Stopping Opioid Deaths With Safe Rooms

California lawmakers are currently considering a bill that would make it legal to inject heroin in certain places.

The bill, A.B. 186, would authorize certain California cities and counties to operate “safer drug consumption” facilities, or safe rooms, where people can use drugs under the supervision of health care providers and without fear of arrest. The facilities would also provide users with information on where to get treatment for drug addiction. The bill would allow the rooms on a trial basis until 2022.

Safe rooms like these have been established in other parts of the world, like Europe and Canada, in an attempt to decrease the instances of drug overdoses, specifically from opioids, and there is evidence that they work. And in the U.S. there are other programs that aim to reduce the risk of death of illicit drug use which have proven effective. Needle exchanges exist in many major cities. There has long been a recognition that making sure intravenous drug users have access to clean needles can help stop the spread of HIV/AIDS and other blood borne illnesses that can be transmitted via used needles. One needle exchange program in Nevada is getting ready to install the nation’s first needle vending machine to make clean needles even more accessible. This program, and other needle exchanges are totally legal and, as of last year, were even eligible to receive federal funding. But safe rooms have not been embraced in the same way in the U.S. There are currently no legally-operated safe rooms anywhere in the country and American opioid deaths have quadrupled since 1999 to over 30,000 deaths in 2016 and 4,659 of those who fatally overdosed last year were Californians, the highest number of deaths for any state.

In spite of the potential to prevent opioid overdose deaths and provide addicts a path to treatment, there is opposition to safe rooms. The California bill has been opposed, in particular, by law enforcement, like the California State Sheriffs’ Association. They said that the bill “sends the wrong message about drug use,” apparently concerned that government-authorized safe rooms can be interpreted as tacit government endorsement of illegal drug use. That’s a valid concern for law enforcement, but it seems to be based on an unrealistic view of the opioid epidemic. Most current opioid addicts, including those hooked on heroin, get started on opioids legally, when they are prescribed by doctors and supplied by pharmacists. In today’s opioid epidemic, the line between patient and addict and the line between doctor or pharmacist and dealer are blurry.

The traditional law enforcement tactic for interrupting drug use is to arrest users and then get information from them and work up the drug supply chain. If the officers who oppose safe rooms use this technique to try to stop opioids, they will get to the international cartels that make and sell heroin, but they will also end up at pharmaceutical manufacturers and suppliers.

These are the companies that have been supplying prescription opioid pain killers that start and fuel the epidemic. West Virginia has the highest rate of opioid overdose deaths per capita in the country, but, until recently, there was no oversight to increasingly large shipments of prescription opioids like hydrocodone and oxycodone that were coming into the state. As West Virginia overdose deaths have climbed in the past few years, suppliers of these drugs have continued to pump them into the state, shipping in enough for every single West Virginian to take over 400 pills.

West Virginia and California are not alone; the opioid epidemic affects every state. State governments and the federal government alike are grappling with how to fight an epidemic that involves opioids that are illegal drugs, as well as opioids that are supposed to be medicines. In fact, increasingly there is no difference between medical opioids and street drugs. One of the most powerful opioids, fentanyl, can be prescribed for severe pain, but is also being manufactured and sold illicitly and is responsible for a growing percentage of the overdose deaths in the U.S.

Currently, it’s acceptable for doctors and pharmacists to provide people with oxycodone, which they can take at home, because it’s considered medically necessary for pain. But for someone who is chemically dependant on heroin, to use it in a safe room under the supervision of a medical professional is illegal. This distinction is based on views of the different opioids that are not necessarily medically or legally helpful in battling the current opioid epidemic, or in saving lives. Stopping the opioid epidemic will probably require changes to how opioids are legislated, used, prescribed, and distributed and may also require a cultural shift in things like how we think about and treat pain and how we expect medicine to make us feel. But stopping a lot of opioid deaths could be much simpler and may just involve allowing for places where addicts can be safe.

Alexis Chapman is a Political Consultant and Writer specializing in policy analysis, from international law to local ordinances. She’s lived in Australia, Ghana, Vermont, Hawaii, and Texas and has worked for small and large NGOs, state legislature, industry associations, and a variety of publications. She is a regular contributor to Political Storm and you can find her on Twitter @AlexisAPChapman.