What's 'controversial' about overdose prevention centers?
Lots of people are "debating" whether consumption sites should be allowed to operate in America. Meanwhile, more than 100,000 people died from totally preventable drug overdose deaths last year.
Hellllloooo!
It’s May 24, in the year of our lord 2022, and that means today is my birthday. I’m 33-years-old and I still haven’t landed a cover story in a big magazine. My Nonny called at 9 a.m. central time—that’s the name my Jewish grandmother, Francine, goes by—and she said the weather in Florida is “warm.” I said the weather in Chicago is “cool.” She asked if she woke me up. “No, nonny. I’ve been awake.” I’ll be getting lunch with my mom a bit later at the Lux Bar, off Rush St.
Apropos of birth, I woke up this morning thinking about the “death drive” after reading some of Freud’s Beyond the Pleasure Principle. What, you ask, lies beyond the foundational human condition to seek out pleasure and avoid unpleasure? Well, according to our No. 1 Boy Sigmund, it’s a yearning to return to a state of “quiescence” (or dromancy or inactivity). That state we are all suspended in preceding our own birth, before the formation of our ego. It’s this longing for nothingness, Freud explains, that accounts for why humans repeatedly reeanct painful and traumatic events.
What is an opium high if not the yearning for quiescence? I, for one, don’t think anybody should die because they are trying to re-produce this quintessential human longing for quiet stillness. And that’s why today’s post from yours truly is about overdose prevention centers, otherwise known as supervised consumption sites, otherwise known as safe injection sites, otherwise known as… you get it.
Yesterday, NPR published an article with the headline “California debates opening supervised sites for people to use drugs.” More than 100 consumption sites are operating in more than a dozen countries around the world. And a recent systematic review of the global literature on these sites concludes:
“For people who inject drugs, supervised injection facilities may reduce the risk of overdose morbidity and mortality and improve access to care while not increasing crime or public nuisance to the surrounding community.”
The NPR article quotes Alex Kral, an excellent harm reduction researcher, who says, "There have probably been tens of millions of injections people have done in these sites over the last 35 years. And no one has ever died of an overdose."
With evidence like this, I gotta ask: What is there to “debate” exactly?
NPR, being a fair and objective source of news, also known as NPR not wanting to be percieved by right-wingers as liberal, quoted Anne Marie Schubert, an “independent” (re: still conservative) district attorney in Sacramento, who argued against opening consumption sites on the grounds that the government cannot “aid and abet” the use of illegal drugs. Here’s Schubert in full:
“You can call it what you want to call it. It's an open drug scene. The fact that we're considering allowing our government to essentially aid and abet the illicit use of drugs that are killing our citizens, I find shocking."
NPR goes on to say that Schubert would “rather see more court-ordered treatment. She says current law does not allow judges to require nearly enough people to seek help.” Like the Michael Shellenberger’s of the world up in Berkeley Hills, Schubert thinks the benevolent legal system ought to be used to force people into “treatment.”
For more on Schubert’s “tough on crime” record, see this piece from last winter by Substance co-writer Tana Ganeva. And here’s me, on Twitter, today.
Oh, and Schubert is now running for Attorney General of California in the upcoming election.
Right as NPR published its piece on overdose prevention centers, Aneeqah H. Naeem, Corey S. Davis, and Elizabeth A. Samuels, argued in the New England Journal of Medicine that President Joe Biden’s White House ought to clear up its ambiguous stance on injection sites.
In 2019, President Trump’s Department of Justice preemptively sued Safehouse, a Philadelphia nonprofit that wanted to open a consumption site, on the grounds that such a site would violate “the crack house statute,” an absurd federal law championed by none other than Joe Biden.
Biden’s DOJ hasn’t really made much of a peep about overdose prevention centers. Biden’s drug policy director, Dr. Rahul Gupta, tends to dodge questions about overdose prevention centers by saying they’re evaluating the research. I don’t know what’s taken them that long, Google Scholar makes the task of evaluating research pretty easy.
Naeem, Davis, and Samules write in NEJM:
“We believe the Biden administration should move quickly to resolve this ambiguity by making it clear that the federal government won’t stand in the way of organizations or state or local governments that want to establish overdose prevention centers.”
Only two legally sanctioned overdose prevention centers exist in America. Both are located in New York City. Rhode Island recently passed a law allowing them, but no site has been implemented yet. Meanwhile, states and localities across the country want to open sites but they’re nervous to do so because they don’t want the DOJ to sue them. Until the federal government acts, these plans to open sites across the country remain in legal limbo.
The NEJM piece offers a few legal and policy routes to unjam the stasis and let sites open up:
Biden’s DOJ could issue a Cole Memorandum, but for overdose prevention centers. The Cole Memo basically said that the federal government would not interfere with states that legalized weed. The same thing could be done for states that open up consumption sites.
Biden’s administration could take the public position that the “crack house statute” doesn’t apply to legally sanctioned overdose prevention centers. The DOJ could announce that they won’t attempt to use the statute against any sites that open up, unlike Trump’s U.S. Attorney, Bill McSwain, who sued Safehouse. (NOTE: McSwain just got demolished as a Republican in the recent Pennsylvania primary race for Governor. Ole Billy Boy did all that work for Trump’s DOJ and Trump returned the favor by not endorsing him and then calling him a “coward” for not fighting to overturn the 2020 election. lol).
Finally, and this is a longshot, but Congress could modify the Controlled Substances Act to outright exempt overdose prevention centers from the crack house statute. They could prohibit using federal funds to enforce the statute against sanctioned overdose prevention centers.
Will any of this happen anytime soon? Meh, I’m not sure. Biden doesn’t really seem all that interested in doing drug policy reform. Drug policy in the Beltway is sort of a backwater. There’s very few national reporters covering it day-to-day (which is probably why I’m unemployable). I feel like Biden’s advisors think any drug policy or criminal justice reform is a “third rail,” that whatever they do will be weaponized against them and Republicans will run on the tried and true message that Democrats are “soft on crime.” Of course, Republicans are already doing that anyway so might as well actually do something that improves peoples lives? I dunno.
Just look at DA Schubert’s rhetoric. She says these sites would mean the government is enabling/condoning/subsidizing the use of illicit drugs. It’s a super silly line of attack because people don’t need the government’s permission to use drugs. Look outside! People are always already using drugs even though it’s a crime to do it! The whole idea of harm reduction is to implement policies and interventions that do not obsess over whether or not people are getting high. Instead, they operate off the simple assumption that getting high shouldn’t result in needless and preventable deaths.
Mr. President, for my brithday, could you please ask someone in your DOJ to write up a memo announcing to the public that your cadre of federal prosecutors won’t sue under-resourced, under-funded, local harm reduction programs that are trying to save people’s lives? Thanks.
As always, thank you dear reader. If you haven’t yet officially subscribed and signed up for Substance, what are you waiting for? It’s my brithday FFS.