Pubdate: Tue, 08 Mar 2016
Source: Baltimore Sun (MD)
Copyright: 2016 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author: Fareen Karachiwalla
Note: Fareen Karachiwalla is a family doctor from Canada who recently 
completed her master's in public health at the Johns Hopkins 
University in Baltimore.

SUPERVISED INJECTION SAVES LIVES

Maryland has made many important strides in the fight against opioid 
addiction, but with 887 people dead in 2014 because of overdose or 
poisoning and a shocking increase in crime and violence related to 
drug addiction last year, we need more than a just steps in the right 
direction. We need to take a leap.

That's why supervised injection facilities (SIFs), like those 
proposed in a bill sponsored by Del. Dan Morhaim, must be considered. 
SIFs are places where adult, long-time injection drug users are 
supervised by clinically trained staff while they consume.

While this may sound radical to some, it is actually quite logical.

Persons with substance abuse disorders typically take their drugs 
where there is no help - in back alleys and bathrooms - and are often 
alone or with friends who are also intoxicated. SIFs, on the other 
hand, provide trained medical personnel who can immediately 
administer rescue medications at the first signs of an overdose and 
ensure hygienic injection practices.

SIFs are also nonjudgmental, safe spaces that can help drug users 
obtain needed treatment, be it short term or long term.

The first SIF in North America, Insite, opened in Vancouver, British 
Columbia, in 2003. This program is one of the best-researched of its 
kind and literally has been found to be life-saving. A 2010 modeling 
study published in the International Journal of Drug Policy found 
that each year, Insite prevents three overdose deaths and 35 new 
cases of HIV. Even more convincing, facilities such as Insite have 
been found to help the most marginalized of drug users: young men in 
their 30s. This is important in Maryland, where young men are at high 
risk of being uninsured when they come to our hospitals seeking care.

Beyond helping people with addictions, SIFs act as a harm reduction 
measure, protecting the rest of society from the dangers of substance 
use. SIFs have not been found to increase drug use (even among those 
trying to quit), drug trafficking or crime, as some critics might 
claim. They actually lead to lower rates of public drug injection and 
used needles found in the streets.

SIFs provide opportunities for drug users to build a trusting 
relationship with health care providers, and hence they lead to 
increases in the uptake of addiction counseling, detox and treatment. 
I am a family physician who works primarily with street-involved drug 
users, and so I know the power of a strong, therapeutic relationship. 
Every day, in addition to seeing scheduled patients, our nurses visit 
community drop-in centers to provide clean drug use equipment and 
chat with users - similar to what a nurse would do at a SIF. Here's 
how this worked for one of my most challenging patients, whom I will 
call "Mr. Z."

If it wasn't for the gradual relationship that developed between my 
nurse and Mr. Zwhile she handed him safe equipment, he would have 
never agreed to a first appointment with me. But slowly over time, 
our nursing staff earned the trust of this 35year-old man, who had a 
traumatic brain injury and used alcohol and multiple drugs, and he 
eventually agreed to see the "doctor upstairs." I quickly learned 
that Mr. Z's multiple unsuccessful attempts at detoxing were because 
of his brain injury, which made him unable to control his impulses. 
After my fifth appointment with him, he is now on track to seeing a 
neurologist and is taking medication for his heroin addiction.

His anti-social behavior has decreased, and he has not had any 
brushes with the law since his involvement with us.

Mr. Z is only a success story because he lived to see his fifth 
appointment. Unfortunately, many drug users will die of an overdose 
before they can ever be connected to the right health services. 
Supervised injection facilities are critical because they give the 
Mr. Zs of Maryland - who may be our friends, family members and 
neighbors - a fighting chance to stay alive long enough to engage in 
treatment. This is treatment that staff at an SIF would be ready to 
offer, and it's why this innovative program should be part of our 
approach to the rampant drug abuse that has become all too 
commonplace in Maryland.
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MAP posted-by: Jay Bergstrom