Should the Government Give Heroin Addicts a Place to Shoot Up?

Editor’s Note: This article previously appeared in a different format as part of The Atlantic’s Notes section, retired in 2021.

That’s the conclusion that reader Thomas approaches in his comprehensive case for “decriminalizing or legalizing all drugs”:

Not only has the global War On Drugs been an exorbitant waste of money, it has fueled the rise of mass incarceration, broken families and communities, and the rise of murderous drug cartels. Furthermore, has it curbed drug consumption in the United States or abroad? No.

If drugs are legalized or remain illegal, the fact of the matter is, people will continue to do them. I think that the focus must be more on harm reduction and rehabilitation. We hear about the “last stop” for most addicts—overdose and death. What doesn’t get much of the attention is the multitude of other problems associated with drug use, such as the spread of HIV and hepatitis infections, as well as the hospitalizations and surgeries (paid for by taxpayers) due to abscesses from sharing dirty needles. Addicts clog up emergency rooms because they’re looking for a fix, looking to get off the street, or they’re suffering from an infection. The healthcare system is not equipped to treat these patients, so they’re patched up and shipped back to the streets without any treatment for their underlying problem with addiction.

In addition to the millions of healthcare dollars saved by the reduction of disease and infection, drugs could be taxed and regulated. This would mean big money for government programs and guaranteed safety for users. I’d imagine there would be far less overdoses if the purity and quality of drugs was standardized and regulated.

Also, with illegality comes stigma. I don’t think there are many people out there that struggle with addiction to heroin or cocaine who are proud to speak up talk about it. So, what happens? People get hooked on some substance or other and it becomes a secret, something done in the shadows. This makes it difficult or embarrassing to seek out treatment because they may feel judged by their family and friends. If we can’t have open realistic conversations with addicts, how can we treat them? Legalization brings the drugs and the people using them out into the light.

Also, I’ve read about clinics where addicts can go to inject drugs. They have access to a safe, clean environment, clean needles, and medical professionals if they overdose. In order to use these facilities, a drug user must meet with a medical professional for 15-20 minutes. They can get information about recovery programs, rehab, maintenance drugs, etc. I’d imagine facilities like these are far more economically and socially beneficial than a crack house or a shooting gallery in an abandoned house somewhere.

Those in-the-shadows places are often where overdoses occur because there’s no one around to call an ambulance when an addict has a bad reaction to an injection. Or if people are around, they’re likely addicts, who are often incapacitated themselves or too afraid to call emergency officials for fear of arrest. There’s a great section in Chasing the Scream that addresses that grim reality, specifically in Downtown Eastside, a neighborhood in Vancouver, British Columbia, that became notorious in the 1980s for skyrocketing rates of heroin overdoses and AIDS. In 2003, to combat the epidemic, the city opened a government-affiliated injection site for drug addicts, Insite, which provides clean syringes and a safe place to shoot up. Here’s an overview of the clinic:

Insite gets between 600 and 800 clients a day, according to CTV News, “and there have been no deaths from overdoses during its run.” Maclean’s Ken MacQueen wrote a profile of the clinic last summer titled “The science is in. And Insite works.” Money quote:

Insite was opened, following extensive consultation, after a public health emergency was declared in Vancouver in 1997 in an attempt to counter more than 1,000 overdose deaths in the preceding years and a spike in HIV and hepatitis C infections caused by shared needles. Dr. Thomas Kerr of the B.C. Centre for Excellence in HIV/AIDS called the outbreak “the most explosive epidemic of HIV infection that had been observed outside of sub-Saharan Africa.” Since then, B.C. has gone from having the highest infection rate in Canada to among the lowest. “In the immediate area around Insite, the 40-block area around the facility, there’s been a 35-per-cent decline in overdose deaths,” says Kerr. “And people who use Insite on a regular basis are 30 per cent more likely to enter addiction treatment.”

Last year, Insite took the controversial step of providing free heroin to some of its worst addicts:

Currently, it’s only for 26 people in the city. [Allen Schauffler, Pacific Northwest Correspondent for Al Jazeera] says these are the heroin addicts who didn’t seem to take to heroin alternatives [like methadone and suboxone] in an effort to get clean. ... “If you give these people doses of heroin every day and keep them comfortable and keep them docile and keep the sort of demons of heroin addiction at bay, then those people are much less likely to end up in an alley, dead with a needle in their arm, or much less likely to sell themselves sexually for money to buy drugs, or much less likely to break into somebody’s car to steal something, or to shoplift or to strong-arm rob or to whatever. So the harm that they can cause to themselves and society is reduced if you simply give them the drug.”

If you see any downsides to injection sites like Insite, or want to address any aspect of our discussion thus far, please let us know: hello@theatlantic.com.