Zombie Ideas: Safe Injection Department

Recently, people in Vermont have been talking about launching a Safe Injection Facility (SIF) to address drug harms arising with the opioid epidemic. With more deaths than ever, trying new approaches make sense — especially “new” approaches like SIFs that have two decades of solid international evidence of efficacy behind them.  Several cities are actively considering the same intervention.

One of the biggest barriers is uncertainty about how federal drug control authorities will react.  Although there are reasonable arguments that SIFs for public health do not violate the Controlled Substances Act, and the national opioid task force has broadly called for extraordinary action, there has been no explicit support from the Trump administration and no effort to carve out space in the law from Congress.

Well, we do have a puerile press release from the U.S. Attorney in Vermont. The document is worth reading as a signal from the current administration, but also as a memorial to disproved zombie beliefs about drug policy. Among the arguments for protecting Vermonters from a well-tested  public health measure: SIFs will “normalize” heroin use (like smoking cessation normalizes smoking); that fentanyl brought in by users will endanger the trained health care workers in the site (like it does in cancer wards — better to let the users die on the street); that drug purchases for use in the SIF will sustain and support the global market for illegal drugs (just ask George Schultz how well our drug enforcement efforts have suppressed the global market); and that allowing drug use in SIFs will send the message to Vermont’s children that drug use is okay — wait, that’s the same as the normalization claim.

This is so sad.  Families, communities, policymakers facing overdose and the harms of opioids have done so much to take on the failed drug war mentality and take a humane approach. Practical prosecutors like Philadelphia’s DA Larry Krasner have embraced the SIF innovation.  There is no question that SIFs need to be done carefully, with community support and rigorous evaluation, but to have a U.S. Attorney dig into the barrel of dead ideas and rant about stuff that just isn’t true — in the face of life and death needs — is just sad.  We need practical and open-minded leadership in drug policy.  Leaders, please trust the evidence and the learning process of public health innovation. Don’t be that US Attorney in Vermont.

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