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HomeArticleDrug Overdoses Increased During Pandemic: Have ‘Safe’ Injection Sites Made a Difference?

Drug Overdoses Increased During Pandemic: Have ‘Safe’ Injection Sites Made a Difference?

Drug Overdoses Increased During Pandemic: Have ‘Safe’ Injection Sites Made a Difference?

A man pauses under a mural in Philadelphia’s Kensington neighborhood, which has become one of the largest open-air heroin markets in the United States, on July 19, 2021. (photo: Spencer Platt / AFP/Getty)

While recognizing the need for creative solutions to curb drug abuse, Catholic medical ethicists have raised moral and practical objections to the new focus on ‘harm reduction’

WASHINGTON — When GOP lawmakers got wind of a first-of-its-kind federal Health and Human Services’ grant for distributing drug paraphernalia to stem the transmission of infectious diseases among chronic users, they quickly called out the Biden administration “for sending crack pipes and meth pipes, targeting minority communities,” as Sen. Marco Rubio, R-Fla., put it.

The White House pushed back, insisting that the Republican claims weren’t accurate, and the pipes would not be included in a new $30-million federal program that provides funds for tools and initiatives designed to mitigate the risks associated with drug use.

Amid the uproar, HHS Secretary Xavier Becerra and White House drug-policy adviser Rahul Gupta defended what the administration calls an equity-based “harm-reduction” strategy for addressing the explosion of drug overdoses that resulted in the deaths of 100,000 Americans between 2020 and 2021.

The partisan skirmish will likely puzzle many Americans. But some critics say it heralds a sea change in the government’s decades-long response to drug addiction. Increasingly, there is less emphasis on prohibition, incarceration and abstinence and more focus on harm-reduction strategies, from the distribution of the overdose-reversing drug naloxone and clean syringes to the expansion of “safe” drug injection sites, a few of which have opened in New York and San Francisco, without federal approval.

This month, drug-policy experts also flagged the Department of Justice’s decision to revisit the federal government’s opposition to a safe drug-injection site in Philadelphia that would offer clean needles and supervise drug consumption to prevent overdoses.

The Trump administration successfully filed suit to block the site’s opening, but Biden’s DOJ just announced that it was in “discussions with state and local regulators about appropriate guardrails for such sites, as part of an overall approach to harm reduction and public safety.”

At the same time, Catholic ethicists have raised moral and practical objections to the new focus on harm reduction, while noting that the Church has yet to issue formal teaching on the matter.

“Doubtlessly, clean needle sites do some good, such as prevent infection and disease,” E. Christian Brugger, professor of moral theology at St. Vincent de Paul Regional Seminary in Boynton Beach, Florida, told the Register. “But they are not without bad side effects. The two most serious are they enable self-destructive behavior, and they make the institutions administering or supporting them look like they support the addictive behavior.”

So if Catholic institutions or leaders “were ever to sponsor or speak out in favor of such things, it would give the impression that the Church supports drug use.” And that, he warned, “would cause scandal, disunity among Catholics.”

 

‘Misguided Compassion’

Father Tadeusz Pacholczyk, director of education at the National Catholic Bioethics Center, which advises Catholic hospitals and dioceses on policy issues, echoed this judgment.

“Those who struggle with substance abuse are deserving of public-policy initiatives that rehabilitate rather than enable the addicted individual,” said Father Pacholczyk.

In contrast, safe injection sites “involve cooperating in, if not directly promoting, a practice that is clearly unethical and highly damaging to society,” he told the Register. “Such programs provide the clean needle and syringe with the intention that the drug addict will use [them] to inject a dangerous and highly addictive substance for other than therapeutic purposes. For this reason, it is difficult to see how the supplying of clean needles can be understood as anything but implicit formal cooperation with evil.”

The ethicist explained that safe injection sites have been endorsed as a way to link drug users with referrals for treatment.

“Yet there is clearly a contradiction between enabling the addiction on the one hand and promoting rehabilitation on the other,” Father Pacholczyk said.

Back in 2019, when Philadelphia’s safe injection site was initially approved in a district court ruling, Archbishop Charles Chaput raised similar concerns, describing the initiative as an example of “misguided compassion” that could undermine a drug user’s struggle to get clean.

Archbishop Chaput argued, in a column for the archdiocese’s newspaper, that modern neurological science confirmed the environmental stimuli accompanying addictive substance abuse can actually trigger cravings. “That’s why 12-step recovery groups urge members to avoid the people, places and things that led to their substance abuse.”

The research suggested that safe injection sites were more likely to enhance these environmental stimuli, thus reinforcing the addiction, he contended.

And while local supporters of the injection sites asserted that the first legal supervised drug-injection site in North America, a Vancouver, British Columbia-based program called Insite, had successfully operated since 2003 and reversed 6,000 on-site overdoses with no fatalities, Archbishop Chaput remained deeply skeptical.

“[S]ome 3.6 million clients have self-injected at the Vancouver-based site, yet only 48,798 (or 1.35%) have received any kind of addiction treatment,” he wrote, while noting the lack of information on the type and duration of the treatment pursued.

 

Federal Policy Shift

At the height of the pandemic, a rapid rise in accidental heroin overdoses caused by the presence of fentanyl mixed with other types of drugs helped energize harm-reduction advocates who seek to offer new solutions, including fentanyl test strips and safe smoking kits, for hardened addicts resisting treatment.

Historically, the U.S. government’s war on drugs, which dates to the Nixon administration, sought to disrupt drug-supply chains, discourage substance abuse, and provide treatment. The recent addition of harm reduction is a notable shift in policy.

“The principal ends of most of our public-health and drug-use policies have been to change high-risk behaviors,” said David Murray, the co-director of the Hudson Institute’s Center for Substance Abuse Policy Research, who previously served as chief scientist and associate deputy director (supply reduction) in the federal Office of National Drug Control Policy in both the George W. Bush and Obama administrations.

In contrast, the harm-reduction movement opposes what it sees as a largely broken and ineffective “punitive” model for addressing drug addiction. And the Biden White House’s updated drug policy suggests the harm-reduction campaign has come into its own.

Yet Murray also expressed reservations about the lack of hard data confirming that harm-reduction “facilities actually achieved the goal of saving lives,” beyond isolated incidents. If an individual is not in treatment, the risk of accidental overdose is still present, he warned.

However, other Catholics familiar with the challenges of drug abuse take a more nuanced approach to harm-reduction initiatives, looking for a philosophy and protocols that “meet drug users where they are” and then move them toward treatment.

“The approach needs to be patient-centered and focused on breaking the cycle” of drug dependency, said Deacon Tim Flanigan, a physician specializing in infectious disease at Brown University who treats and ministers to patients battling drug addiction and HIV/AIDS.

 

Dignity-Based Approach

Deacon Flanigan has firsthand experience with the high rate of recidivism that makes “substance abuse a chronic relapse disorder.”

He said, “Our faith teaches that each person is made in God’s image and is called to be an adopted son or daughter of God. Meeting them where they are is important.”

Deacon Flanigan is open to drop-in shelters and clean-needle distribution programs that seek to “help the individual person” on their path to sobriety, while questioning the approach of safe injection sites.

“Some champions of the harm-reduction movement take a libertarian approach: If you are using drugs, it is your choice, and we can’t judge. This ignores the fact that drug addiction is a medical condition that requires treatment,” he said, and a politicized approach “can do more harm than good.”

John M., 57, a Massachusetts native and a Catholic who ended up in foster care after his parents’ divorce, got hooked on drugs and served more than 20 years in prison for a string of felonies, told the Register that safe injection sites should be an option for people like him.

Now clean, John believes that this kind of program would have helped him “avoid contracting AIDS” and might have nudged him into treatment sooner.

The major downside to safe injection sites, as he saw it, was the negative “impact on neighboring businesses in the community,” as most communities “don’t want homeless people congregating nearby.”

No doubt, local community groups are deeply concerned about the message “safe drug consumption” sites send to children and to recovering addicts and express alarm at their impact on struggling urban neighborhoods.

Shawn Hill, a co-founder of the Greater Harlem Coalition, a group concerned about the recent opening of OnPoint, a safe injection site in East Harlem, doesn’t quibble with the new program’s goals and protocols.

Hill has toured the facility where a comfortable lounge allows visitors to speak with a counselor. The drug-consumption area in the back includes a number of study carrels, each fronted by a mirror that allows a counselor to observe the face of the person as they consume the drug and intervene when necessary.

But Hill takes issue with the city’s decision to open the program in a “community of color, close to a preschool, a large apartment building with affordable housing, and a subway stop.”

“In addition to the dealers who come here to tempt the drug users [visiting the site], other people come to buy drugs and have no interest in any treatment program,” he said. “This leads to a large incidence of using and overdosing” in the neighborhood.

The new site, he said, “could have been located in an industrial zone, off the thoroughfare. We want a safe community.”

 

San Francisco’s Experience

The city of San Francisco’s supervised drug-consumption site has also sparked controversy, as local officials battle a spike in crime and an explosion of fatal overdoses amid tented encampments on city blocks littered with human feces and discarded syringes.

“This site is about getting people connected with immediate support, as well as long-term services and treatment,” a representative for the city’s Department of Emergency Management told the San Francisco Chronicle, referring to a nearby “Linkage Center,” where a range of services are available.

But critics of the new site, including Michael Shellenberger, author of San Fransicko: Why Progressives Ruin Cities, have challenged the city’s claims.

“The city is carrying out a bizarre medical experiment whereby addicts are given everything they need to maintain their addiction — cash, hot meals, shelter — in exchange for … almost nothing,” Shellenberger charged in a Feb. 7 column.

To back up his argument, he reported that the site had welcomed 220 daily visitors in a roughly three-week time frame, yet city officials told him that “just two people went to detox, so far.”

The city also opened a nearby “safe sleeping site,” where homeless drug users consume fentanyl and meth, further complicating efforts to promote treatment.

“If you’re coming into a place that’s supposed to guide you toward the end of seeking treatment and recovery, and there are people using drugs around you, that becomes an incentive to keep going,” Keith Humphreys, a Stanford University School of Medicine addiction expert, told Shellenberger. “It’s like trying to have an AA meeting in a bar.”

 

The Need for Hope

Likewise, Father Pacholczyk is concerned about the deeply pessimistic message that emanates from a public-health strategy downgrading human agency, an approach that will do little to strengthen the resolve of recovering addicts, and is profoundly at odds with Christian anthropology and hope.

“Harm-reduction policies often advance an anthropology that despairs of the possibility of human transformation, avoiding real engagement of the moral wrongs that are occurring,” he said.

“While drug addiction certainly puts a major dent in human freedom, it would be false to conclude that an addict can’t make choices. The only reason there is any hope left for an addict is because he still has a small and diminishing space of freedom that he can act on, allowing him to decide whether or not to begin a new journey,” the priest concluded. “He can choose to take the first step along the road leading away from addiction towards rehabilitation.”

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