Tuesday, December 19, 2017

Supervised injection facilities for opioids

From Statnews:
As a doctor, I was opposed to supervised injection facilities. Now I’m ready to give them a try  By Henry L. Dorkin (the president of the Massachusetts Medical Society).

"Over the last few years, I have watched with a blend of amazement and grave concern as an odd phenomenon has unfolded against the backdrop of our nation’s opioid crisis: Despite the clear need to battle this ongoing epidemic with all of the tools at our disposal, one evidence-proven option — supervised injection facilities — is being overlooked, and even disparaged.
"A supervised injection facility is a safe, clean space where individuals can inject drugs they already possess under the supervision of trained medical staff. The facilities also offer sterile injection equipment. The advantage is that medical expertise is immediately present in case an emergency occurs. At the same time, these on-site clinicians can facilitate pathways to treatment and rehabilitation from the chronic disease of opioid abuse disorder.
"As a physician and president of the Massachusetts Medical Society, I was initially inclined to oppose the concept of supervised injection facilities. How, I thought, could a health care professional, someone grounded in ethics and an oath to “do no harm,” stand by and watch as individuals inject street drugs into their veins?
"The concept of supervised injection facilities fits well with the overarching and proven public health philosophy of harm reduction: meeting patients where they are in their disease to eliminate existing barriers to rehabilitation.
With lives being lost each day from all segments of our society, dealing in theoretical solutions can be counterproductive. Fortunately, supervised injection facilities operating in other parts of the world have yielded substantial and evidence-backed reductions of death, disease, and expenditures.
"To better understand the utility of these facilities, the Massachusetts Medical Society created a task force to examine the evidence for and against supervised injection facilities. This group produced a report that reviewed all available data regarding the use of supervised injection facilities around the world.
"The report clearly showed that these facilities save lives. For example, after the Insite facility opened in Vancouver, British Columbia — the first supervised injection facility in North America — researchers reported a 35 percent decrease in the number of lethal overdoses in that area.
"Shortly after our medical society overwhelmingly voted to adopt a policy in support of a pilot supervised injection facility program in Massachusetts, the American Medical Association adopted a similar policy.
"As we continue to look for ways to increase access to recovery programs for those with opioid use disorder, we must remember that in order to get people into recovery, they must first stay alive."

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