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Sanders and Warren Back Legalization of Injection Sites for Drug Users

There are no safe consumption sites in the U.S. The Trump administration wants to keep it that way.

Sen. Elizabeth Warren speaks on health care during an event on Capitol Hill, in Washington, D.C., on September 13, 2017.

Ryan Hampton has a message for politicians and the rest of us: He would have entered recovery much earlier if there were a safe consumption site in Los Angeles, where he struggled with heroin addiction for years.

Safe consumption sites, also known as overdose prevention sites, safe injection sites and supervised consumption services, are clinical but community-oriented spaces where people are provided clean supplies to use drugs, typically by injection, under the supervision of medical staff who are trained to provide first aid and reverse a potential overdose. Safe consumption sites also connect drug users to health care that offers a path toward addiction recovery if they wish. Hampton says that if he’d had access to clean syringes, first-aid supplies and medical help, he could have avoided long-lasting health problems. Some of his close friends would still be alive.

Research shows such facilities are highly effective at preventing overdose deaths and the spread of disease, while reducing drug use and increasing entry into addiction treatment. Proponents of safe consumption sites see them as a real public health solution to the nation’s opioid overdose crisis, but the Trump administration is actively working to stop the sites from taking root in major cities across the country.

Last week, Democrats Bernie Sanders and Elizabeth Warren became the only leading presidential candidates to support the legalization of safe consumption sites. (New York City mayor Bill de Blasio has pushed for supervised consumption in his city, but he has said little about the issue as a presidential candidate.) Sanders and Warren’s announcements were buried in the candidates’ dueling plans to confront the nation’s opioid woes and overhaul the criminal legal system and made only a blip on the media radar. However, if more politicians follow Warren and Sanders’s lead, they could empower activists on the front lines of the overdose epidemic and leaders of major cities who have already collided with the Trump administration over plans to establish safe consumption sites.

There are about 120 safe consumption sites in 12 countries around the world, but none are currently operating in the United States, at least not legally and aboveground. The Trump administration is working to keep it that way. Warren and Sanders’s announcements came just days after the Trump administration was in court attempting to block a proposed site in Philadelphia that has won broad support among health officials and the public. The brewing political battle is solid evidence that the opioid crisis has thrust the field of harm reduction into the mainstream. With origins in the activist underground, harm reduction is a broad field of practices aimed at reducing the harms of drug use, ranging from encouraging people to drink water while consuming alcohol to providing clean needles and first aid supplies to use while injecting heroin. Instead of forcing people into jail or rehab, harm reduction meets people where they are at to make drug use safer.

In a press call with reporters last week, senior administration officials told Truthout safe consumption sites violate federal drug laws, and claimed the sites are not effective at ushering drug users into addiction treatment — a goal Congress has put billions of dollars toward, alongside funding for law enforcement.

Just don’t tell that to Hampton.

“This is total fake news, and it shows how little the White House really understands the solutions that we should be driving to end the addiction crisis,” Hampton told Truthout in an interview.

Hampton is the author of American Fix: Inside the Opioid Addiction Crisis – and How to End It and founder of the Voices Project, a nonprofit that amplifies the voices of drug users and people living in recovery and with addiction. He said politicians can argue over what the research says about supervised drug consumption, but his own lived experience reveals a deep need for such supportive services. Without a steady supply of clean syringes, Hampton contracted hepatitis C and encountered other serious health problems. He wanted to recover from addiction, but found himself stuck in a “spin dry cycle” of ineffective treatment. What if he had connected with clinicians at an overdose prevention site – his preferred term – where drug users are not stigmatized and health care is a public resource rather than a source of profit?

“I would have found my way into recovery much sooner, because I would have established trust with a clinician, a qualified health care provider, instead of some shady treatment center that was just trying rip off my insurance company, or my mother,” Hampton said.

Safety and a Pathway to Recovery

Since entering recovery, Hampton has traveled the United States and the world talking with harm reductionists, people living with addiction and in recovery, and their friends and family members. For those on the frontlines of the opioid crisis, the benefits of supervised consumption are obvious. Opioid addiction is very difficult to treat, even with access to excellent health care. People cannot be expected to quit overnight, and relapse is common.

A dead drug user has no chance at recovery. Using drugs under medical supervision is infinitely safer than using them on the street or in a locked bathroom. At a safe consumption site, staff are on hand to reverse an overdose if necessary, identify medical problems and assist people with accessing drug treatment, regardless of what point they are at in regards to addiction and recovery. Hampton said he has met Trump supporters who also support safe consumption sites, because their family members have struggled with addiction and related health problems.

However, the White House has dispatched officials to make the case against safe consumption sites in the press, accusing state lawmakers and leaders in New York City, San Francisco, Seattle and beyond of enabling addiction by planning to open local sites. This echoes decades of arguments against harm reduction based on the idea that abstinence and prohibition are the only solution to drug problems.

Speaking to reporters on background, senior administration officials said they do not want people moving from facility to facility using illegal drugs; they want them in treatment. They claimed that safe consumption sites in other countries have low rates of referral to treatment programs. It’s unclear what research grounds this claim. In a 2018 New York Times op-ed, then-Deputy Attorney General Rod Rosenstein pointed to an off-hand statistic gathered by one reporter at a recently opened safe injection site in Canada, where staff estimated that about 10 percent of participants had entered treatment. Statistics gathered from other sites across the world show much higher rates of participants entering treatment and reducing harmful consumption.

M-J Milloy, a research scientist at the British Columbia Centre on Substance Use, studied a safe consumption site in Vancouver, Canada, for years and has reviewed data from similar programs across the globe. Studies on safe consumption site participants in Vancouver found that those who used the service frequently were more likely to start the process of detoxing off drugs with help from programs offered on-site. Participants were also more likely to stop injecting drugs and start medication-assisted therapy for addiction.

“When we compared people who are using at safe injection sites to those who are not, we found that using at a safe injection site was strongly associated with going into detox and initiating maintenance therapy,” Milloy said in an interview.

The argument coming from the White House also flies in the face of Hampton’s lived experience.

“They are dead wrong on this, and this seems more of the propaganda … coming out of the days of ‘just say no’ than a true public health response,” Hampton said.

Senior administration officials touted the expansion of court-ordered diversion programs that steer people arrested on drug possession into treatment rather than jail or prison, but activists and journalists have spent years pointing out the myriad problems with this type of system. Run-ins with law enforcement interrupt treatment people are already receiving and further stigmatize drug use, driving people living with addiction away from public resources. Plus, activists like Hampton argue that drug users should enter treatment because they want to, not because they were arrested and ordered by a judge. The administration’s logic, Hampton said, appears to be stuck in the framework of the failed war on drugs, which attempted to tackle drug problems by criminalizing people and pushing abstinence-only public health campaigns. It hasn’t worked for decades.

Joe Biden’s “Crack House” Law

In Philadelphia, where activists and public health officials are poised to open a site called SafeHouse in a neighborhood notorious for overdose deaths, the Justice Department has invoked a specific section of federal law to block the project. The so-called “crack house statute” makes it illegal to manage a building where people use prohibited drugs. The statute was championed during a spate of public alarmism over crack cocaine in the mid-1980s by then-Sen. Joe Biden. Biden’s presidential campaign has been marred by his record of tough-on-crime and pro-drug war legislation that contributed to mass incarceration and the criminalization of communities of color. He has apologized for his earlier record and introduced a plan to reduce incarceration and increase access to mental health and addiction treatment. He now says that no one should be incarcerated for drug possession alone. However, his campaign did not respond to an inquiry from Truthout about support for safe consumption sites.

Legalizing safe consumption sites may require legislation repealing Biden’s “crack house statute,” or separate legislation that explicitly legalizes and regulates such space altogether. However, if a president were elected who supported safe consumption sites, they could simply order the Justice Department to leave the sites alone — and abandon the lawsuit against SafeHouse filed by the Trump administration. This de facto legalization would allow state lawmakers and local officials to move forward with the project across the country. Andrew Yang, the social entrepreneur and Democratic presidential hopeful, supports decriminalizing possession of small amounts of opioids, a proposal that could make it easier to open safe consumption sites. However, Yang’s platform does not specifically mention safe consumption sites. Hampton said Yang’s drug policies are half-baked and lack insight from people on the ground. Yang’s campaign did not respond to a request for comment.

“I think all of the candidates — and I have pushed some of them — need to talk to folks with lived experience,” Hampton said.

Truthout reached out to a number of Democrats running for president about safe consumption spaces, including Sen. Cory Booker, Sen. Kamala Harris, Pete Buttigieg and Beto O’Rourke, but they did not respond to requests for comment. The Democrats running for president have generally criticized mass incarceration and called for increased access to mental health services and addiction treatment, but safe consumption sites may still appear to be too controversial for much of the national stage.

Yet that’s not the case for Sanders, Warren, de Blasio and Democratic leaders in major cities across the country. Hampton said other Democrats shouldn’t wait to take a side, especially as the Trump administration moves to block a critical response to the opioid overdose crisis.

Back in the late 1980s and 1990s, syringe exchange programs (which are part of safe consumption sites) were highly controversial, because they were viewed as enabling drug use. In fact, syringe exchanges enabled drug users to access clean needles, dramatically reducing HIV and hepatitis C infection rates across the globe. They are now considered a gold standard in the world of public health.

“The Democrats should be leading the way on this issue. It’s only a matter of time,” Hampton said. “If Donald Trump doesn’t want to be on the right side of history of this issue, then Democrats can have an opportunity to fill that gap and be on the right side of history.”

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