A new report published by the Baltimore-based Abell Foundation suggests the city take a page out of other countries’ books and establish designated drug consumption spaces in East and West Baltimore to reduce overdoses, HIV infections and crime and promote addiction treatment.
The report, written by Johns Hopkins University Bloomberg School professor Susan Sherman, defines safe consumptions spaces (SCSs) as designated areas where drug users can inject, smoke or snort substances. At each site, medical and case management staff and former drug users supervise the people inside, offering them sterile equipment and condoms, answering questions about safe consumption practices and, when necessary, administering the life-saving overdose drug naloxone.
They also can refer users to housing, treatment, and legal assistance. They never assist in administering drugs to users, according to the report.
The world currently has nearly 100 SCSs in 66 cities scattered across 11 countries, though only two operate in North America, specifically in Vancouver, British Columbia. Canada is considering implementing more SCSs to battle its scourge of opioid addiction, and Sherman suggests Baltimore – currently dealing with its own deadly rampage of addiction – pilot two of its own SCSs in drug-use hot spots on the east and west sides of the city.
Money would be a major motivation, according to the report. One site in Vancouver generated an estimated $6 million benefit per year in the form of savings on HIV deaths ($500,000 per fatality, in Canadian dollars) and overdose deaths ($660,000 per fatality, in U.S. dollars).
The boon could be even greater for Baltimore, where an estimated 24 percent of drug-injecting users are HIV positive and an 84 percent have Hepatitis C virus, according to the report. In the second half of last year alone, 290 people died from overdoses in Baltimore City, just over half of them from using fentanyl.
The facilities would reduce transmission of diseases with sterile conditions and equipment and overdoses with life-saving treatment options, according to the report. They could also refer more of Baltimore’s addicts to treatment. At one Vancouver site, 57 percent of drug-injecting users started addiction treatment and 23 percent stopped injecting drugs altogether.
Sherman notes in the report that Baltimore County Del. Dan Morhaim – the same legislator undergoing an unrelated ethics investigation in the General Assembly for his involvement in a planned medical marijuana business – proposed a bill last year that would have allowed for the development of SCSs in Maryland. The bill didn’t make it out of committee, but it received some buzz and Morhaim has already reintroduced it this year. The General Assembly would have the authority to enable the creation of SCSs in Baltimore, the report says.
More locally, the report says a mayor, council members or agencies in a given jurisdiction could enact laws allowing for SCSs in designated areas. According to the report, Baltimore City policymakers would have authority to do so under the City Charter, which says the Health Department should “establish and implement policy for the treatment and prevention of physical and mental illnesses,” or via the City Health Code or by calling a local state of emergency.
Baltimore City Health Commissioner Dr. Leana Wen said in an interview that safe injection facilities “are one potential tool that could also be used to reduce overdose deaths,” but added, “as we understand, federal regulations would preempt city rules or health codes about safe injection facilities.”
“We need every evidence-based tool at our disposal to combat this epidemic of opioid overdose deaths, but we also need legal guidance from city, state and federal officials in order to determine the feasibility of safe injection facilities here in Baltimore City,” she said. “Assurance from the Department of Justice is a necessary first step. As of now, it is a hypothetical conversation that depends on the interpretation of federal law by a new presidential administration.”
As Wen alluded to, such spaces would still be violating federal controlled-substances laws by allowing drug use on their premises. The Abell Foundation report says the city could avoid becoming the target of federal legal actions by permitting “community-based organizations or other independent entities” to operate the centers.
In its conclusion, the report again proposes placing a pair of facilities on each side of the city within already-established community-based groups, so as to incorporate an “integrated model” with other services like housing assistance and mental health treatment referrals. It also suggests allowing all methods of drug use – not just injection – and focusing on community education about drug use, engaging the criminal justice system and conducting “rigorous” research on the results, among other ideas.
“SCSs are a cost-effective, necessary part of a comprehensive package of services to reduce the burden of mortality and morbidity among [people who use drugs], and to reduce the painful effects of this crisis on the wider community,” the report says.
