How can I supervise heroin injections and live with myself? A Philly nurse on safe injection sites | Perspective

"You want me to do what?" "Where's your compassion?" "What a waste of resources!" "I have an obligation to help people stay healthy."

These are conflicting responses I imagine nurses and health-care professionals may have when asked to provide care at safe injection sites, places where people can use drugs under medical supervision. There aren't any such sites right now. But the City of Philadelphia announced that it will encourage setting them up.  Should health-care professionals participate?  It's a dilemma wrought with ethical, moral, legal, and regulatory issues and more questions than answers.  As a nurse, I can understand and appreciate both sides.

I have been trying to educate myself on this subject for the last year, after the teenage son of a family friend died from a heroin overdose. Would the existence of a safe injection site have prevented his death? I don't know.

On one side of the issue, these sites address a staggering public health issue, serve a good purpose, provide a safe space for drug users, help avoid/lessen overdoses and deaths, reduce transmission of infectious diseases, offer counseling and help to get off drugs. Conversely, there is concern that such sites would proliferate predatory practices of drug dealers selling near the sites.  In addition, there is the law, drug possession and use is illegal, as is the presence of nurses and health-care professionals when people are injecting themselves with heroin.

In deciding whether to support or work in safe injection sites, nurses must consider the code of ethics by which they are bound and the dilemma posed by the desire to do both — ensure their patient's best interest while preserving their own professional integrity.  How can I supervise drug injections and live with myself?

According to the code of ethics, nurses must take appropriate action when they see illegal practices that place the best interests of patients in jeopardy.  However, safe injection sites, even if their legality is at issue, provide a service that may be in the best interest of the individual.  Nurses must be mindful of competing moral demands and conflicting values in collaborating for human rights in complex, extreme, or extraordinary practice settings.  How do I take nursing students to safe injection sites for clinical experience and also teach them about a culture of health and safety, and the American Nurses Association Code of Ethics? What happens when a nurse executive asks a roomful of nurses to supervise heroin injections?

Each individual will need to decide whether to support safe injection sites on his or her own.  There needs to be debate and discourse among students, faculty, and health professionals, many of whom are likely to struggle in evaluating this extraordinary situation.

So where do I come down?  Yes, safe injection sites shelter an illegal activity and are not regulated. But, in my view, it would help lessen senseless overdoses and deaths – and perhaps get people into treatment.  The common denominator for sites is the code of ethics provision on integrating social justice.  It speaks of a shared responsibility among all nurses and health professionals to shape health care locally and nationally and take action to influence leaders, government agencies, legislators, and professional organizations.

It's a tough call. But I can live with safe injection sites for one basic reason: I think they will save lives. And as a nurse, that's what I'm all about.

Philadelphia's recent decision to encourage such sites to combat the opioid crisis signifies a watershed moment for health and social policy and the role of nurses and health professionals in addressing the city's and nation's opioid crisis.  And it offers an option for drug users and promise to break the cycle for their family and friends.

Beth Ann Swan is a professor at  Jefferson College of Nursing and was dean of the nursing school from 2011 to 2016.