Study: Safe Spaces for Drug Use Could Save Millions Annually

The opioid epidemic has resulted in a record number of overdose-related deaths and countless cases of opioid misuse disorder. Throughout the country, numerous needle exchanges have been opened to combat diseases associated with injection drugs, such as HIV and hepatitis C virus (HCV).

While these places allow injection drug users to trade used needles for clean, new ones, individuals are not able to take part in drug use in the facility.

A new cost-benefit analysis published by the Harm Reduction Journal discovered that opening a facility in Baltimore, MD, in which individuals could safely use drugs could save more than $6 million. The hypothetical facility was also observed to reduce deaths, HIV, HCV, ambulance calls, and hospitalizations, while increasing treatment uptake among this population, according to the authors.

Monitored “safe consumption” spaces provide an indoor facility where individuals can use drugs in the presence of medical professionals that can reverse potential overdoses. While illegal in the United States, these facilities have been implemented in various cities globally, especially in Europe.

The facilities can also be used to connect patients with substance use disorder treatment, healthcare, and housing, according to the study.

"Today, thousands of Baltimoreans are risking their lives to inject drugs instead of seeking treatment,” said lead study author Amos Irwin, MA. “We estimate that more than 100 new people would enter treatment every year if the city had a supervised injection facility. Bringing these people into a safe space actually helps reduce drug use, not increase it."

These findings add to mounting evidence that links safe consumption spaces to a decrease in overdose-related deaths and an increase in treatment, according to the authors.

The facilities can offer a new approach to control the opioid epidemic at a critical time in the United States. Last year, there was a record number of deaths related to fentanyl, which is significantly more potent than heroin. In Baltimore, fentanyl is largely being added to heroin.

"No one has ever died from an overdose in a safe consumption space," said senior study author Susan G. Sherman, PhD, MPH. "Thousands of lives have been saved. There are lots of doors people can walk through when they are addicted to drugs. We want them to walk through a door that may eventually lead to successful treatment -- and keep them alive until they are ready for that."

In the study, the authors examined costs of operating a safe consumption facility in Vancouver, Canada, and projected the impact of the facility based on data from Baltimore.

They found that operating a 1000 square foot 13-booth space in Baltimore for 18 hours per day would cost $1.8 million annually, according to the study. The Vancouver facility provides a safe space for 2100 individuals who partake in approximately 180,000 injections annually in the same size space.

Based on data from the Vancouver facility, the authors project that a facility in Baltimore would save $7.8 million. Additionally, the space would prevent 4 new cases of HIV, 21 new cases of HCV, 374 days of hospitalization for soft tissue infections, 6 overdose-related deaths, 108 overdose-related ambulance calls, 78 visits to the emergency department, and 27 overdose-related hospitalizations, according to the study.

The authors also estimated that 121 individuals would seek treatment for substance misuse disorder.

"Six million dollars is a lot of money for one facility to save," Dr Irwin said. "It is almost a third of Baltimore City's entire budget for HIV, sexually-transmitted infections, and substance abuse treatment and prevention."

This year, a bill that would allow safe consumption spaces was voted down by the Maryland General Assembly; however, the Massachusetts Medical Society issued a recommendation last month about creating the spaces.

In March 2017, Maryland Gov Larry Hogan signed an executive order that declared a state of emergency regarding the opioid epidemic, highlighting the desperate need for new approaches.

The authors wrote that many drug users are using illicit drugs on the street or in abandoned houses, which leaves them vulnerable to violence, arrest, or overdose-related death. Creating safe facilities would provide individuals with a clean environment and clinical supervision. These facilities prohibit sharing or selling drugs, so they do not condone illegal behavior, according to the study.

"We know what doesn't work when it comes to the so-called 'War on Drugs' in the United States because we have an opioid epidemic that is only getting worse," Dr Sherman said. "The stakes are even higher now with so much heroin and other drugs adulterated with fentanyl. You can keep doing what you are doing or you can try something that has been proven by evidence and is considered usual care in a dozen nations."