According to the Center for Disease Control there was an estimated 72,000 drug overdose deaths in 2017.  Over 72,000 families experienced the loss of a loved one in 2017 due to a drug overdose. This sharp increase in drug overdose deaths is the result of several factors: increased and over prescription of opiates as pain relief for patients and an increase in synthetic opiates in the US drug market. Approximately 29% of patients prescribed opioids for chronic pain misuse them.
Strategies for Treatment and Saving Lives
The National Institute for Health has created five priorities to respond to the opioid crisis: improve access to treatment and recovery services; promote use of overdose-reversing drugs; strengthen our understanding of the epidemic through better public health surveillance; provide support for cutting-edge research on pain and addiction; advance better practices for pain management.
Across the US cities and rural communities are combating the opioid epidemic with new ideas and methods than previously. Communities are now seeing drug misuse as a treatable health issue rather than criminal act that should be punished. Supervised Use Sites are one strategy being considered by cities to prevent overdose deaths and serve as a pathway to treatment for people who (mis)use drugs.
Supervised Safe Use Sites are places where people who inject drugs can consume drugs under medical supervision. 63 cities around the world have Supervised Safe Use Sites, and have experienced zero overdose deaths since they opened in the early 1990s. Across the US 11 cities are exploring Supervised Use Use Sites to combat the opioid epidemic.
Denver’s Opioid Experience
In 2017 Denver experienced 201 drug related deaths, more than deaths by vehicular accident. In 2018 the Denver Department of Public Health and Environment developed its Opioid Response Strategic Plan which seeks to prevent substance (mis)use, improve treatment access and retention, and reduce harm. The action plan specifically calls to reduce barriers to a Supervised use site, which has been noted internationally to reduce harms associated with drug (mis)use such as: overdose deaths, the spread of HIV and Hepatitis C, and abscessed wounds.
 National Institute on Drug Abuse. (2018). Overdose Death Rates. Atlanta: Center for Disease Control https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
 National Institute on Drug Abuse. (2018, March). Opioid Overdose Crisis. Atlanta: Center for Disease Control.https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis#six
 Vowles KE et al. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 56(4):569-576. Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156(4):569-576. doi:10.1097/01.j.pain.0000460357.01998.f1.
 Price, D. T. (Performer). (2017, April 19). Secretary Price Announces HHS Strategy for Fighting Opioid Crisis. National Rx Drug Abuse and Heroin Summit, Atlanta, Georgia, USA.https://www.hhs.gov/about/leadership/secretary/speeches/2017-speeches/secretary-price-announces-hhs-strategy-for-fighting-opioid-crisis/index.html
 Ghorayshi, A. (2018, September 6). The Feds Say Safe Injection Sites Are Illegal. Here Are All The Places Considering Them Anyway. Buzzfeed News.https://www.buzzfeednews.com/article/azeenghorayshi/safe-injection-site-proposals-map
 https://www.colorado.gov/pacific/cdphe/vital-statistics-program Colorado Department of Public Health & Environment. (2018). Vital Statistics Program. Denver: Colorado Department of Public Health & Environment.
 Denver Department of Public Health & Environment. (2018). Opioid Response Strategic Plan. Denver: Denver's Collective Impact Group.
If we truly want to get people out of the public eye with injecting, the facility cannot be moved too far out of the downtown area. The Supervised Use Site would take folks from publicly injecting (outside, in an alley, at the library, in Civic Center park, in business bathrooms, etc.) and in to a controlled environment where trained health professionals can be engaging them with access to services, substance abuse treatment, mental health professionals, housing professionals, etc.
What does this mean to our business community? Denver currently lacks proper public health interventions to significantly reduce rates of public injection, something many businesses experience in the form of people utilizing public bathrooms to inject as well as open injecting in common spaces such as parks, sidewalks, and alleyways. These venues are neither sterile nor safe and, sadly, are often the very places where people, without proper supervision or intervention, die of overdose. A Denver SUS would significantly impact rates of public injection and would serve to help connect our marginalized citizens to evidence-based healthcare and support.
Thanks to the 63 cities operating these programs internationally, there is data to show that these facilities do not increase crime in the area of operation.
Please read these articles below for more information on Supervised Use Site impacts on crime rates and public safety.
The Harm Reduction Action Center has been an important partner in researching opiate and drug use in the City of Denver. The HRAC currently serves over 6,500 community members in their location and has been a discreet neighbor. The average heroin user injects 3-5 times per day. The average cocaine user injects 12-15 times per day. 88% of their participants have never been to a syringe access program before, meaning only 12% of folks have been in another state to access sterile syringes and knew to reach out to find that service in Denver. The HRAC will monitor any sort of influx, but don’t expect this to become a tourist destination for injectors. Other states are pushing forward with this initiative, so Colorado will not be the only one with a Supervised Use Site.
Secondly, 63 other cities have Supervised Use Sites, and conduct studies to demonstrate the effects of having a SUS in an area. This study below shows that the opening of North America's first SUS was not associated with an influx of drug use in an area. It did show that there was a substantial reduction in binge drug use after the opening of the SUS.
It is to be noted that the drugs will be pre-obtained before the person were to arrive at the agency. Currently, no drugs are allowed to be bought or sold within four blocks of the Harm Reduction Action Center. Those rules would continue to apply for this initiative. Drugs are illegal and law enforcement continues to be in charge of arresting dealers. Law enforcement has not been able to arrest their way out of this opioid epidemic. The HRAC works closely with Denver Policy Department on a multi-pronged approach with harm reduction efforts such as Narcan use and trainings, tours, meetings, and more.
The purpose of an SUS mutifold: to reduce the harms associated with intravenous drug use; to connect individuals with social resources; to act as a gateway into drug treatment programs.
Harm reduction is a philosophy that accepts that individuals will engage in risky behavior, therefore it is in the public's best interest to reduce the harms of this behavior. What we can do today is prevent and eliminate the transmission of HIV and viral hepatitis and keep people alive from overdose.
In 2016, 174 people died of an overdose in the City of Denver. Of those folks, at least 20 died outside, in a park, in an alley, or in a business bathroom.
As with syringe access, the staff at the HRAC are engaging a very marginalized population with nonjudgement and compassion. When they are ready to make a change or do something different, these service providers at the HRAC are the first folks they come to.
The HRAC, along with this initiative, is a gateway in to substance abuse treatment. Instead of people injecting quickly in an alley by themselves, they will be injecting in a safe space where they will have time for a conversation for treatment. This is the model for other SUS around the world.
Canada's SUS, Insite, served 6,532 people, and provided 5,368 referrals to other social and health services in 2015 alone. These programs appeal to those who have nowhere else to go, and begin to provide a support structure that can link them to services as they are ready.
Currently there are limited treatment options for people who are struggling with drug addiction and do not have private health insurance. For in-patient treatment, which is not covered by medicaid, there is a 2-4 week waiting period, individuals need to detox 72 hours prior to being admitted.
For opioid/heroin users, there are a couple of options for medicated assisted treatment. One is called suboxone: of the prescribers that can prescribe suboxone in the state, less than 50% do so, and less than 10% take Medicaid. For methadone, if someone has a valid Colorado ID and some form of payment, they can get in in 4-7 business days.
To read more about the City and County of Denver's Opioid Strategic Plan follow this link.