the things that I'm struggling with. Is it okay to ask you for help? Can we sit down and talk?’
MF: So, when you're saying “these problems” you mean the comorbidities that people might have along with drug abuse: depression, a history of certain types of trauma.
DR: It's all of that. It’s drug use. It’s childhood trauma. It’s mental health issues. But it's also family issues. It's the despair somebody feels when they've lost a job, when they spent time homeless, when they've been in jail. That counseling, that human touch is really important in getting people on a different path.
MF: What would you say to the people who hear about this and see this as promotion of bad behavior?
DR: We've spent decades trying to stop people from using drugs. And if there's one thing that we've learned from that is that we don't have enough deterrent to keep people healthy and alive, and we've got a look at this in a different way. That what's might feel to you like bad or inappropriate behavior is often somebody struggling with a chronic disease, struggling with addiction, struggling and trying to find a way to get help, but they're not there yet.
MF: If I were to walk into a supervised injection facility, what would I see?
DR: Depending on how it's set up, you’ll go in and you'll talk to somebody who's going to help you at the door of the facility to understand what you need. The facility doesn't provide drugs. There's no drug selling on the promises, but you have a table or a booth where you can go and sit down and there’ll be a nurse there overseeing what's happening. If you're injecting and you run into a problem--you do too much and you start to overdose--there's a healthcare professional able to respond right away. But more importantly, there's also all lot of counselling, a lot of other staff there to provide that support and say, ‘listen, we're here for you.’
MF: Now this plan in Ithaca is not only supervised injection. What are some of the other services they plan to offer that you support?
DR: We're really interested in the proposal to shift the focus of how law enforcement approaches people who are using drugs. And make law enforcement the tool for good to get people linked to healthcare and social services, instead of just arresting them. It’s part of a broader trend that we're seeing across the country, where police chiefs are standing up and saying, ‘we can't arrest our way out of this epidemic. We need to treat this as a health issue.’
MF: If I were on the street watching an interaction between a law enforcement officer and a person addicted to heroin, what would that look like?
DR: What you’d see is that law enforcement officer talking to the person and instead of it being an antagonistic relationship: ‘I’m going to search you, I’m going to see if you have drugs on you, I'm going to arrest you.’ Saying, ‘listen, I know that you're out here and no matter how you got here there's resources for you. If you come with me, I can get you connected to a case manager, I can connect you to a social worker, and we can start to explore how we can get you some help.’
MF: There are some people would see that and think that we're not being tough enough on drugs.
DR: If being tough on drugs worked then we wouldn't see skyrocketing overdose rates. It's not just about being tough on drugs. We've been too tough on people who use drugs and we’ve pushed them to the margins of society. That's where people start to get into riskier patterns of drug use. That's where people start to give up on themselves, and that's where people start to die from an overdose.
This story was produced by Side Effects, a public media reporting collaborative focused on public health.