Statement on Proposed Drug Injection Sites
Oct 28 2021
We are writing as cofounders and members of the California Peace Coalition, a formal coalition of parents of homeless children addicted to illicit drugs, parents of children killed by fentanyl, recovering addicts, homeless service providers, and community leaders.
America urgently needs a serious and comprehensive strategy to halt and reverse the rise in illicit drug deaths, from 17,000 in 2000 to 99,000 in the twelve months preceding March 2021, and yet the Biden administration has still not offered one. Instead, it has announced piecemeal measures that alone and together are grossly insufficient. We call on President Joe Biden to address the nation directly and immediately on what his administration’s plan is to address the crisis.
Allowing cities to create “safe injection sites” for heroin, meth, and fentanyl drug users is an incomplete fix. These sites have only been shown to work in countries which also employ a suite of police and health care interventions for their chronic drug use population. The evidence that drug injection sites could reduce deaths in the present U.S. context is largely confined to one observational study, at one unsanctioned site in an undisclosed U.S. city, and the authors warn that their findings cannot be generalized. If implemented in a vacuum, without a role for expanded law enforcement and psychiatric care, the proposal advocated by Harm Reduction Coalition and Drug Policy Alliance will leave the thousands of users it intends to serve without lasting treatment for chronic addiction, and at the risk of eventual overdose and death.
It is notable that Amsterdam, a city that has done one of the best jobs in the world in reducing drug deaths, drug dealing, and homelessness in a humane and efficient way, provides heroin and safe injection sites for fewer than 130 people. And yet U.S.-based advocacy organizations as well as activist journalists routinely overplay the role of these sites in the drug policies of Netherlands, Portugal, and other European nations while omitting coverage of more broadly applicable and well-established strategies such as contingency management, where addicts are offered concrete rewards for abstinence like housing or cash, and the coordination of law enforcement and social services.
In truth, the small number of people allowed to use heroin in the Netherlands are people for whom all conventional approaches, including medically assisted therapy such as with Methadone or Suboxone, have failed. In other words, heroin maintenance and drug injection sites are offered as a last resort as part of a comprehensive national plan, which includes universal psychiatry, law enforcement, and drug treatment on demand. They are not the first steps in dealing with the crisis, which is what some advocacy organizations are seeking in the United States.
Ten months into the Biden administration, it is high time that President Biden present a comprehensive plan to help cities and states shut down dangerous drug dealing, whether on street corners or on mobile apps like Snapchat; enforce laws and offer mandatory drug treatment as an alternative to prison to addicts; and shut down the open drug scenes following the same strategy used by Amsterdam, Frankfurt, Lisbon, Vienna, and Zurich, which combined social services and law enforcement.
We stress that we are in favor of evidence-based harm reduction, including the distribution of clean needles to injection drug users. But, needle exchange is no substitute for ending drug dealing and providing drug treatment on demand, as well as mandatory treatment as an alternative to prison. When pursued to the exclusion of other drug policies, harm reduction alone cannot solve the drug deaths crisis.
We further urge the Biden administration to seek involvement of a broader group of experts and advocates than the handful of voices monomaniacally pursuing drug injection sites. Their advocacy is biased and distorted, involving manipulative and euphemistic language. We do not know that drug injection sites would be “safe,” and yet that word has been built into the proposal, and repeated uncritically by HHS officials and reporters. What we do know is that the proposal has little to do with what has worked in Europe.
The role of the public policy-making process is central to the lives of every person in the U.S. The main purpose of the government is to have lawmakers set policy and then have government workers carry out those policies. Unfortunately, the current drug policy set forth today ensures that our most vulnerable population will not only continue to live in despair, but also die on our streets. If we seek to rehabilitate those on our streets, our policy must reflect that.
As parents of homeless children addicted to illicit drugs, parents of children killed by fentanyl, recovering addicts, homeless service providers, and community leaders, we are dedicated to seeking effective, practical, and urgent action to stop and reverse the drug death crisis. We have presented our ideas about what we need, based on what has worked in Europe, and in cities around the U.S. We look forward to an evidence-based engagement with HHS and the Biden administration more broadly over how to achieve a radical drop in drug deaths.