Supervised/Safe Injection sites

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Permalink Reply by Eric on October 15, 2009 at 11:44am

I personally believe that we as providers have no buisness doing things such as that, as healthcare professionals condoning drug use goes against the oath we take to do no harm in my opinion.

Eric

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Permalink Reply by Justin on October 15, 2009 at 12:17pm

I think this is an interesting question. You could argue that if they are going to do the drugs anyways, that having a site like this would help reduce the spread of diseases from dirty needles, and might potentially be a location where these individuals could gain access to addiction treatment.

On the other side, you could argue that you are supporting their "bad habit." The definition of "bad habit" is tricky though as many individuals who would criticize someone who utilizes IV drugs are addicted to legal substances such as alcohol, tobacco, or prescription pain medications.

Overall, I think if it was done correctly and provided clean needles and access to addiction treatment it would be a positive. The problem I think is that even if this type of site were available, I don't know how many people would actually utilize it.

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Permalink Reply by dr-exmedic on October 15, 2009 at 12:25pm

These have long been advocated as a way to reduce harm, and are a great idea.

Either we can have people using drugs in a safe, clean environment, which allows them to do the self-harm of using drugs, or we can have people out there who won't use the drugs any less, but will have the added harms of HIV, hepatitis, talc emboli, endocarditis, etc. As someone who's at risk for needlesticks and bloodborne pathogens in general, I suppose I have a certain selfish interest in reducing the rates of HIV and hepatitis by any means possible...as should we all.

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Permalink Reply by NinFin on October 15, 2009 at 3:07pm

This is an interesting question that I am sure will have people on both sides of the issue as we have already heard from.

My thoughts, at least right now, is that this would cause an ethical problem for EMS providers, at least as far as our licensure goes. Right now, I don't know of any state that will certify/license someone with a felony criminal record. I don't all of the state laws so please correct me if i'm wrong. My point is this, if you inject someone with a illegal substance in the guise of making sure they don't overdose or having a "safe" place to do what they are going to do anyway, then are you also guilty of the drug offense?

It's kinda like a parent allowing their child and his/her friends to drink alcohol in their home. Even though they teens are drinking in a "safe" environment, the parent can still be charged and convicted of supplying alcohol to a minor.

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Permalink Reply by Robert Sullivan on October 15, 2009 at 5:04pm

I don't have a strong opinion about needle exchange, but I don't think EMS should be involved with it. With budgets being so tight, who is going to pay for it?

Our community programs have been almost eliminated in the past few years. If we're going to spend money on things other than calls, l'd rather spend it on CPR classes and injury prevention programs to help people who don't abuse drugs first.

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Permalink Reply by TheCannulator on October 15, 2009 at 7:16pm

I think you are drawing very very long bow as far as felonies arising from supervising a druggie using their own heroin. These site are exempt from legislation usually anyway.

Having said that, a bit of Darwinism never goes astray.

Whilst a comparison to most substance abusers is always made when talking about addicts, I'm pretty sure most alcoholics don't bash and rob little old ladies for a shot of tequila. Illegal substance abusers do my head in because of their gutlessness and selfishness- I would never volunteer to supervise them.

NinFin said:

This is an interesting question that I am sure will have people on both sides of the issue as we have already heard from. My thoughts, at least right now, is that this would cause an ethical problem for EMS providers, at least as far as our licensure goes. Right now, I don't know of any state that will certify/license someone with a felony criminal record. I don't all of the state laws so please correct me if i'm wrong. My point is this, if you inject someone with a illegal substance in the guise of making sure they don't overdose or having a "safe" place to do what they are going to do anyway, then are you also guilty of the drug offense?

It's kinda like a parent allowing their child and his/her friends to drink alcohol in their home. Even though they teens are drinking in a "safe" environment, the parent can still be charged and convicted of supplying alcohol to a minor.

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Permalink Reply by Ben Waller on October 15, 2009 at 11:11pm

I wouldn't want to work there, but I have no problem with it. The war on drugs is a complete failure, so we may as well take the profit motive out of it. That will reduce crime, reduce OD's, and take the motives for most of the violence out of the distribution chain.

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Permalink Reply by Jonathan Gilliam on October 16, 2009 at 12:36am

This is simply a choosing between two evils. The program, from what I have heard and read about it, is designed to help stop the spread of HIV/AIDS primarilly. This, along with other bloodborne diseases. It's a pragmatic approach which was spawned from the realization that once the drugs are in the hands of the user, we won't stop them from using it. So it is better to give them an option where they can get a clean needle, clean injection saline, and stop reusing/sharing needles and stop drawing water from puddles on the street.

Here's one unseen benefit of this program though. If your drug users are coming in to a place to get clean needles and such, they can be identified and offered rehab to get off of drugs. Again, from what I know about the program, this is exactly what's being done in Vancouver. I don't think they are the only Canadian city to be doing this, but I can't be sure in who else has similar programs. Locking up drug users does no good, this may actually help. Plus it allows law enforcement to go after the real problem, the dealers.

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Permalink Reply by Nathan on October 16, 2009 at 12:44am

I like the Darwin concept on this one.

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Permalink Reply by blair4630 on October 16, 2009 at 7:53am

Yes, natural seclection will thin the herd.

Nathan said:

I like the Darwin concept on this one.

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Permalink Reply by blair4630 on October 16, 2009 at 8:06am

I agree the war on drugs has been, nationally, not the biggest success, but I have two disgreements with you here.

First, I don't think giving clean needles to junkies in any way takes the profit motive out of the drug business. They don't sell dirty needles, they sell drugs. Getting clean needels makes it safer, but in no way more or less, quantity wise, of what the junkies buy.

Second, locally, our drug task force has done wonders in our area in terms of drugs, crime, and the like. In the past few years, our county wide crime has dropped drastically, our service overdoses have dropped remarkably, and out of town dealers (mostly from Baltimore, NYC, Pittsburgh, and Philly) have stopped coming into the area in large numbers (as those caught are now, once convicted, facing an average of 40-80 years in prison). A few years ago, the task force in our area decided it isn't playing around anymore, and the results have been HUGE. For this second point, though, i understand that you, being in SC, have no possible way of knowing what is going on in my region, I just wanted to point out that the "war" on drugs does work in some areas, maybe it's a matter of best practices that should be shared.

Ben Waller said:

I wouldn't want to work there, but I have no problem with it. The war on drugs is a complete failure, so we may as well take the profit motive out of it. That will reduce crime, reduce OD's, and take the motives for most of the violence out of the distribution chain.

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Permalink Reply by dr-exmedic on October 16, 2009 at 7:57pm

blair4630 said:

A few years ago, the task force in our area decided it isn't playing around anymore, and the results have been HUGE. For this second point, though, i understand that you, being in SC, have no possible way of knowing what is going on in my region, I just wanted to point out that the "war" on drugs does work in some areas, maybe it's a matter of best practices that should be shared.

More likely, all it's done is forced your local addicts to go elsewhere and take their problems there....

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