Tuesday, January 2, 2018

Opioids and harm reduction: drug checking and Safe Injection Facilities

From Mason Marks writing on the Bill of Health blog at Harvard Law School:

The Opioid Crisis Requires Evidence-Based Solutions, Part III: How the President’s Commission on Combating Drug Addiction Dismissed Harm Reduction Strategies

" it is noteworthy that the Commission ignored harm reduction strategies such as drug checking, which could reduce deaths due to consumption of contaminated opioids. Many countries including Austria, Belgium, Switzerland, Portugal, Spain, Switzerland, and the Netherlands offer free and confidential drug checking (also known as pill testing) to drug users. Drug checking could reduce consumption of adulterated drugs and provides opportunities to support and counsel users who may otherwise receive no contact with medical or public health professionals. Drug checking is also a valuable source of information about drug use such as pricing, availability, effects, and composition of street drugs. This information can be used to further our understanding of drug use and its effects.
Some experts argue that drug dealers will be less likely to add dangerous adulterants to their products if they know that consumers have a mechanism to test their contents. The identification of drug contents can alert authorities to the presence of synthetic opioids, which can lead to public warnings and announcements that may further drive dealers to withdraw deadly additives from the market. The practice can also improve law enforcement efforts to reduce the illegal importation and sale of synthetic opioids. Dr. Carl Hart, Chair of the Department of Psychology at Columbia University, supports the use of free and anonymous drug checking in the United States. In a Scientific American article, heargues that the opioid crisis is a distinctly American problem. According to Hart, “Throughout Europe and other regions where opioids are readily available, people are not dying at comparable rates as those in the U.S., largely because addiction is not treated as a crime but as a public health problem.” Drug checking is one example of how European countries approach drug abuse from a public health angle rather than a punitive law enforcement perspective.
Critics of drug checking argue that it could normalize drug use or “send the wrong message” to potential users. For instance, the practice could create the appearance of safety when in fact the drugs being consumed are dangerous. ...
"Supervised injection facilities (SIFs), arguably a more controversial option than drug checking, were also ignored by the President’s Opioid Commission. SIFs provide a place for people to inject drugs under professional supervision to minimize the risk of HIV and hepatitis C infection, drug overdose, and death. They are primarily used in Switzerland, Canada, and Australia. However, the City of Denver is taking steps to become the first U.S. city to offer SIFs. In November, a plan for a pilot program won unanimous approval from a bipartisan ten-member legislative committee. However, the City’s General Assembly must approve the plan in January 2018 for it to move forward. Seattle and San Francisco are considering similar proposals. The State of Vermont is also considering using SIFs. On November 29, 2017, a commission of health and law enforcement professionals, led by State’s Attorney General Sarah George, recommended that Vermont make SIFs a part of its opioid strategy. However, the Vermont Commissioner of Public Safety and the Vermont Association of Police Chiefs disagree. The Commissioner stated, “Facilitating the ongoing use of heroin through SIFs sends the wrong message, at the wrong time, to the wrong people.”
"A 2014 review published in the journal Drug and Alcohol Dependence, examined the outcome of 75 studies and concluded that SIFs are an effective harm-reduction strategy not associated with increased drug use or crime. In early 2017, the Massachusetts Medical Society published its analysis of SIFs. It found that peer-reviewed research published in leading academic journals, such as JAMA and the New England Journal of Medicine, supports the conclusion that SIFs produce positive outcomes such as reduced mortality and increased access to drug treatment.
"Admittedly, there could be an “ick factor” associated with SIFs, and overly zealous drug control advocates could find them repugnant. However, when thousands of lives are at stake, emotional reactions to SIFs must be weighed against the scientific evidence. If the evidence suggests that SIFs are effective, then lawmakers must be courageous and allow their decisions to be guided by science rather than emotions such as disgust."

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