To Josh Shapiro: Supervised injection sites save lives | Expert Opinion

Gov.-elect Josh Shapiro recently reiterated his opposition to overdose prevention sites, also known as supervised injection sites or safe(r) consumption sites, places where people with addiction can use drugs under medical supervision and be revived if they overdose. In 2018, Shapiro suggested that there is “no safe way to inject yourself with this type of poison.” While this may be true at some level, it’s also true that our current approach to addiction isn’t working. And as long as people continue to use drugs, there are objectively safer ways that they can consume those drugs.

Like many interventions in the world of addiction, supervised injection sites can seem counterintuitive, and people often wonder about the “moral hazard” of such operations. Will this encourage more drug use? Is this actually safe?

» READ MORE: After another delay in a decision on supervised injection sites, Shapiro says he still opposes them

As a doctor who specializes in addiction, I’ve heard these arguments before. For instance, in 2015, people voiced similar concerns about a plan to distribute naloxone — a medication that reverses opioid overdose. But the state’s then-Surgeon General Rachel Levine issued a standing order in 2015 that anyone can purchase naloxone without a prescription, and the program has been a huge success. Naloxone distribution is now a cornerstone of harm reduction efforts both across the commonwealth and across the country.

For context, Pennsylvania ranks eighth in overdose deaths per capita. Over 5,000 Pennsylvanians died from an overdose in 2021, which is roughly the equivalent of the entire population of Eagleville, Pa. Fentanyl, xylazine, and a myriad of other substances pervade the banned drug supply and make initiating treatment for opioid use disorder increasingly difficult. Additionally, only about one-third of all inpatient drug and alcohol rehabilitation facilities in the United States offer FDA-approved medications for opioid use disorder.

Addiction specialist physicians, allied health professionals, and community resource groups are playing against a stacked deck. We need help.

It’s important to remember that every overdose death is preventable. While supervised injection sites are not the ultimate solution to the overdose crisis, they are a critical, evidence-based intervention that can play a significant role in stemming the tide of mass suffering and death. Studying addiction and its treatment can be extremely difficult, so it’s both a wonder and a blessing that we have so much good evidence attesting to the safety and efficacy of supervised injection sites. These sites reduce overdose deaths, decrease the rates of blood-borne infections like HIV and hepatitis, decrease litter from used syringes in the community, and decrease the burden on emergency services. They have also been shown, time and again, to not increase the rate of substance use, and to actually increase the rate at which people enter into formal medical treatment.

It’s important to remember that every overdose death is preventable.

To date, across the world and across decades, there are no accounts of a single fatal overdose occurring at a supervised injection site. This is an absolutely astonishing figure and a testament to the care and compassion of the folks who operate these sites.

In their short time operating, two supervised injection sites in New York City have already reversed hundreds of overdoses. Each one represents a friend, a neighbor, a family member — someone who was not absent at the dinner table last week at Christmas, their life extinguished by an eminently preventable calamity.

Ultimately, we have two choices. We can continue to march to the drumbeat of war and allow the thundering forces of dehumanization to drive our policymaking, or we can recognize the generations of chronic miscalculation which have led us to this dark moment and forge a brighter, healthier, and more humane path forward together.

I urge Gov.-elect Shapiro, his new administration, and legislators and policymakers across the commonwealth to embrace the evidence-based tools we have. One day I hope that we can look back on this grim chapter of our history with solemn remembrance, but also stark determination — determination to never again simply bear witness to suffering, but to rectify our mistakes and ameliorate it.

James R. Latronica is an addiction specialist physician and public policy chair of the Pennsylvania Society of Addiction Medicine based in Pittsburgh. @JamesRLatronica