Editor’s Note: This post is in response to an op-ed published last month in The New York Times by Deputy Attorney General Rod Rosenstein, in which Rosenstein argued against supervised injection sites.
Rosenstein’s Op-Ed in the New York Times
In response to the current opioid crisis a number of cities in the United States are considering establishing safe injection sites for users of heroin and other illegal drugs. This is not a new idea. Cities in Canada and Europe currently have them, including a successful program in Vancouver. Safe injection sites provide a place for people to inject illicit drugs under medical supervision. In addition to a clean and warm space, they typically offer sterile injecting equipment and basic healthcare. Many also provide referrals to treatment, housing and other services. Critically, all safe injection sites include trained staff to respond to overdose, leading many experts to refer to them as “overdose prevention sites,” to better reflect this core aim.
In a strongly worded but poorly supported editorial in The New York Times, Deputy Attorney General Rod Rosenstein recently claimed that safe injection sites pose a dangerous risk to public safety and will make the opioid crisis worse. He has offered no evidence for these claims. He has also warned cities, counties and health services that open safe injection sites in the United States that they will be met with “swift and aggressive action” from the Department of Justice.
There is a body of scientific research into safe injection sites, including debates about how their efficacy should be measured, that we need to take seriously. The evidence from this research provides no support whatsoever for Rosenstein’s contentions, including his claims that safe injection sites “destroy the surrounding community,” or send a message to teenagers – or anyone else – that “drugs can be used safely.” Put simply, research does not show that safe injection sites encourage illicit drug use or pose a public safety risk.
Rosenstein’s most striking claim is that safe injection sites increase the risk associated with injecting drugs. This is a baseless assertion that is not supported by either research or common sense. Tens of thousands of people have used Vancouver’s well-known (and closely studied) InSite facility since it opened. Many have overdosed. Nobody has died. To our knowledge, nobody has ever died of an overdose in any safe injection site anywhere in the world. Rosenstein himself says that these sites “stand ready to resuscitate addicts who overdose.” He does not explain why this is somehow objectionable to him.
Rosenstein’s editorial is filled with hyperbole and pejorative rhetoric. It is within Rosenstein’s authority to issue threats, but evidently it is not within his abilities to justify them. Tellingly, he argues that safe injection sites are a bad idea because they are illegal, and are illegal because they are a bad idea. To accept this circular argument not only renders us captive to drug enforcement policies disdained by a growing number of Americans; it also absolves such approaches from ever having to prove their effectiveness.
A diverse group of US and international researchers who study substance use disorders and drug policy have signed this editorial. Our fields of expertise include medicine and psychiatry, public health, public policy, history, social sciences and more. We hold a variety of views on drug policy, and we do not always agree on the causes of the opioid crisis or the best ways to address it. But we do know that our response to this crisis should be based on sound evidence and not inflammatory rhetoric. In view of that shared commitment, we direct the attention of the Trump Administration to research that indicates the importance of healthcare coverage, including that provided by the Affordable Care Act and the Medicaid expansion undertaken as part of that program, in supplying life-saving treatment for opioid use disorder.
The history of the US government’s war on drugs is littered with officials who make evidence-free, strident claims, often at the expense of the most vulnerable people. Along with selective enforcement along the lines of race and class, fear-mongering is one of the drug war’s defining features. Both the scientific method and responsible governance dictate that we do better, and the mounting death toll of the opioid crisis demands it.
Signed:
Kathleen Frydl, Ph.D.
Joseph M. Gabriel, Ph.D.
Damon Barrett, LLM.
Caroline Jean Acker, Ph.D.
Al Alfaro, LMSW, CASAC
Mackenzie Amara, MA
Kenneth Anderson, MA
Stewart Auyash, Ph.D., MPH
Ahmed M. Bayoumi, MD, MSc, FRCPC
Leo Beletsky, J.D., MPH
David R. Bewley-Taylor, Ph.D.
Jade Boyd, Ph.D.
Ilana Breslau, Ph.D.
Lauren Brinkley-Rubinstein, Ph.D.
Scott Burris, J.D.
Thaddeus Camlin, Psy.D.
Nancy D. Campbell, Ph.D.
Jennifer J. Carroll, Ph.D., MPH
Caroline Chatwin, Ph.D.
Amy J. Colley, Ph.D.
John Collins, Ph.D.
Robert L. Cook, MD, MPH.
Ross Coomber, Ph.D
Hannah Cooper, S.M., Sc.D.
Jerry Costley, LCSW
Nick Crofts, Ph.D, AM
Joanne Csete, Ph.D
Denise Angela Cullen, LCSW
Peter Davidson, Ph.D.
Corey Davis, J.D., MSPH
Patt Denning, Ph.D.
Sherry Deren, Ph.D.
Kate Dolan, Ph.D
Timothy Donovan, MSW, LCSW-C
Anne Earle, LMSW, CARC
Nabila El-Bassel, Ph.D.
Sam Friedman, Ph.D.
Jonathan Giftos, MD, AAHIVS
Michael Gilbert, MPH
Paige Guion, RN
Rebecca L. Haffajee, J.D., Ph.D., MPH
Holly Hagan, Ph.D.
Helena Hansen, MD, Ph.D.
Carl Hart, Ph.D.
Jeffrey S. Harman, Ph.D.
David Herzberg, Ph.D.
Timothy Hickman, Ph.D.
Elaine Hyshka, Ph.D.
Scott Kellogg, Ph.D.
Thomas Kerr, Ph.D.
Juline Koken, Ph.D.
Marc LaRochelle, MD, MPH
David Levine, J.D.
Rick Lines, Ph.D.
Lisa Caren Litt, Ph.D.
Jeannie Little, LCSW
Charlie Lloyd, Bsc, MPhil.
Theresa Lopez-Castro, Ph.D.
Brandon DL Marshall, Ph.D.
Bradley Mathers, Ph.D
Ryan McNeil, Ph.D.
Allison McKim, Ph.D.
Kendra McSweeney, Ph.D.
Shannon M. Monnat, Ph.D.
Patricia Moore, Ph.D.
Julie Netherland, Ph.D.
Charles Novak, MS, MLADC
Jennifer D. Oliva, J.D., MBA
Danielle Ompad, Ph.D.
Aaron Orkin, MD, MSc, MPH, CCFP, FRCPC
Wendy E. Parmet, J.D.
Matthew R. Pembleton, Ph.D.
Mical Raz, MD, Ph.D., MSHP
Suzanna Reiss, Ph.D.
Lindsey Richardson, Ph.D.
Khary Rigg, Ph.D.
Samuel Kelton Roberts, Ph.D.
Benita Roth, Ph.D.
Debra Rothschild, Ph.D.
Lipi Roy, MD, MPH
Christopher Ruhm, Ph.D.
Stephen Shoptaw, Ph.D.
Kate Seear, Ph.D
Alex Stevens, Ph.D.
Gerry Stimson, Ph.D.
Claudia Stoicescu, Ph.D.
Heino Stöver, Ph.D.
Steffanie Strathdee, Ph.D.
Carol Strike, Ph.D.
Andrew Tatarsky, Ph.D.
Cristina Temenos, Ph.D.
Sheila Vakharia, Ph.D.
Ingrid van Beek, MD, AM
Alex S. Vitale, Ph.D.
Justine Waldman, MD
Ingrid Walker, Ph.D.
Alex Wodak, MD, AM
Jamie Wolf-Dolan, PsyD
Evan Wood, MD, Ph.D.
Nickolas Zaller, Ph.D.
Tali Zilberman-Neuhaus, MSW