For a long time, the War on Drugs promoted a total ban on controlled substances, from just saying “no” to labeling those with chemical dependencies as monsters and failures, especially if they relapse after being sober. At the time, experts thought that these tactics would scare children into shunning drugs, and that society at large would regard clients with substance use disorder with horror.

The War on Drugs has changed since these early years. In part, these old tactics simply haven’t worked. According to the CDC, over 1 million people have died since 1999 due to opioid overdose, and these rates continue to escalate regardless of how many kids simply say “no.” The trends of designer drugs like ecstasy and synthetic drugs like K2 and gravel have, like their names suggest, caught on with younger generations who see them as hip.

Clearly, shaming controlled substances and their users hasn’t worked. In fact, stigmas simply drive many users underground, where they take drugs in isolation, swap dirty needles, and inject drugs without anyone present to make sure they’re ok. The result? More trips to emergency centers, more deaths, and more grieving families. This is the core philosophy behind harm reduction practices to winning the long-term war on drug use.

What are Safe Injection Sites?

Activists have sought inventive ways to bring injury and fatality down. Safer injection sites have especially caught on among many local communities. Starting in Rhode Island in 2021, state and local officials have erected centers to provide a safe environment for clients to take drugs. Licensed physicians monitor clients, provide sterile syringes, wound care, and other material, and offer counseling and referral services. The staff provides a judgment-free zone, and users can come and go as they please.

To be clear, not everyone can open a safer injection site. Interested parties must navigate a maze of regulations regarding staff training, client information and privacy laws, and overdose prevention planning to make sure that the site’s operation aligns with federal and state substance abuse laws and medical ethics. For instance, New York City’s safe injection site regulations mandates strict procedures for distributing, using, and disposing of dirty syringes, prescribing medications, and making sure that patients don’t come to further harm. The last point has become a major controversial sticking point.

Are Safe Injection Sites Really Safe?

The idea of a safer injection site might seem counterintuitive. Individuals who have grown up in the War on Drugs might have a hard time accepting government funds directed towards helping clients “shoot up.” Critics have argued that safe injection sites actually promote drug use, make it seem okay if someone relapses, and make communities more dangerous.

The medical ethics involved are no doubt complex. Technically, safer injection sites are illegal. According to 21 U.S. Code § 856, commonly called the “Crack House Statute,” knowingly opening and maintaining a site where controlled substances are sold and used are illegal. In 2021, the Third Circuit Appellate Court ruled that anyone who operates a safe injection site violates this statute and has committed a federal crime. The court reasoned that anyone who went to a site would probably do so to take drugs, which would undermine the statute’s purpose to decrease drug use and to keep communities safe.

The court’s ruling shows how many people, from lawmakers to the public, continue to regard any type of substance use as automatically dangerous. However, advocates of safer injection sites have pointed out that supervising drug use, rather than stigmatizing it, can actually help make communities safer.

Do Safer Injection Sites Increase Drug Use?

As for the clients themselves, whether considering addiction management for the first time or having relapsed, a supervised environment helps them avoid overdosing, feeling shame that propels their substance use disorder, and becoming violent. In addition, many clients receive counseling and support from clinicians and site therapists. One study has pointed out that clients who patronize safer injection sites become more inclined to enter treatment and commit to their programs.

Do They Reduce the Number of Overdoses?

Currently, safer injection sites occupy a gray area in the law and in society. Many states that operate these sites do so under the same laws that have made marijuana legal. Just as clients might legally smoke weed, they can also take controlled substances, as long as they stay clear of federal laws. And the practice of using injectable drugs in a controlled environment, where clients may be monitored and receive immediate aid as needed, significantly reduces the client’s risk of accidental overdose.

Needle Exchange and HIV/Hepatitis Prevention

Safer injection sites typically include needle exchange services to equip clients with sterile syringes and safely dispose of used needles. This significantly reduces clients’ risk of contracting blood-borne illnesses, such as HIV and hepatitis. In addition, clients’ risk of developing serious and even life-threatening wounds from the use of dirty needles is substantially decreased.

American Family Physician cites many studies that show that a safe environment discourages clients from taking drugs in public spaces, such as parks. Not only do clients stay out of sight from judging eyes, they can safely dispose of their dirty syringes and bandages, which decreases the chances that a child or passerby might accidentally prick themselves and contract and potentially spread HIV, hepatitis, or other infectious diseases.

Do Safer Injection Sites Increase the Cost of Addiction Treatment?

Safer injection sites have made cities safer, not more dangerous. For critics who object to taxpayers funding these sites, international studies in Vancouver and Sydney have shown that the reduced costs in medical emergency services, disease outbreaks, and police services have generated $2.33 savings per each dollar spent. In the United States, officials in Baltimore and New York City estimate that taxpayers would save millions by lowering the numbers of people overdosing on opioids.

The idea of safer injection sites remains morally fuzzy. Should society help people with substance use disorder take drugs in order to wean them off? People remain understandably uncertain about lessening the stigma around drugs. It goes against years of learning to just say no. But given the alarming rates of overdoses, fatalities, and grief, drastic times might call for drastic measures. For many public officials, doctors, and family members, the alternative of staying the course has a price too high to pay.