Seattle and King County have helped persuade the American Medical Association to endorse safe drug sites, in a roundabout way.
On Tuesday, the AMA voted to endorse pilot supervised drug consumption sites as part of a larger public health response to the rise in opioid use and overdose deaths during the past two decades.
“Studies from other countries have shown that supervised injection facilities reduce the number of overdose deaths, reduce transmission rates of infectious disease, and increase the number of individuals initiating treatment for substance use disorders without increasing drug trafficking or crime in the areas where the facilities are located,” reads an AMA press release.
Also called safe drug sites, supervised injection facilities (SIFs), or community health engagement locations (CHELs), the sites allow consumption of illicit drugs under medical supervision, with staff for drug treatment and other services on-call to any user who accepts them. Some are injection-only, while others allow smoking and other methods of ingestion. Seattle and King County each plan to implement a pilot safe drug site based on a series of recommendations from an opioid response task force.
Among the most influential sources of evidence underlying the AMA’s vote was a report released in April by the Massachusetts Medical Society which concluded that “rigorous” evidence shows that safe drug sites “achieve positive outcomes” including fewer lethal drug overdoses. The report also found evidence suggesting safe drug sites lead to more access to drug treatment, less spread of bloodborne diseases, less drug-related litter, and fewer complaints about public drug use and no increase in crime in surrounding areas. Because there are no current above-ground safe drug sites in operation in the United States, most of the evidence on their efficacy comes from studies of sites in other countries, including InSite in Vancouver, B.C.
But the Massachusetts report also considered the political realities of trying to implement such sites, even on a pilot basis—and that’s where Seattle and King County come in. The MMS report cites Seattle, New York City, and San Francisco’s attempts to create pilot sites as evidence that there is currently an “opportunity” to turn safe drug sites into a political reality: “In September 2016, King County (Seattle, Washington area) Task Force on Heroin and Prescription Opiate Addiction, convened by the mayor of Seattle, recommended two SIFs open in Seattle and just outside the city. The sheriff of Seattle [sic] supports the recommendation” (King County Sheriff John Urquhart and Seattle Chief of Police Kathleen O’Toole both support the sites).
“A growing number of U.S. cities are exploring SIFs to address the growing opioid crises in their cities and communities,” the report adds, before urging the Massachusetts legislature to follow suite.
Dr. Jeff Duchin of Seattle/King County Public Health, who co-chaired the opioid task force, responded to the AMA endorsement. “The endorsement by the American Medical Association to establish and evaluate supervised injection facilities acknowledges the recommendation by our local Task Force,” he said, according to a press release. “The available evidence shows these sites should be included, along with treatment expansion and other prevention measures, as a strategy to combat the epidemic of heroin and opiate drug addiction and overdose deaths in Seattle & King County.”
Seattle and King County are currently deciding where to locate their pilot safe drug sites. However, there is no timeline for completion.
There is also an effort to block the sites from opening. In May, a group calling itself Citizens for a Safe King County began collecting signatures for an initiative to ban such sites in the county. As of last week the group said they had about half the signatures they needed to make the ballot.