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Will NYC Legalize Safe Injection Facilities for Drug Users to Reduce HIV and Overdoses?

October 30, 2015

Will NYC Legalize Safe Injection Facilities for Drug Users to Reduce HIV and Overdoses?

Will New York City become the first first U.S. city to allow supervised injection facilities (SIFs) for injection drug users?. Hundreds of people, including public health and HIV advocates, filed into the wooden pews of the Unitarian Church of All Saints on Manhattan's Upper West Side to hear four high-profile experts from around the world relay strategies and battle stories from their successful fights to implement SIFs in their respective countries.

"It was a hard road," said Tony Trimingham, who led the effort to establish Australia's first SIF after he lost his son to a heroin overdose in 1997. "But there are not actually that many opponents, they just have very loud voices. Most of the general public is not for or against it, but if you can advocate and make them aware of the issues through stories like mine, they will vote yes."

Globally, at least 98 SIFs exist in 66 cities in ten countries, with France recently approving four. Numerous scientific papers have shown that these facilities drastically reduce the likelihood of drug overdoses, slash transmission of HIV and hepatitis C, and increase the likelihood that people who inject drugs' (PWID) will seek out detox services. SIFs also greatly reduce the number of used syringes cluttering city parks and streets and the rate of crimes associated with drug use, such as carjackings and muggings -- all while saving cities millions of dollars a year in averted health care costs.

Across the U.S., heroin and opioid use is surging, with the national rate of heroin overdose deaths nearly quadrupling between 2002 and 2013. HIV outbreaks attributed to injection drug use have occurred in rural areas such as southeastern Indiana and northern Kentucky, which have never before confronted a large-scale epidemic and have few resources to combat rising rates of infection. And everyone from New Jersey Governor (and presidential candidate) Chris Christie to Time magazine's editors has proclaimed that the country needs to confront this raging opioid epidemic. Nevertheless, nearly three decades after the first SIFs opened their doors in Europe, and despite overwhelming evidence of their public health and economic utility, not a single SIF exists in the U.S.


"Someone in this country has to break the seal and, as soon as they do, it will get a huge amount of attention," said Matt Curtis, policy director at VOCAL-NY, one of the coalition members leading the SIF NYC campaign. "It will be controversial, but it will elevate the conversation around this issue throughout the country."

Curtis says that, due to a confluence of factors, now may be the perfect time to finally break that seal in New York City. Drug overdoses in NYC have risen 40% since 2010, and new HIV infections attributed to injection drug use reportedly cost the city nearly $10 million a year. Homelessness is at an all-time high, with over 60,000 people sleeping in city shelters on any given night and a record 116,000 different persons spending at least one night in a shelter in fiscal year 2014.

PWID without stable housing are much more likely to inject in public, which SIF NYC says doubles their chances of overdose and quadruples the odds that they will reuse syringes. According to two recent studies, over half of NYC PWID visiting syringe-exchange programs have recently injected in a public or semi-public place, and over half of surveyed small business owners reported having encountered people using drugs in their bathrooms.

The current political climate is another factor influencing the timing of the launch. The city's current administration, led by Mayor Bill de Blasio, stopped arrests for possession of small amounts of marijuana in 2014 and seems more amenable to harm-reduction solutions than previous administrations. In addition, as part of Governor Andrew Cuomo's plan to end AIDS in New York State by 2020, he convened a task force of 63 HIV experts to design a blueprint for ending the epidemic. It includes a call to implement SIFs in New York state.

"I think it is really important that the Governor endorsed the entire Blueprint," says Curtis. "However, he is not out there saying we need SIFs, and getting them is going to require a lot of additional education and outreach among elected officials, the public and the media."

During the SIF NYC panel, which was hosted by the Open Society Foundation and moderated by Amy Goodman from Democracy Now!, each speaker noted two key components of how SIF NYC -- and groups in other cities -- can successfully fight for SIFs. One, enlist the support a spectrum of societal sectors, including community organization, families of drug users, health care professionals, and whenever possible, police officers and religious leaders. Two, "raise a little hell," in the words of Senator Larry Campbell, a former Vancouver mayor whose election platform included a promise to open an SIF.

Trimingham told the story of how, after the Sydney city government refused to act when SIF legislation was introduced, his coalition "raised hell" by establishing a safe-injection room in a church. It was promptly raided by police, resulting in widespread media coverage and the arrest of the resident minister. The SIF was soon approved.

Liz Evans, the co-founder and former executive director of PHS Community Services Society, which provides housing and other services to drug users in Vancouver's poorest area (where the SIF Insite is also located), discussed the media friendly campaigns and protests it organized, including building hundreds of coffins. She shared the evidence of Insite's success in reducing the number of public injections and discarded needles and in improving PWID's health, leading to 76% approval ratings for Insite across Vancouver in 2007, just four years after it opened.

Werner Schneider, an author of the four pillars of harm reduction strategy (harm reduction, prevention, treatment, enforcement) -- now used as part of harm reduction efforts internationally -- discussed his work spearheading the effort to establish the first SIF in Frankfurt, Germany, in the 1990s. "At the time, HIV and hepatitis C were out of control and tuberculosis was coming back in the area of the city with the biggest drug scene," he said. "Hundreds of PWID were dying in the parks and stairways and alleys of downtown Frankfort. Today, drugs and drug-related problems are not seen as a major problem. In fact in polls, they rank around the need for more bicycle lanes and the operating hours of the public library."

The day after the Upper West Side event, Curtis escorted the four experts to meet with NYC council members and other officials to introduce them to the campaign. Curtis and SIF NYC have also been screening a documentary, Everywhere But Safe: Public Injecting in New York, produced by Curtis and Taeko Frost, in Albany (including at the State Department of Health) and at various NYC venues (including the New York Academy of Medicine). He reports that, since they released the film, colleagues from cities around the U.S. have contacted them to learn how they can start similar efforts to establish SIFs in their cities. In San Francisco, advocates are already mounting an SIF campaign like the one in NYC.

"Here in the United States, we are so far behind, and my community is sick of being treated like third class citizens," said Tyrell Jones, a member of VOCAL-NY and former drug user, at the start of the Q&A session. "We the people have the power, but we have to use it. We will be mobilizing."

Lucile Scott is a writer living in Brooklyn, New York, who has written extensively about the global and domestic AIDS epidemics for POZ magazine and organizations including amfAR and Housing Works.

Copyright © 2015 Remedy Health Media, LLC. All rights reserved.

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