Source: In The Debate Over Safe Injection Sites, What Does The Science Say? : Shots – Health News : NPR

What’s The Evidence That Supervised Drug Injection Sites Save Lives?

Elana Gordon for WHYY

Supervised injection sites, like Insite in Vancouver, Canada, provide drug users with clean needles and other supplies to help prevent the spread of disease.

As drug-related deaths rise to record numbers, at least a dozen U.S. cities are considering opening supervised injection sites, where people can use illicit drugs with trained staff present, ready to respond in case of an overdose.

The future of such proposals in the U.S. is uncertain. A California bill that would greenlight a pilot injection site in San Francisco awaits the governor’s signature, but a representative of the Justice Department vowed to crack down on any such site in recent public statements.

Critics say supervised injection sites encourage drug use and bring crime to surrounding communities. Proponents argue that they save lives and can help people in addiction reconnect with society and get health services.

Out with the dark alley, fear and shame, they say, in with a safe space, clean injection supplies, care and compassion. It’s an approach that falls under the umbrella of harm reduction, a public health philosophy that emphasizes lessening the harms of drug use.

But what does evidence say? If the policy goal is to save lives and eventually curb opioid addiction, do these sites work?

It’s a tricky question to answer, although many of these sites have been studied for years.

At least 100 supervised injection sites operate around the world, mainly in Europe, Canada and Australia. Typically, drug users come in with their own drugs and are given clean needles and a clean, safe space to consume them. Staff are on hand with breathing masks and naloxone, the overdose antidote, and to provide safer injection advice and information about drug treatment and other health services.

But most have grown out of community and grassroots efforts, according to Peter Davidson, a researcher specializing in harm reduction at the University of California San Diego who is researching an underground supervised injection site in the United States. They lack big budgets for comprehensive services or for conducting high level evaluations, he says.

Still, he says the research – both “the grey” and the robust – point to the benefits, especially in preventing deaths among society’s most vulnerable. No death has been reported in an injection site. A 2014 review of 75 studies concluded such places promote safer injection conditions, reduce overdoses and increase access to health services. Supervised injection sites were associated with less outdoor drug use, and they did not appear to have any negative impacts on crime or drug use.

At safe injection sites like Insite, in Vancouver, Canada, drug users can inject drugs under the watch of trained medical staff who will help in case of overdose

“If there had been unintended consequences, I suspect that would have been picked up by now,” says Davidson. “It’s reassuring.”

Research debates

However, in another review of studies published in August in the International Journal of Drug Policy, the researchers, criminologists from the University of South Wales in the United Kingdom, found that the evidence for supervised injection is not as strong as previously thought. Only eight studies met the researchers’ standards for high quality design. And of those, the findings on the effectiveness of supervised injection were uncertain, with no effect on overdose mortality or needle sharing.

“Nobody should be looking at this literature making confident conclusions in either direction,” says Keith Humphreys, an addiction researcher and psychiatry professor at Stanford University who wasn’t involved in the study.

Humphreys says he’d welcome better tools to address the drug crisis. He doesn’t think the latest analysis points to supervised injection as being harmful, though. The real problem is, the analysis found there just are not a lot of good studies, period, on supervised injection.

“They can’t rule out no effect, they can’t rule [in] an effect,” he said. “So I think we should be pretty cautious.”

M-J Milloy, an epidemiologist with the British Columbia Centre on Substance Use and an associate editor of the International Drug Policy Journal which published the UK analysis, doesn’t think this review reflects the evidence.

“Their decision to exclude all but eight studies is in my view one of the methodological flaws,” he says, adding that the analysis looked at measures beyond the scope of some of what individual studies set out to assess.

[To read the full story by Elana Gordon, including the potential of opening such a facility in Philadelphia, go to: https://www.npr.org/sections/health-shots/2018/09/07/645609248/whats-the-evidence-that-supervised-drug-injection-sites-save-lives]

 

This story is part of a reporting partnership with NPR, WHYY’s health show The Pulse and Kaiser Health News.

Elana Gordon is 2018-19 Knight Science Journalism Fellow at MIT. You can follow her on twitter at @elana_gordon.