No city in the U.S. offers a designated site, at least legally, for heroin users to safely inject.
Seattle is moving in that direction, as are San Francisco, Philadelphia, New York and Boston.
Could Portland, where hundreds of people have died of overdoses in recent years, join that list?
That’s the hope of several public health advocates and at least one state legislator. Mayor Ted Wheeler is also open to the idea, having once tweeted, “I would look at a safe injection site in Portland — whatever is backed by data, we should pursue.”
The Oregon Health & Science University-Portland State University School of Public Health held a standing-room-only-forum at Lucky Lab in Northwest Portland dedicated to the topic last November. Sen. Elizabeth Steiner Hayward, a Beaverton Democrat, stood up and said safe consumption sites are “one of the factors we need to include” in addressing opioid misuse.
“There’s a lot of appetite for this,” she said. “I have colleagues in the Legislature who are absolutely on board.”
The road from idea to reality is riddled with challenges, from legal to real estate to insurance to public opposition to funding. Advocates are taking it slow, building support and keeping a sharp watch on other cities further along in the process.
“The county uses the term ‘overdose prevention site,’ and our agencies believe the model could be one — small — component of a comprehensive approach to combating substance misuse,” said Tri-County Health Officer Dr. Paul Lewis. He added that the county has no plans to operate such a site, which “mitigates, rather than solves, the larger problem. The most critical work remains prevention and treatment."
Portland has a history of being out front in the harm reduction aspect of the opioid crisis. The Rose City was the third to open a legal syringe exchange in 1989 and the first to publicly fund it. Portland was the first city in Oregon to implement training in the overdose antidote naloxone.
One question advocates of safe consumption spaces will have to address revolves around moral hazard — won’t this just encourage risky behavior? Haven Wheelock, program coordinator for Portland-based Outside In’s needle exchange program, has some thoughts on that.
“People are using drugs every day in very risky ways,” she said. “They are using in places without access to clean water, like freeway overpasses, under bridges and in public bathrooms. They are hiding, so people don’t see them. By giving people a place to use, they are able to take fewer risks. They have clean new equipment that they then dispose of safely, and, most importantly, they are not alone and hidden if they were to overdose so they would be likely to survive.”
Studies have shown that safe consumption sites, which are staffed by health care professionals, save lives and save money. Such spaces have been up and running for three decades in Canada, Europe and Australia. They decrease public use and needle litter and allow users to obtain sterile supplies. If they overdose, a trained professional can respond.
“No one has ever died in a supervised consumption room,” Shannon Riley, regional project manager for the Overdose Emergency Response in Vancouver, told attendees at OHSU’s forum.
Powerful fentanyl drugs are killing scores of people, primarily on the East Coast, and it’s a matter of time before they appear here, said Sam Chapman, advocacy director for Safer Spaces Portland. A safe injection space, primarily serving those living outside, would allow users to test the purity of their drugs.
Already, the death toll is mounting. In 2016, 160 people died from opioids in the Portland metro area, with another 130 through the first three quarters of 2017, according to preliminary data. That doesn’t count the people who die from viral hepatitis, skin infections, heart infections and other ailments that can result from opioid use.
As far as next steps, a tour of safe consumption spaces in Vancouver, B.C., by state and local officials is in the works, though no date has been set, Chapman said. He said he’s not seeking public funding, at least at first.
“I’m confident we can find private funding,” he said. “I’m not at liberty to disclose where it would come from.”
There’s also federal “crackhouse” laws to work around. Attorney General Jeff Sessions already threatened to squelch a safe consumption proposal in Vermont.
Wheelock said strong political support is essential before any public agency will take on such a controversial project. The needle exchange received a lot of pushback when Outside In first started it, she noted.
“With the amount of people dying regularly, we’re seeing more acceptance of creative solutions,” Wheelock said. “The science is clear that they’re helpful in keeping people alive. Drug user stigma is still very, very, very present in our society. It’s going to be about having the political will.”