Special Response: Over 100 Researchers and Practitioners Respond to Rod Rosenstein on Safe Injection Sites

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. 

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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

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4 Comments

  1. Before we rush into advocating safe injection sites, let us look at the way we presently treat opioid use disorder (OUD) and ask some hard and uncomfortable questions. On paper, the neurobiology of opioid is well understood and we have three highly effective medications to treat OUD. – methadone, buprenorphine and naltrexone. Only a small fraction of OUD patients receive one of these medication. We have to ask:

    Methadone is often called the ‘gold’ standard for the treatment of OUD. Why is this medication still subject to severe restrictions where patients have to stand in line each morning to receive a daily dose? Why the resistance to change the restrictions? The majority of the methadone clinics offer methadone as the only treatment option. Imagine if the 1500 or so methadone clinics expanded their services and offered all three medications as part of comprehensive services. We probably would not need safe injections sites.

    Buprenorphine is another highly effective and safe medication to treat OUD. This is the only medication that is subject to restrictions on prescribing. As a result less than 4% of US physicians have obtained the DEA-waiver. We are in a major crisis. Why not remove these restrictions on an emergency basis to expand treatment services? This single move would dramatically increase access to treatment.

    The third medication naltrexone was developed to prevent opioid detoxed patients from relapsing when they returned home from residential treatment or incarceration. Its application is even more relevant in the present situation given that we have not succeed in curbing the supply of opioids. Sadly, this medication is barely used and often the subject of criticism.

    Before we rush into the unknown territory of safe injection sites, it makes senses to break down the present barriers that restrict access to evidence-based treatments. Countries like France did it and so can we.

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