addiction

The Case for Ithaca’s Proposed ‘Safe’ Space for Heroin Users

Ithaca, New York, might be about to try something really, really interesting — something that flies in the face of the normal American approach to drug treatment.

ABC News reported Wednesday:

The town of Ithaca, New York, is contemplating the creation of “safe” spaces for drug users, highlighting how some authorities are working to battle drug use by viewing it as a public health threat rather than simply an illegal act.

Mayor Svante Myrick announced on Tuesday he would consider a “supervised injection facility” where patients can safely inject drugs under clinical supervision as part of his multi-point plan focused on addressing drug use in Ithaca. Myrick is expected to unveil more details of the plan at a news conference today.

The plan “is rooted in public health and harm reduction principles” and “aims to prevent drug use and sales, reduce overdose deaths and infectious disease, decrease rates of incarceration, expand access to treatment, and save taxpayers money,” Myrick said in a statement on Tuesday.

Myrick noted that this plan was inspired by “European policies,” and that’s exactly where one would expect to find them. As a rule, Americans haven’t looked kindly on policies like needle exchanges, let alone even more radical-sounding ones like this. The frequent reaction is that they “encourage” drug use. Things might be changing a bit given the broader softening of public opinion on drugs, but it’s hard not to imagine there won’t be some pushback from Ithacans upset with the idea of a facility like this within their city limits (the ABC article takes a pretty zoomed-out approach and doesn’t quote any critics).

A couple years ago, I got to go on a group tour of this sort of facility in Hamburg, Germany, called Drob Inn (warning: lots of German) and speak with some of the public-health workers there. Two takeaways stuck with me, one small and one big. The small one was simply that, in the eyes of supporters of and employees at those clinics, it doesn’t make sense to conceive of these clinics as “encouraging” heroin use. They are for people with addictions — no one is saying, “I am going to start using heroin because there is a place for me to do it.”

Which leads to the bigger takeaway: From a public-health perspective, it is incredibly important to keep heroin users (and other intravenous-drug users) in contact with the public-health system. In fact, Drob Inn employees saw that as a big part of their mission. When clients showed up, employees never hectored them to stop using drugs or nudged them toward addiction treatment, or anything like that. Instead, they made sure they were doing okay, provided them treatment for any health issues they were dealing with, and so on. One of the primary goals was to give patients access to health care, and staffers were wary about driving them off by lecturing them about their drug use.

Once you accept that a given heroin addict is, at least in the short term, going to be using heroin regularly, and the important question becomes whether they are going to shoot up in an alley or in a park or in a safe medical facility, it clarifies things a bit. Even setting aside the fact that heroin users, like all human beings, deserve to not deal with agonizing illness and injury — people are really good at dehumanizing intravenous-drug users, after all — it isn’t just about the heroin users. It’s about everyone else, too. The effects of heroin use that isn’t “safe,” and the associated injuries and illnesses that result, can ripple outward well beyond the user, ranging from crimes of desperation to sexually transmitted diseases. There’s a cost to all of this, and it falls not only on the users themselves but on a city itself.

None of this proves, of course, that Ithaca’s idea is a good one. That will depend on the specifics and the execution. But hopefully NIMBY-esque concerns won’t win out over an idea that really does have some merit and logic behind it — at least not without a healthy and informed debate.

The Case for ‘Safe’ Space for Drug Users