Intravenous drug use, and heroin abuse in particular, has been a major public health concern in Washington state for roughly thirty years. It’s a deep-rooted, serious problem that has recently gained attention in other parts of the United States.
Washington is ahead of the rest of the country in adopting aggressive public health policies that can save the lives of drug users and reduce the harm they might suffer. The state is a national leader in needle exchanges and safe injection sites.
The most dangerous and addictive drugs — methamphetamine, cocaine, heroin and other opioids — can be injected. Intravenous drug users inject a drug directly into their bloodstream using hypodermic needles. This method is also called shooting up or mainlining.
IV consumption is a popular method of drug use because it is more efficient than the other methods. When injected, drugs in a user’s bloodstream will reach their brain within minutes. But if they consume a drug that is too strong, there is little warning. They can die within minutes.
Most IV drug users in King County use heroin. Around half of Seattle-area heroin users regularly injected heroin in 2015, according to the University of Washington’s Alcohol & Drug Abuse Institute.
Heroin injectors face specific dangers. Sometimes it’s cut with thickeners such as laundry detergent or flour. If producers cut the drug, they can make more money. That practice endangers IV drug users. If they inject heroin that’s stronger than usual, they increase their risk of overdose.
Fentanyl is a common heroin mixer. It’s an opioid that’s even more powerful than heroin, but it lasts for a shorter period of time.
Fentanyl overdose has become a risk for Northwest IV heroin users. Fentanyl first caused a rash of overdoses in the western U.S. in 2006, after a Mexican cartel mixed the drug with heroin. Washington first responders and public health officials began to worry about fentanyl again in late 2016.
Seattle police suspect fentanyl could be a cause of four overdoses that occurred on Jan. 8, 2017, according to the Seattle Times. That day, four people overdosed on heroin along Seattle’s Aurora Avenue North within hours of each other. Three died, and one went to the hospital.
Needle exchanges and safe injection sites can reduce some of the danger faced by IV drug users. The sites allow IV drug users to trade used, dirty hypodermics for new, clean needles without charge. IV drug users are at less risk of spreading blood-borne illnesses if they can use their own clean needle, instead of borrowing one from a fellow user.
Tacoma hosts the United States’ oldest continuously operating needle exchange program, the Tacoma Syringe Program. TSP began operations in 1988. Eighteen other needle exchange programs operate in 15 counties across the state. Needle exchanges are different from safe injection sites.
Safe injection sites are facilities where IV drug use is supervised by medical professionals. These professionals can intervene in the event of an overdose. In a safe injection site, users who pass out or overdose are safe from the sexual and physical assault, theft and harassment that they could experience in the world at large. Site staff can also refer users to medical treatment, including drug rehabilitation.
In January 2017, Seattle became the first U.S. city to make plans to open a safe injection site. If Seattle’s plan goes ahead, the city will open one injection site in the city limits and another in a nearby suburb with help from the King County health department.
Seattle’s plan has prompted debate, some of it heartbreaking. Some state legislators from outside Seattle are against the idea. They introduced a bill to ban safe injection sites. A former King County prosecutor whose son died from a heroin overdose wrote an emotional, powerful op-ed in the Seattle Times in opposition to the plan. Others responded in favor of safe injection sites.
Clearly, the debate about injection sites causes strong feelings. However, the available data on the issue shows that injection sites have a number of public health benefits in their surrounding neighborhoods.
Seattle’s injection site advocates often cite Vancouver, Canada’s operational injection site as an example worthy of imitation. Vancouver’s injection site, called Insite, opened in 2003. Insite was the first safe injection site in North America.
Vancouver’s experience with Insite is the closest example for Seattleites to study. While Insite is still controversial in Canada, it has been praised by international and public health officials in British Columbia. It seems to have made a positive impact on its neighborhood, and it has not caused drug use to increase in the area, according to news reports.
Safe injection sites haven’t solved Vancouver’s IV drug crisis, but they have prevented a lot of needless death and misery. They can also put drug users in contact with counselors, health care workers, and other caring, sober people who can help them get on a much-needed path to recovery.
People who use needle exchanges or safe injection sites aren’t required to seek testing or treatment. However, the sites educate them about the risks of drug use and the benefits of getting tested for disease. Medical professionals in Washington hope to build relationships with IV users and convince them to seek treatment.