Allowing safe sites for injecting opioids in the US would save lives and lower healthcare spending significantly for affected communities, according to ICER’s latest draft evidence report. In 2018, opioid overdoses killed 948 Connecticut residents and there are signals that the rate has risen during the pandemic. Supervised injection facilities (SFIs) are part of a public health approach that relies on harm reduction theory, which is controversial for addictions. SFIs have been successful in other countries in reducing overdose deaths, getting people into treatment, improving the quality of life for communities, and lowering healthcare costs.
At SFIs, people can inject drugs they acquired elsewhere while being monitored by trained medical staff and will be treated if necessary. Most sites also have other services including counselling, education, personal hygiene facilities, monitoring for infections, and connections to treatment, primary health care, and social services. Many can test drugs for potency and dangerous toxins before people use them.
Several US states and cities are moving to authorize SFIs.
Relying on input from people and communities affected by addiction as well as reliable research, ICER evaluated the benefits of SFIs in other countries and a published report on one unsanctioned facility in the US. ICER found that SFIs reduce ED visits, hospitalizations, and ambulance calls in their communities and that no one has ever died at an SFI. Because SFIs don’t operate on the medical model, people who use them report better care and improved trust of the healthcare system. Consequently, SFI users are more likely to enter treatment for addiction and more likely to get care for healthcare problems at earlier stages of disease. Despite often strong community resistance to opening an SFI, most report impressive community support after implementation. Community residents are far less likely to encounter public drug use after an SFI opens and the quality of life for community residents improves. There is no evidence that opening SFIs attracts more drugs or users to the community and there is no evidence of increases in crime.
SFIs are built on successful syringe service programs (SSPs), which provide safer options for injecting drugs including sterile needles and syringes, clean water and other equipment but do not allow the use of drugs in the facility. There is good evidence that SSPs work in reducing blood borne infections and transmission. Connecticut has 13 SSP locations, some operating for decades.
ICER estimated the savings of opening SFIs for six US cities from lower ED visits, fewer and shorter hospitalizations, and fewer ambulance calls, adjusting for the additional costs to operate SFIs. Annual savings ranged from $3.4 million for Atlanta to $4.2 million for San Francisco.
As SFIs are funded through public funding, like other effective public health programs in the US, the considerable savings in healthcare costs go to payers and are not necessarily invested back into community public health. For SFIs to be sustainable, this has to change.
ICER’s report is an exceptional primer on the problem of the opioid epidemic, how it is changing, and what we can do about it. Very recommended reading. The report is open for public comment by people affected by addiction and others.