In the twilight of the legislative session, Gov. Charlie Baker, R-Mass., signed into law an additional measure aimed at combating the opioid crisis in the Bay State. While well-intentioned, it’s no panacea for the epidemic. Fortunately, U.S. lawmakers need not strain their necks scanning the horizon for a model solution.
Canada took action in 2016 to make naloxone — a life-saving drug that prevents or reverses the effects of opioids — available without a prescription. In Ontario alone, a resident can get as much naloxone as he or she needs from any participating pharmacy in the province, for free. Don’t know where to get naloxone? The Ontario government has developed an easy-to-navigate website to allow people to locate pharmacies that stock the treatment as well as mobile units that deliver the drug along defined routes.
By discarding the prescription requirement for naloxone, the Canadian government has helped break down the powerful stigma that attaches to opioid users. The stigma of addiction can negatively affect a person’s self-esteem and damage relationships with loved ones. Perhaps the most unfortunate consequence of stigma is its ability to prevent those suffering from addiction from accessing the treatment they need. And at the public health level, stigma results in widespread economic, social and medical costs.
Unfortunately, in the United States, a patchwork of state laws still governs this life-saving drug’s availability, and the federal government has deemed naloxone a prescription drug. The U.S. Food and Drug Administration has been working with drug makers to follow Canada’s lead and develop an over-the-counter version for mass distribution. But more can be done.
The most controversial proposal to address the opioid crisis may also be the one with the most promise. Supervised injection facilities provide a safe space where people can consume previously obtained drugs, such as heroin and fentanyl, under the supervision of staff trained to respond in the event of an overdose or other medical emergency. These spaces also provide a medium for counseling and referrals to other social and health services. As of November 2017, there were more than 25 approved supervised consumption sites (SCSs) across Canada.
In Australia, where safe injection sites have been legal for over a decade, a Sydney facility managed over 3,400 overdose-related events without a single fatality over a period of nine years. Residents were also half as likely to observe people injecting drugs in public at the end of the nine-year period.
San Francisco was poised to be the first U.S. city to open safe injection sites last year. A 2016 cost-benefit analysis estimated that “establishing a single Insite-sized SIF facility [in San Francisco] would save roughly US$6.1 million per year.” Moreover, “A single facility would have a large impact citywide, given the significant net savings of $3.5 million.”
Unfortunately, the city halted progress on its reform efforts when officials discovered that moving forward would put the city at odds with both California and federal laws. However, Golden State lawmakers are attempting to advance a bill that will protect anyone associated with the injection sites — including property owners, employees and drug users — from arrest.
While personal views differ significantly on the best ways to address this public health crisis, there is great value in investing in evidence-based treatment for substance dependence. A World Health Organization report found that “for every dollar spent on treatment, 7 dollars are returned in cost-savings.” Indeed, treatment is proven to be cost-effective in both developed and developing countries. And it costs far less than imprisoning drug users.
On their own, these approaches will not stop the spread or use of these devastating drugs. Collectively, however, they form a promising harm-reduction approach that other countries around the world have adopted and found effective.
Nicolas John is the Northeast Region Manager at the R Street Institute