In Philadelphia, 1,116 people died of a preventable drug overdose in 2018. When the city Department of Public Health released this data last May, many community members saw a success: an 8% reduction in deaths from the year prior. But we cannot neglect the loss of 1,116 sons, daughters, friends, and neighbors when overdose deaths are preventable.
The reported decrease is not only from fewer individuals experiencing overdose — it happened because more overdoses were nonfatal, thanks to the access and distribution of naloxone throughout the city. From July 1, 2017, to June 6, 2018, the Department of Public Health distributed more than 37,000 doses of naloxone throughout Philadelphia. Because naloxone is available without a prescription, can reverse an overdose, and lower the fatality risk of fentanyl exposures, it is a highly successful strategy for harm reduction.
Harm reduction is based on the concept that people have autonomy and naturally engage in behaviors that can pose risk. Many people are willing to risk driving over the speed limit, having unprotected sex, using drugs, and drinking alcohol, for example. Harm reduction merely acknowledges that risky behaviors occur and offers guidance to mitigate risk. Wearing a seat belt and using condoms are harm reduction strategies. However, when considering drug use, some deem addiction a moral failing of choice that merits penalty rather than assistance.
An overdose prevention site, another harm reduction strategy, has been federally deemed a medical facility, one that offers sterile syringes, naloxone and respiratory support in case of respiratory depression, and harm reduction education by medical staff. Those services happen alongside infectious disease screening, peer support, and treatment services.
Critics like those at the U.S. Attorney’s Office have described an overdose prevention site as a “bring your own drugs” policy. That negative framing leads people to be severely misinformed on the medical capacity of the facility. These sites do not provide substances and cannot ascertain the origins of substances used. Hepatitis, HIV, trauma, and preventable overdoses are all public health issues that have implications for both the client and the surrounding community. As a public health initiative, overdose prevention sites aim to tackle these issues and protect everyone.
Misconstrued as “enabling drug use,” overdose prevention sites, in fact, support vulnerable individuals by offering on-site peers — in Pennsylvania, called certified recovery specialists — to navigate and encourage direct pathways to treatment. Treatment barriers are typically monumental: recurrent opioid withdrawal symptoms, authorizations and insurance challenges, lack of care navigation, and intense stigma.
Critics of overdose prevention sites also raise community safety concerns. Yet the fact stands: Overdose prevention sites save lives, and do so for the health of the entire community. Please consider the idea of yourself having a fatal disease, and someone offers you a 10% chance of treatment and survival — 10% more than what you face on your own. Would you take it? Would you motivate a loved one to take advantage of the opportunity? Absolutely.
More understandably, some community members are wary of a potential spike in crime when a facility opens. Modeling current sites that successfully operate around the world, data does not suggest that crime rates increase in areas surrounding an overdose prevention site. A 2014 review of studies found that these sites have been associated with less outdoor use, a decline in overdose rates (no fatal overdose has ever occurred in a supervised site), an increase in health services, and no negative impact on drug use or crime. Another study reported no increase in drug trafficking, no increase in assault, and a decline in vehicle theft around the facility in Vancouver, Canada.
Sites should be demographically chosen based on where people are already congregating, already using, and already overdosing. Sites can be distributed so that services reach all demographics, even in communities that have a “hidden” overdose crisis because users are forced to use behind closed doors.
People don’t die because they use too much. They die because there is no one there to help them.
Brittany Salerno is an MPH candidate and research coordinator in emergency medicine at the Perelman School of Medicine at the University of Pennsylvania. Jeanmarie Perrone is a professor of emergency medicine at Perelman and director of the Penn Medicine Center for Addiction Medicine and Policy. Utsha Khatri — a fellow in the Department of Emergency Medicine at Perelman — contributed research to this piece.