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Harm Reduction
Summary
“‘There is a lot of evidence that interventions of this type generally do not have an appreciable effect on overdose deaths,’ Lehman told CBS News. ‘There’s a fixed pool of resources available for helping people who are dealing with substance use disorder. If you’re spending the dollars on an intervention that doesn’t work, like supervised consumption sites … you’re not spending dollars on [addiction medication] and evidence-based treatment.‘
Commentary
Lehman is wrong. We do have evidence that supervised consumption facilities (SCFs), also referred to as overdose prevention centers (OPCs) or overdose prevention sites (OPSs), have appreciable effects on overdose deaths.
From Kennedy et. al (2017):
“Consistent evidence demonstrates that SCFs mitigate overdose-related harms and unsafe drug use behaviours, as well as facilitate uptake of addiction treatment and other health services among people who use drugs (PWUD). Further, SCFs have been associated with improvements in public order without increasing drug-related crime. SCFs have also been shown to be cost-effective. This systematic review suggests that SCFs are effectively meeting their primary public health and order objectives and therefore supports their role within a continuum of services for PWUD.”
From Levengood et. al (2021):
“Supervised injection facilities in the included studies (n=number of studies per outcome category) were mostly associated with significant reductions in opioid overdose morbidity and mortality (n=5), significant improvements in injection behaviors and harm reduction (n=7), significant improvements in access to addiction treatment programs (n=7), and no increase or reductions in crime and public nuisance (n=7).”
From Potier et. al (2014):
“Seventy-five relevant articles were found. All studies converged to find that SISs were efficacious in attracting the most marginalized PWID, promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency. SISs were not found to increase drug injecting, drug trafficking or crime in the surrounding environments. SISs were found to be associated with reduced levels of public drug injections and dropped syringes. Of the articles, 85% originated from Vancouver or Sydney. Conclusion: SISs have largely fulfilled their initial objectives without enhancing drug use or drug trafficking.”
What is true is that we don’t have enough studies that test whether these sites lower population-level overdose mortality rates, as the evidence we do have is limited and inconsistent. But the goal of these sites is not just to save lives, which we know it does on-site even if the users experience a fatal overdose at a later point in life. It also serves as an access point to the very medical services Lehman is suggesting we spend money on, and it draws users away from public locations towards a designated place with supervision. Studies show it succeeds at these, which is not something we can say for prohibition, mass incarceration, or the War on Drugs. As time goes on, we might find that they can reduce overdose death rates for the population as well. We do know that there is no observable increase in crime or trafficking as a result of these sites, so the fears about drug dealers using these sites as a base to find more customers is unfounded.