“Safe Drug Spaces” Make Sense Only When Coupled with Addiction Interventions

In almost forty years of working with people to help them overcome an addiction, I have witnessed countless times the most painful loss a family can imagine, the loss of their loved one to a fatal and preventable overdose. The grief that haunts those left behind can echo for generations.

I have also seen the best that treatment and recovery have to offer: lives saved, children reunited with parents, and recovered men and women dedicating themselves to lifting others out of the hopeless pit of addiction.

As our nation follows the lead of many other countries in creating “safe drug spaces,” with the first to open in Rhode Island in March, there’s a bit of a ‘tug-of-war’ between my head and my heart.  My head knows that evidence shows that this practice works.  It allows drug users to be monitored and potentially revived if they imbibe a fatal dose.  But my heart feels that the miracle of recovery can only really begin when substance addicted individuals pursue abstinence, and safe drug spaces may instead encourage them to prolong their use.

Safe Drug Spaces are Supervised Heroin Injection Sites

We need to be clear that these are sites where clean needles are provided, intravenous injection of heroin will be encouraged, and potentially fatal overdoses counteracted with the ‘miracle drug’ Narcan.   This is graphic, and for most, disturbing.  Wherever the legislation is proposed for the creation of safe drug spaces, angry letters to the editors appear in local newspapers objecting to the use of tax dollars toward this end.

However, this practice needs to be considered next to the alternative, which is the lonely death of the drug user in secrecy, or the transmission of HIV from the sharing of a dirty needle.  Obviously, there’s no coming back from a fatal overdose, and our nation is in the grip of an overdose epidemic fueled by the confluence of fentanyl availability and the isolation and despair caused by the COVID-19 pandemic.  Many of these overdose deaths could have been reversed with the timely dispensation of Narcan.

Safe drug spaces are a prime example of the “harm reduction” strategy of treatment which, in short, aims to keep drug users alive long enough to give them an opportunity to achieve recovery. The evidence shows that where harm reduction strategies are employed, there is a decrease in death by overdose.

Addiction is Complex and Counterintuitive

The user’s loss of willpower over the addiction needs to be considered when decisions about safe drug spaces are being made.  But, unless you have experienced addiction first hand, it’s nearly impossible to understand that it’s not a personal choice.  According to the National Institutes of Health, 10% of Americans suffer from a  substance use disorder (SUD), so that means that about 90% of Americans will have never experienced being physically and psychologically dependent on a substance.

During the progression of the disease of addiction, choice is lost.  This has to do with brain chemistry and our survival instinct.  When we experience withdrawals from an addictive substance, our primitive mid brain equates getting more of the drug with survival and hijacks the decision making process from our frontal cortex, where rational thought occurs. The results can look to others like a depraved and selfish addict who would do anything to experience another high.

I can tell you as someone who has helped recovering mothers fight to get custody their children back from the legal system (and sadly, some are never able to achieve this), that even the most basic human instinct of caring for a child can fall by the wayside when addiction takes hold.  Undoubtedly, the vast majority of active drug users wish they could stop, but don’t have the necessary support system to  do so. This is where safe drug spaces can truly make a difference.

The Goal of Safe Drug Spaces Should Be an Intervention on the Drug Use

Users who partake in safe drug spaces should be required to complete some step to bring them closer to pursuing abstinence-based recovery.  That can be as simple as completing a questionnaire that confirms they are aware of what programs are available to help them. Or, more ideally, they would engage in a brief counseling session with a drug counselor.

We need to make sure that these ‘at-risk’ individuals know that help is available and now is a great time to pursue recovery.  Treatment is more effective than ever, and it’s also more comfortable.  There have been great advancements in medications, like buprenorphine, which reduce the cravings and withdrawals of those who are giving up opiates.  When this type of medication assisted treatment (MAT) is coupled with counseling and participation in support groups, outcomes are excellent, in some studies greater than an 80% success rate..

Every user who enters a safe drug space needs to be made aware of these options and given ample opportunity to pursue recovery with as much support as we can possibly afford. Otherwise, we risk prolonging the root problem by providing the setting for them to use the drug unfettered.

About the Author

Scott H. Silverman has been helping men and women recover from addiction for almost 40 years. He is the CEO of Confidential Recovery, a treatment program in San Diego that specializes in helping executives, veterans, and first responders recover from an addiction to drugs or alcohol.

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