Safer Consumption Spaces in the US: Expert Q&A

In response to the ongoing opioid misuse epidemic and associated rise in deaths as a result of overdose, there has been an increasing focus on the development of resources to address these issues. Some experts propose that safer consumption spaces (SCSs) should be included in such effort. These are defined as “protected places used for the hygienic consumption of pre-obtained drugs in a non-judgmental environment and under the supervision of trained staff,” as stated in a press release about a recent report by AIDS United and Project Inform regarding efforts to implement SCS in the United States.¹

According to various research findings, the benefits of SCSs include reduced overdose-related deaths, infectious disease transmission, and hospitalizations, as well as increased healthcare engagement and cost-effectiveness.² In Vancouver, Canada, for example, there was a 35% reduction in the rate of overdose deaths within 500 meters of a SCS, and up to 57 HIV infections are prevented each year because of one SCS there. In addition, these programs have not been shown to increase drug use or crime, as opponents have suggested.²

If the response to the opioid crisis is “limited solely to traditional investments in treatment and law enforcement, it will ultimately fail to adequately address the complex health and psychosocial needs of people who use drugs,” as noted in the report itself.² However, the United States government has historically opposed harm reduction approaches, including syringe services programs, and the US Department of Justice has threatened legal consequences for the establishment of a SCS. Certain jurisdictions in the US already have legal strategies underway to defend the legality of SCSs as they prepare to legalize this resource.²

As such, AIDS United and Project Inform are “calling on private philanthropy to step in and support organizations working to implement and legalize these life-saving services,” the report authors wrote.²

For a clinician perspective regarding SCSs, Infectious Disease Advisor interviewed Jessica Meisner, MD, MS, postdoctoral fellow in the Division of Infectious Diseases at the Hospital of the University of Pennsylvania, whose areas of focus include the intersection of the opioid epidemic and infectious disease.

Infectious Disease Advisor: What are some of the main points of debate regarding the implementation of SCSs?

Dr Meisner: The main argument around these spaces is, “Are we condoning people’s drug use?” I have talked to a lot of people who feel that it condones the behavior, and even encourages it. My argument is that opioid use disorder is a chronic medical disease, similar to diabetes or hypertension, and that someone can’t become sober if they die from an overdose. This is a very marginalized patient population, and because of stigma, bias, and negative experiences, these patients often don’t come into contact with the healthcare system until they overdose or become incredibly sick. A SCS would keep them safe while giving them the opportunity to access more resources, including behavioral health and basic medical care.

Vancouver’s Insite is a great example of how this works and saves lives.³ They have statistics that demonstrate not only lives saved using naloxone but also how many referrals have been made for medication-assisted treatment or behavioral health.