ITHACA, N.Y. — On December 18th at 4:30pm in the Governor Daniel D. Tompkins Building (121 E. Court Street Ithaca, NY 14850) in the second floor legislative chambers the monthly Health and Human Services committee will continue the discussion on supervised injection sites.
Across the country we are seeing consistent increases in opioid use with a huge upsurge in first time users and people transitioning from prescription drugs to heroin. Usage spans across all income and racial groups and both urban as well as rural communities, which have seen the greatest rates of increase. Deaths, either directly or indirectly caused by opioid overdoses, are on a steady rise as are associated diseases like Hepatitis C and HIV as a result of needle sharing.
Tompkins County has seen its fair share of these increases including a rise in opioid overdose deaths reaching 21 in 2016 and 14 in the first 6 months of 2017 (not including drug related deaths).
For decades in the United States we have focused our efforts on a model referred by many as the war on drugs. Statistically speaking, drug raids and crack downs have not systematically reduced either selling or use and may be a catalyst for shifting drug activity zones. This model has not systematically reduced transmission rates of related infectious diseases like Hepatitis C and HIV and may lead to unsafe injections exacerbating emergency room usage as a result of, for example, skin and soft tissue infections, sepsis, and heart valve infections as well as overdoses. This mode has not promoted systematic shifts towards treatment or abstinence by users and has led rather to crowded jails and an overtaxed court system.
There is agreement within government, law enforcement, healthcare, and the community that the factors impacting drug use and abuse are nuanced and multifaceted. Using a revolving door through the criminal justice system as a means to reduce the harmful effects of drug use is both ineffective and inappropriate. Trends in drug use are just as much a result of systemic social, racial, and economic inequality, a lack of proper housing, insufficient affordable childcare, insufficient access to healthcare, and unequal access to education.
There is no one line of action to impact existing usage trends and the community is in the process of developing several strategies such as: a Law Enforcement Assisted Diversion (LEAD) program, increased drug detox and treatment facility capacity, increased mental health assessment in the jails and support within the community, and improved housing and defense council for previously incarcerated residents to name a few.
In 2016, the city of Ithaca presented a comprehensive plan to address the drug crisis in our community. In the report 5 classifications for recommendations were identified including: governance and leadership; education; recovery-oriented treatment, harm reduction, and ancillary services; community and economic development; and public safety.
One harm reduction recommendation stood out and received particular attention – supervised injection sites (SIFs). Last month at the Health and Human Services committee meeting Dr. William Klepack, a Dryden physician and the Medical Director for the Tompkins County Health Department provided extensive information on the health and public health impacts of SIFs.
In the 97 SIFs existing in 11 different countries over 10 million supervised injections have occurred over the last 37 years without a single overdose death. Beyond significant reductions in deaths due to overdose, according to Dr. Klepack’s research, SIFs have been found to accelerate individuals transitioning into medically-assisted treatment, reduce needle sharing, and reduce emergency room usage, hospital admissions, and surgeries.
Like needle exchange programs before them, SIFs are controversial and raise both fear and concern that they will exacerbate the issue of drug use and abuse. Community members, government and law enforcement alike have raised questions about implementation and effectiveness.
This month’s HHS public committee meeting is an opportunity for legislative members to speak with expert stakeholders to discuss some of these concerns. Given the active assembly bill (A8534) that would establish the public health framework to create SIFs in New York and establish legal immunity for persons using or working or helping establish an SIF now is a good time for the community to get all the information we can.
Featured image: Two overdoses were reported within 10 minutes at the corner of West State and South Plain streets in October. 2017 will likely be the most fatal year for drug related deaths at least within the past 10 years. Photo by Jolene Almendarez/The Ithaca Voice