Health Policy Update

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Feb. 9, 2017

Safe consumption sites, also known as safe injection sites, are places where an individual may use a drug, most commonly heroin, under the supervision of medical personnel. Proponents of these programs stress their role in harm reduction by preventing overdose deaths and connecting individuals who use drugs with treatment and other medical services. Opponents argue that it is inappropriate to sanction or facilitate drug use and it could impact public safety. This year, legislatures in California, Maryland, and Vermont are considering bills authorizing safe drug consumption sites, and in Washington state, proposals to prohibit consumption sites were submitted.

In California (AB 186), localities would be permitted to authorize the operation of supervised injection services programs for adults while in Maryland (HB 519) and Vermont (H 108), the state or a local health department would be allowed to authorize the programs. These bills require safe consumption programs to establish operating procedures, provide reasonable security of the program site, and staff training for the delivery of program services. Additional program requirements include:

  • Onsite supervision by healthcare professionals or other trained staff
  • Sterile consumption supplies, syringe collection, and disposal services
  • Answers to questions regarding safe consumption practices
  • First aid, if needed, monitoring for potential overdose, and treatment or rescue medications (e.g., naloxone)
  • Access or referrals to services (e.g., substance abuse disorder counseling and treatment, medical services, social services, testing for HIV, viral hepatitis, and STDs, reproductive health education and services, and wound care)
  • Education to participants on the risks of contracting HIV and viral hepatitis
  • Education to participants on overdose prevention and access or referrals to obtain naloxone
  • Education to participants regarding proper disposal of needles and syringes

The bills require an annual report from the program operators to the authorizing entity (e.g., locality or health department). The report is to include:

  • Number of program participants
  • Aggregate information regarding the characteristics of program participants
  • Number of hypodermic needles and syringes distributed for use onsite
  • Number of overdoses experienced and the number of overdoses reversed onsite
  • Number of individuals directly and formally referred to other services and the type of service

The bills authorizing safe consumption sites also establish an exemption from criminal sanctions to any entity or person involved with an authorized program. The exemption includes participants, operators, property owners, volunteers, and staff.

The bill in California would require the program to develop eligibility criteria for program participants. The bill in Maryland permits the program to bill the participant’s insurance carrier for the cost of covered services.

The bills in Washington (HB 1761 and SB 5223) propose a statewide referendum on the prohibition of safe consumption sites. The measures stress that the operation of safer consumption sites is “inconsistent with the state’s goal of remedying substance use disorder issues.” If enacted, the proposals would preempt local jurisdictions from enacting laws and ordinances related to the regulation of safe consumption sites and require each local board of health to certify to the state legislature and state board of health that no private or public safe injection sites are operating in its local health department jurisdiction. Additionally, any local expenditure related to safer consumption sites would result in the loss of state funding.

With opioid overdose death rates on the rise, increasing in the United States by 15.6 percent between 2014 and 2015, and states exploring the role of safe drug consumptions, the debate for and against such sites is expected to continue.