Philly’s opioid crisis

UPDATED: HHS disputes report that nation’s top doc came out in support of safe injection sites

A provided statement says the entire Trump Administration is against this type of “illegal” facility.

Vancouver's safe-injection site was the first to open in North America

Vancouver's safe-injection site was the first to open in North America

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michaelawinberg-square-crop-feb2018

Update:

A spokesperson from the Office of the Assistant Secretary for Health contacted Billy Penn on May 25 to assert that the initial article from Modern Healthcare was incorrectly worded, and that what Adams actually supports is science-driven “community choice” when dealing with the opioid epidemic.

On May 26, they provided a new statement unequivocally indicating that Adams and the entire Trump Administration are opposed to safe injection sites:

The Administration and the Surgeon General do not support so called “safe” injection sites as a means to combat the opioid epidemic and its consequences. In addition, there is no evidence to demonstrate that these illegal sites reduce drug use or significantly improve health outcomes for those with opioid use disorder. So called “safe” injection sites lack the necessary scientific support to be considered a standardized evidence-based practice in the U.S.

The original article below is annotated to reflect this different stated position.


 

If one thing’s for sure about the idea to open a safe injection site in Philly, it’s that the response has been massively conflicted. Over the last few months, people have debated the merits of the comprehensive user engagement site proposal, and community meetings about it have been rife with disagreement.

But the country’s top doctor has apparently decided he likes the idea. [Ed: According to emails from OASH Press Secretary Kate Migliaccio Grabill, this is not true.]

U.S. Surgeon General Dr. Jerome Adams, appointed by President Trump, announced he supports the facilities on a national level. On Wednesday, he appeared to come out in support of various harm reduction measures to combat opioid addiction, including medication-assisted treatment, syringe exchange programs and safe injection sites, according to a (now-disputed) report from Modern Healthcare. [Per Grabill, this report was incorrect: “At the ACEP event, [Adams] gave examples of what the range and conversation on harm reduction can include, but in no way did he state or imply an endorsement of safe injection.”]

To explain his support for these methods, which some find controversial, Adams cited their success in lowering opioid overdose deaths in other countries. [Grabill clarified that Adams believes that a “conversation about harm reduction can range from basic education to condoms to SSPs and all the way to safe injection sites. Each community needs to look at their burden of disease, examine what the science says and to decide what is right for them.”]

“As you look at France, they were able to drive down their opioid rates and their heroin usage by making it easier for folks to get access to MAT,” Adams said at an American College of Emergency Physicians forum in Washington, D.C. (MAT stands for “medication assisted treatment”). “So, we know that this can work.” [Grabill did not directly dispute that Adams said this quote printed by Modern Healthcare.]

In the last year, Philly has been one of several cities — including Seattle, Denver, San Francisco and New York — to propose opening a safe injection site to help lower rates of opioid overdose deaths.

This announcement by the top medical professional in the U.S. is especially notable because his state-level counterpart in Pennsylvania hasn’t yet taken a stance.

Pa. Secretary of Health Rachel Levine said in February that she had no comment on Philadelphia’s safe injection site proposal. (BTW, that’s despite the fact that she supported a different statewide harm reduction measure — Levine instituted a standing order prescription for naloxone, allowing all Pennsylvanians to access the overdose antidote.)

Philadelphia officials announced in January that they would “actively encourage” opening a safe injection site in the city. They called their proposal a comprehensive user engagement site in an attempt to emphasize that it would be connected to addiction treatment services, and people wouldn’t be limited to injection drugs — they could also use non-intravenous drugs on site.

In the months since, a handful of Philly people have sounded off on the proposal.

Pennsylvania Attorney General Josh Shapiro and Praise 107.9 radio host Solomon Jones both came out against the idea. City Councilmembers Maria Quiñones-Sanchez and Cindy Bass said they needed more information before they could support the proposal, while city public health officials have welcomed it.

Adams previously pushed for harm reduction approaches when he was Indiana’s Health Commisioner, and earlier this year issued an advisory calling for more people to carry naloxone. President Trump has yet to (personally) take an official position on safe injection sites. [The statement provided by the OASH, reproduced at top, indicates the entire Trump Administration is against them.]