Researchers at the Johns Hopkins Bloomberg School of Public Health recommend that Baltimore turn to an unorthodox way of dealing with its heroin epidemic by opening two facilities that provide people a safe place to take drugs.
While the idea of “safe drug- consumption spaces” is just starting to gain traction in the United States, the researchers said such facilities have helped stop deaths in other countries. There are 97 safe spaces in 66 cities and 11 countries, according to the report.
The report comes as the nation faces a growing opioid epidemic. In Baltimore alone, an estimated 19,000 people inject drugs, and there were 481 fatal overdoses during the first nine months of 2016, a 65 percent increase over the same period the year before.
“It is a public health emergency, and we need every single evidence-based tool that is at our disposal,” said Susan Sherman, a professor at the Bloomberg School and the report’s lead author.
But Sherman acknowledged there are legal hurdles, and critics blasted the idea. One said the government should focus its efforts on opening more treatment facilities.
“The government should be spending our resources on helping people get off drugs, not helping them get high,” said Mike Gimbel, former director of the Baltimore County Office of Substance Abuse and now a private consultant.
The facilities would be akin to allowing legal drug dealing, Gimbel said. He said addicts probably wouldn’t use the centers because they like to get high several times a day and it would be inconvenient to travel to a center. They also might fear police are watching, he said.
There are also questions about the legality of allowing people to use illegal drugs.
It is illegal under federal law and the Maryland criminal code to possess controlled substances, so anybody who used the safe spaces to use illegal drugs could be arrested. People who work and run the facilities could be open to criminal charges, too.
Breaking federal law also could endanger federal funding the city receives, Baltimore Health Commissioner Leana Wen said.
While Wen said that the safe space concept is a model the city could explore, she doesn’t think the idea could move forward without the blessing of the federal government.
“As I understand, it depends on interpretation of federal law,” Wen said. “We have a new presidential administration that has yet to weigh in on a safe injection facility.”
Legislation pending in the General Assembly would allow for the creation of such sites, but it is unclear whether it will pass.
Sherman said a state law could provide some legal protection, conceding, “If there is no state protection, people are a lot more exposed.”
In the meantime, a coalition of groups that includes the Abell Foundation and the Open Society Institute-Baltimore already have been studying and discussing the idea of opening safe drug-consumption spaces.
Open Society has provided Sherman funding to hire a community organizer to build support for opening such centers in the city. The foundation that owns the nonprofit has provided funding to safe space facilities in European countries and Australia. It also has been involved with a site in Vancouver, British Columbia.
“One of the questions is, are we in a moment where we can move on this? I believe that we can,” said Scott Nolen, director of drug addiction treatment programs at the Open Society Institute-Baltimore. “We have blown epidemic out of the water; we are now in unchartered territory the way people are overdosing.”
Several cities are looking at opening safe spaces, according to the Abell Foundation report, including New York; Ithaca, N.Y.; and San Francisco. Last month, the King County (Wash.) Board of Health voted to open two facilities — one in Seattle and another in the surrounding county.
The safe spaces involve a form of treatment called harm prevention. The priority is not necessarily to get people into treatment but to prevent them from dying or getting HIV from using dirty needles or abscesses from too many injections. They also keep people from walking around the streets high, which can put them in dangerous situations.
The report found that Vancouver saw a 35 percent reduction in overdose events around one of its safe consumption spaces, compared with the city as a whole. In Australia, Sydney saw a 68 percent reduction in ambulance calls in the vicinity of its safe space.
The facilities also would provide services such as counseling and access to drug treatment. Over time, use of the safe space can lead people to seek treatment, the report said. In Vancouver, 57 percent of people who inject drugs at one safe site started addiction treatment, and 23 percent stopped injecting drugs altogether.
The safe spaces can also be cost-effective, Sherman said. A recent study of the Institute Safe Center in Vancouver said it generated an annual benefit to society exceeding $6 million. Baltimore likely would see similar savings, through reduced overdose deaths and averted cases of HIV and other infections, the report said.
Rep. Andy Harris (R-Md.) said such facilities would only make the underlying problem worse.
“Instead of concentrating on methods to provide adequate drug rehab programs, especially supporting and expanding access to faith-based programs that work for those afflicted with the scourge of illegal drug addiction, this study suggests that essentially legalizing heroin dens and crack houses in Baltimore is the answer,” Harris said in a statement.
“The real answer lies in improving our education system, providing job opportunities in a growing economy, and, most importantly, making sure that we have adequate treatment programs to accommodate the growing number of addicts, and bringing these addicts into those programs through the justice system if necessary,” he said.
