Why not at least talk about safe-injection sites for heroin users before banning them?

I’m not certain supervised-injection sites make sense in Pierce County.

What I am certain of is the way we talk about them — or don’t talk about them, rather — isn’t helpful.

We’re in the grips of an epidemic. Nationally, roughly 64,000 people died from drug overdoses in 2016 — the largest annual jump in U.S. history and a spike directly tied to the rise of opioids and synthetics like fentanyl.

Locally, there were 694 opioid-related deaths statewide in 2016, with 81 of those deaths coming in Pierce County

People are dying, too many of them, at numbers that now surpass the height of the AIDS epidemic.

Clearly, answers are needed — and new ones.

Still, in Pierce County and elsewhere — at least outside of Emerald City — any rational discussion of supervised-injection sites remains strictly off limits, tabled by the political minefield that surrounds them.

Soon, the Pierce County Council will take up a resolution that would prohibit supervised-injection sites throughout unincorporated parts of the county — even though no such sites have been proposed. Advocates like Jim McCune and Pam Roach view the move as preemptive.

If it’s successful, Pierce County would join a growing list of local jurisdictions that have moved to ban supervised-injection sites before they ever arrive, including Snohomish County, Federal Way, Auburn, Bellevue and Lynwood.

I understand the concern.

The idea of supervised-injection sites — and giving IV drug users a place to shoot up — is jarring, especially given how dangerous heroin is and how we’ve been conditioned to view its use.

Beyond understandable concerns about what such a facility might bring along with it — like increased crime, or an influx of users — there’s a host of theoretical, moral, and ethical questions that go along with creating spaces that would seem to condone the use of heroin.

At the same time, we’ve got an undeniable crisis on our hands — a crisis ripping apart lives, families and friendships.

In moments like these we owe it to ourselves and our communities to find solutions wherever they might reside and allow space for thoughtful discussions even when they’re difficult.

Dr. Thomas Kerr, a professor in the department of medicine at the University of British Columbia and Associate Director of the B.C. Centre on Substance Use, is familiar with such discussions.

Back in 2000, Kerr — whose work focuses on illicit drug use, HIV/AIDS and health policy — came at the idea of supervised-injection facilities from an abstinence-based treatment mindset. Though supervised-injection facilities have operated in Europe for decades, with research to back them up, Kerr was skeptical as Vancouver weighed the proposition.

“I thought that sounds like a really bad idea — that it just kind of perpetuated drug use and telling (IV drug users) it’s OK to use when we should be trying to get them into treatment,” Kerr said.

Three years later, in 2003, the first supervised-injection facility in North America opened in Vancouver. Kerr was a prominent member of a team of researchers involved with a three-year study analyzing the site’s effectiveness, and – not surprising, given his background — it was the science that swayed him.

He said research has clearly shown that Insite — which opened in downtown Vancouver’s Eastside — has met “all its basic objectives.”

The facility reduced overdose deaths amongst those who utilized it, improved public order by reducing the number of people shooting up on the street, reduced the transmission of infectious disease, and cut down on the number of improperly disposed of syringes in the community.

It was also cost-effective, and — more importantly — it led to a “substantial increases in the number of people entering abstinence-based treatment,” Kerr said.

Meanwhile, none of the fears people had about the facility came to fruition. There was no increase in crime and no increase in the number of people experimenting with drugs.

Today, Kerr has been studying supervised-injection sites for nearly two decades — traveling to Europe and Australia in the process, and publishing more than 40 peer-reviewed articles on the subject.

He said the science is clear, and he’s watched the attitudes of skeptics in his country evolve with it.

“Essentially in Canada, there is really no scientific debate about these facilities,” he said.

There are roughly a dozen of them throughout the country, Kerr pointed out, with more opening soon.

“When I read the discourse (in Washington), to me it’s very clear people are just acting like scientific evidence doesn’t exist, and like we don’t know anything about these facilities,” he said.

“All the fears that people are drumming up to justify banning these facilities have not played out, ever,” he continued. “You can put the blinders on and dream up all these negative impacts, but there’s just no basis to it. It’s not factual.”

Peter Davidson, an assistant professor in the department of medicine at the University of California San Diego has had a similar experience. He’s been studying an underground supervised-injection site since 2014 and agreed that all available data suggests it is an effective model.

“There’s always the concerns that just because it worked well in one setting doesn’t meant it will work well in other settings,” Davidson said. “But the findings of our research … is that it seems to do the same things.”

Both Kerr and Davidson were quick to note that supervised-injection sites are not a cure-all. They have limitations, like geographic reach, and are truly effective only when paired with adequate addiction-treatment services. They work best in areas already dealing with a high number of users, Davidson said.

Whether they’d be a good fit for Pierce County, in other words, is open for debate.

That is, if only such a conversation was allowed to take place.

Kerr called the current climate in Pierce County “highly irresponsible, given the opioid-overdose epidemic that’s facing North America right now.”

“When we’re talking about matters of life and death,” Kerr said, “we have an obligation to base our decisions on the best scientific evidence, not speculation.”

Sounds sensible to me.

Unfortunately, when it comes to objectively weighing supervised-injection sites, reason isn’t exactly carrying the day.

This story was originally published March 16, 2018 at 12:30 PM with the headline "Why not at least talk about safe-injection sites for heroin users before banning them?."