Making Sense Out of Bioethics

"Safe Injection Sites" and Tackling IV Drug Abuse

 So-called "safe injection sites" are special buildings where drug addicts can go to shoot up illegal drugs without fear of arrest or prosecution. Such a facility has been operational in Canada on the east side of Vancouver for several years, and drug abusers from around the area come to receive clean needles, ampules of sterile water, swabs for cleaning injection sites, band-aids, ascorbic acid powder (to cut the drugs with), and small metal spoon tools. The  Canadian government has been funding this site and is in the process of renewing the funding. Other municipalities like San Francisco and New York have also been considering instituting such sites. Many groups are opposed to these drug zones, seeing them as cooperating in, if not directly promoting, a practice that is clearly unethical and highly damaging to society. They argue that taxpayers should not be forced to pay for places where people can use illegal drugs and destroy their lives. 

The idea behind the safe injection sites is to reduce the collateral damage from drug abuse. Proponents argue that since addicts have begun to use the safe injection sites, the crime rate on the east side of Vancouver has fallen, and that the rates of HIV and hepatitis have declined because clean needles have been made available. Because nurses can keep an eye on addicts after they shoot up in the facility, they say that deaths by overdose will decline, since ambulances can be called more easily than if drug users were shooting up alone in a darkened alley. They further claim that the needle exchange program can allow users to remain healthy until they get help for their substance abuse problem. There is even a priest who has penned a kind of defense of these sites, writing, "Some people would say you're giving them the OK. I disagree with that because I think the implication is that we're dealing with people who can make choices. When they're addicted that's a whole different kettle of fish." In other words, drug users, like fish, have no free will. 

While drug addiction certainly puts a major dent in human freedom, it would be false to conclude that an addict can't make choices. The only reason there is any hope left for an addict is because he still has a small and diminishing space of freedom that he can act on, allowing him to decide whether or not to begin a new journey. He can choose to take the first step along the road leading away from addiction towards rehabilitation. Our public strategy for dealing with drug addiction must always show great sensitivity towards that tiny space of freedom that remains in each individual struggling with addiction. After all, it is precisely this freedom that sets us apart from our animal counterparts. Public policy should not contribute to shrinking that space of freedom even further through approaches that enable destructive behaviors and greater addiction. 

The widely touted claim that safe injection sites reduce collateral damage from drug abuse is itself dubious. Researcher Garth Davies, at the conclusion of an extensive analysis of the question, notes how safe injection sites are "too often credited with generating positive effects that are not borne out by solid empirical evidence." The claim that crime rates dropped in Vancouver following the opening of the safe injection site may have resulted from the injection of 60 police officers into the area when the facility opened (including 4 officers stationed immediately outside the facility), rather than from the injections occurring at the facility itself. He concludes, "In truth, none of the impacts attributed to the safe injection facilities can be unambiguously verified." 

Public funding should be directed towards rehabilitation programs rather than safe injection sites. Some argue that safe injection sites may themselves, on occasion, afford the opportunity to lead addicts towards rehabilitation. Yet there is a contradiction between enabling the addiction on the one hand and promoting rehabilitation on the other.  

This contradiction may be seen very clearly in what our society has learned about treating alcoholism. Most of us have seen — even among our families and neighbors — how destructive the addiction to alcohol can be. Not only can it ravage a person's life, but it can also destroy their family, lead to loss of employment, and, even, in some cases, endanger the lives of others through drunken fits or drunken driving. We've also seen how many alcoholics have been helped by twelve step programs like Alcoholics Anonymous, where the accumulated wisdom of millions of former addicts recognizes clearly that the only way they can conquer their addiction is through supporting each other never to have another drink. Imagine that, instead of supporting programs like AA and alcoholic rehabilitation centers, a government were to establish bars where alcoholics could come to get drunk, by providing clean glasses, furniture and bathrooms, healthy hors d'oeuvres and munchies, and police protection so that they couldn't be robbed in dark alleys. Would any of us really think that this would be promoting their rehabilitation? Those who struggle with substance abuse are deserving of public policy initiatives that rehabilitate rather than enable the addicted individual. 

Rev. Tadeusz Pacholczyk, Ph.D. earned his doctorate in neuroscience from Yale and did post-doctoral work at Harvard. He is a priest of the diocese of Fall River, MA, and serves as the Director of Education at The National Catholic Bioethics Center in Philadelphia. See www.ncbcenter.org