Safe injection sites save money but also they saves lives.
Philadelphia has, for decades, had a reputation of being a major heroin haven on the East Coast, with its heroin being of such high quality that people purposely moved there for that purpose alone. In recent years with the opiate epidemic steadily getting worse, this reputation only grew more steadily — and then dropped off with the introduction of fentanyl analogues such as acetylfentanyl, butyrfentanyl, and carfentanil (drugs whose names correspond to their chemical formula that are dozens to hundreds of times more potent than morphine) into the heroin supply. Nevertheless, people still swarm to Philadelphia in droves. Puerto Rico drops its heroin addicts off into Philadelphia and people from the surrounding counties and states still come to the city seeking its once-legendary (and now extinct) pure fix.
With all of these people going to the city seeking an almost mythical fix that’s been tainted with chemicals humans can’t even consume, it’s not a surprise that the number of fatal and nonfatal overdoses in the city has risen to astonishing and record-breaking numbers. From sidewalks and convenience store bathrooms to buses and trains and even the basements and bedrooms of their parents and partners, overdoses are happening and killing addicts and leaving wounds in the hearts of their loved ones.
Those who are lucky to survive a serious overdose are left changed by the experience. My most serious overdose convinced me that I needed recovery again, after relapsing with three years clean. Yet, overdoses may not be enough to convince some addicts that they need to seek recovery. And, honestly, that’s okay, there’s nothing wrong with not getting it the first time. Addiction isn’t a rational or reasonable thing, it’s a mental illness that often accompanies other mental illnesses.
People who have experience with addiction or with addicts know this about us — they know that many of us simply don’t understand that we have a problem and that we often don’t know that we need help until we’ve reached our bottom. For those who don’t know, a “bottom” is a point where people with substance abuse issues realize that we have a problem and hit an emotional, physical, financial, or social wall in our lives. It’s the point where we realize that we’ve, in some way, destroyed our lives in one way or another. Reaching a bottom can take months or it can take years. My first bottom came after years of using and drinking, but my second came only after a few months of using after my relapse. Each person is different.
Realizing that people may not hit their bottom fast enough for them to be able to survive addiction, recovery advocates developed ideas that would keep them alive and relatively safe until they’ve decided to seek recovery (in whatever form that may take shape for them). In the beginning in North America, this took the form of harm reduction education. Recovery advocates and medical professionals educated drug users (addicts or not) in how they could use drugs in ways that would keep them as safe and healthy as possible under the circumstances.
They championed the user of Narcan shots and nasal spray, eventually getting the medicine to be given without prescription and free from some pharmacies. Additionally, in Philadelphia, the city and various nonprofit organizations give trainings out for free. This helped, and continues to help, the situation. However, it wasn’t enough. With more and more potent fentanyl analogues — called fentalogues in the online drug user community — being put into the heroin, it took more Narcan than most civilians (and even rescue officials) had on them at any one time. So they needed to get more radical.
In January, reduction and recovery advocates got the City of Philadelphia to green light safe injection sites in the city. Very little in the way of plans have been developed for these sites and speculation as to how they’ll be implemented and developed is premature. Yet it was a time of rejoicing for advocates, it was the Tsar Bomba in the war we’re all fighting against addiction. A turning point for all of us. Finally, evidence-based tools are starting to be used. Yet, not everyone was happy.
There were people — non-addicts antagonistic towards addicts, loved ones of addicts, and even recovering addicts — who reacted in ways that were similar although antagonistic non-addicts hold different views about the humanity of addicts that the loved ones of addicts and recovering addicts do. Across all forms of media (including social media), the refrain was essentially to allow addicts in active addiction to die, although for different reasons.
Many of the non-addicts against the safe injection sites were against them because they didn’t want public dollars going to help addicts (despite the fact the city said it would not be funding the sites) and they believed that addicts are going to die anyway (and deserve to). The ignorant ones, pushing viewpoints that were against the very humanity of active addicts, believed that addicts in active addiction were making a choice to use and were too weak to stop, and so they deserved to die and society would be better off for it. The recovering addicts and loved ones of addicts against the sites generally espoused the viewpoint that it’s only putting off death and that it won’t help them get clean, some believing it’ll only empower them to continue. The refrain heard in the rooms with increasing frequency, “some have to die so that others might live”, was echoed directly and indirectly in comment sections on Facebook, Twitter, and news sites.
All of these sentiments are essentially eugenicist and Social Darwinist in nature because addiction is seen by some as a choice that’s made and people are too weak to choose it (even recovering addicts voice ideas influenced by this concept). Conversations on addiction are often steered by these ideas, those who can’t stop or can’t live up to the lofty ideal of “total abstinence” are dismissed as weak human beings who shouldn’t be allowed to live. The conversations end up — directly or indirectly — stating that people in active addiction are worth more to society dead than using, even if that using is controlled and safe. It doesn’t matter what ideas people come up with to make addiction less of a problem or less deadly because we’ll always be preferred dead and not using over alive and not abstinent.
We have to reject these incorrect and malicious viewpoints and voice our support for safe injection sites even if we’re not injection drug users ourselves. We have to show that addicts — in recovery or not, abstinent or not — have value as human beings simply because we are human beings. Conversations on addiction have been steered by this devaluation of human life for too long and too many lives have been lost to death and to jail as a result.
Safe injection sites save money but also they saves lives. I call on people interested in social justice and the basic concept of equality to steer conversations away from malicious viewpoints that degrade human value and towards viewpoints that show that all people have value.