A new study co-authored by Johns Hopkins public health researchers suggests installing one 13-booth safe injection facility for Baltimore’s drug users could save millions of dollars.
Installing such a location, called a “safe injection facility,” in the city could cost approximately $1.8 milion per year, but would generate a projected $7.8 million in savings from expenses on overdose deaths, treatment costs for HIV, Hepatitis C and other infections and costs associated with ER visits and ambulance calls, to name just a few areas.
Susan Sherman, a professor in the Johns Hopkins Bloomberg School of Public Health, conducted the cost-benefit analysis study with three colleagues from the Bloomberg School and researchers from the University of British Columbia, the Criminal Justice Policy Foundation and the Law Enforcement Action Partnership (LEAP). (The latter two are national nonprofits advocating for drug policy reform shifting away from War on Drugs-style policing.)
Sherman wrote the Abell Foundation’s February report touting safe injection facilities as a viable public health solution for Baltimore’s raging drug-use epidemic. The report suggested installing two safe-injection facilities on the East and West sides could save the city money, prevent overdoses and get more people into drug treatment programs.
The new study, published this month in the Harm Reduction Journal, explores how such facilities could cut costs based on a model used in British Columbia. A facility there called Insite has 13 booths available to users of heroin and other injectable drugs to partake in their vices, with medical staff standing nearby to administer Nalaxone and any other necessary medical treatment. They offer sterile needles to mitigate spread of diseases and infections and provide condoms for safe sex and outreach referral for addiction treatment, among other services.
By the authors’ calculations (rounded up), an Insite-like facility in Baltimore could prevent six overdose deaths, four HIV infections, 21 Hepatitis C infections and 374 hospital days for skin and soft tissue infections per year. The annual benefits from preventing overdoses for medical staff and patients, they say: About 108 fewer ambulance calls, 78 fewer emergency room visits and 27 fewer hospitalizations.
“We conclude that a SIF would be both extremely cost-effective and a significant public health and economic benefit to Baltimore City,” the authors conclude.
The projected $6 million net savings figure – equal to more than a quarter of the Baltimore City Health Department’s harm reduction and disease prevention budget, they write – would depend on operating and regulation costs, coordination with other agencies serving drug users, potential underestimations of medical treatment expenses and other variables.
“Since there are no actual regulations, guidelines, or actual physical plans for a SIF in Baltimore, we can only make a conservative guess at facility cost,” the study notes.
However, even accounting for over- and under-approximations for six different criteria, the study says the net savings from having such a facility would range from about $4.5 million to nearly $7.5 million.
The proposal to let drug users legally use has its detractors. City residents worry the facility would bring increased drug use and crime to their neighborhoods, similar to what communities have seen with methadone clinics.
Baltimore County Del. Dan Morhaim proposed allowing safe injection facilities in Maryland during this year’s and last year’s General Assembly sessions, though the bills didn’t get very far in either case, and Gov. Larry Hogan told WBAL year he thinks the idea is “absolutely insane.”
Speaking with Baltimore Fishbowl in February, City Health Commissioner Leana Wen said she wants her department to have “every evidence-based tool at our disposal to combat this epidemic of opioid overdose deaths,” but said that Baltimore would need legal approval from city lawmakers and federal authorities. “As of now, it is a hypothetical conversation that depends on the interpretation of federal law by a new presidential administration.”
That’s not happening with Attorney General Jeff Sessions at the helm of the Department of Justice. Earlier this month, Sessions issued a memo to all federal prosecutors reinstating War on Drugs-era policies of pushing mandatory sentences for drug offenses. The move reversed an Obama-era change that reduced federal attention to drug-related crimes, which the president noted has disproportionately targeted minorities and created swollen jail populations over the last several decades.
Advocates for safe injection facilities say federal resources could be put to better use while cities pilot the strategy already used in 66 cities in 11 countries.
“Police have to deal with people who inject drugs on a daily basis for overdoses, ambulance calls, and public drug use,” said LEAP executive director Neill Franklin, a former Maryland state trooper and Baltimore police officer, in a statement. “A [safe injection facility] would put this issue into the capable hands of public health experts and let officers focus on finding and arresting dangerous criminals and helping victims.”
