Are Prescription Heroin and Safe Injection Sites the Key to Slowing the Opioid Crisis?
A painkiller addiction often starts with a doctor over-prescribing drugs – whether it be to the user his/herself or a family member that leaves the pills accessible. In many cases, painkiller addiction is unintended. Getting addicted to pain pills has become a societal problem, and the need for diverse solutions is becoming increasingly evident.
What is the State of the Opioid Crisis in the US?
The opioid crisis in the US reached new heights in 2017. The preliminary data from last year shows there there were 17% more deaths from drug overdoses between May 2016 and May 2017 compared with the previous year. Drug addiction is the leading cause of death among Americans younger than 50 – surpassing car accidents and gunshot wounds.
Opioid addiction, heroin addiction and other types drug addiction are diseases, not just bad health choices that can be reversed on a whim or dropped. With this in mind, society needs to continue to work on developing solutions to the opioid epidemic that don’t rely on prison and forced detox as the leading methodologies. Sustainable solutions to the opioid epidemic will require policymakers to view the issue through a public health lens. A heroin addiction affects everyone – not just the addict.
What is Innovative Harm Reduction?
Innovative harm reduction plans bring humanity back into the problem solving equation. Simply criminalizing drug use and branding it as a moral failure on part of users does absolutely nothing to abate the opioid epidemic. Harm reduction encapsulates the idea that people who abuse drugs are going to use them despite how much treatment is available and no matter what preventive measures are taken in the first place to deter them. If the system wants to avoid having people addicted and subsequently dying from drugs, one of the best options of to mitigate the risk that comes with using these drugs. These innovative harm reduction ideas are taking the place of methadone, suboxone, and medication assisted treatment.
Often, the very causes of drug addiction are the same things that work against addicts moving toward recovery. Part of what can fuel perpetuated opiate addiction is simply a lack of access to treatment options. Another major factor contributing to heroin addiction is mental illness. People who mental illnesses who abuse drugs often turn to these substances as a mean of self-medicating. Innovative harm reduction programs take these realities into account.
What Are the Benefits of a Safe Injection Site?
One example of a successful innovative harm reduction initiative is a safe injection site. Safe injection sites are legally-sanctioned facilities where users of intravenous drugs can inject pre-obtained drugs under medical supervision. These facilities are designed and intended to lower the health and societal repercussions associated with injection drug use.
The are several benefits offered by safe injection sites. Personnel at these sites provide sterile injection equipment, pamphlets and other information sources about the reducing the harms of drugs, including:
- Healthcare options
- Treatment referrals
- Access to trained medical staff
- Hygienic amenities and other related services
Available evidence about these facilities supports the idea they help to reduce the risk for HIV and hepatitis transmission, can prevent overdose deaths, lower public injections, lower the number of discarded syringes and increase the amount of people who end up entering a drug treatment facility.
What Are the Benefits of Prescription Heroin?
The benefits of prescription heroin, known as diacetylmorphine, have been documented through different investigations over the last few years.
The findings of one study, published in 2012 in the Canadian Medical Association Journal, found that treating heroin addicts with prescription heroin is more cost-effective than using methadone maintenance treatment. Methadone is used to reduce withdrawal symptoms for people going through detox from opiate addiction. It helps to reduce physical dependence because it contains opiates. The researchers found that patients treated with methadone therapy cost society about $1.14 million, while people treated with medically-prescribed heroin cost society $1.09 million.
These savings were primarily due to higher quality-adjusted life years (QALY) as well as lower amounts of criminal activity. People who received prescription heroin saw 7.96 more QALY, while people who received methadone saw just 7.46 more QALY.
“Our model indicated that diacetylmorphine would decrease societal costs, largely by reducing costs associated with crime, and would increase both the duration and quality of life of treatment recipients,” writes study leader Dr. Aslam Anis, professor at the University of British Columbia school of population and public health, and his co-authors. “Because opioid users commit less crime and have lower rates of health care use and death while in treatment, the benefits in cost and health utility attributable to diacetylmorphine stemmed chiefly from its capacity to retain patients in treatment for longer periods than with methadone maintenance treatment.”
Patients treated with prescribed heroin are more likely to stay in heroin rehab once they seek treatment or stop using heroin altogether when compared with people treated with oral methadone. Lower levels of use and criminal activity ultimately benefit society as a whole.
Can Prescription Heroin and Safe Injection Sites Help Abate the Opioid Epidemic?
Right now there are nearly 100 facilities around the world in places that serve as safe injection sites, but there are a few cities in the US that are in talks to establish city-sponsored sites – chief among them, Philadelphia. Top Philadelphia officials are calling for the city to be the first to sponsor such innovative harm reduction plans. They recognize that most research projects on the subject say harm reduction innovation programs reduce the rates of lethal overdose and don’t lead to higher levels of crime.
Unfortunately, evidence-based studies are unable to change everyone’s mind. One of the big barriers facing prescription heroin, safe injection sites and other innovative harm reduction programs is community backlash. Many people who live in the epicenters of the opioid epidemic want to see the problem completely erased from their streets. The general consensus is that they don’t want to see people overdosing or shooting up in public spaces like bathrooms and alleyways. They’re afraid that creating centers for people to go to for heroin, even safe heroin, still creates areas of congregation for drug use and potential for interaction with themselves or their children. This is built on the common belief that drug abusers are dangerous, but stronger public education efforts can help to quell concerns and lead communities down the path of allowing such programs to exist.