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January 4 , 2023



Do Safe Injection Sites Reduce Overdose Deaths?

A March 2022 paper published on PLOS ONE entitled: Evaluating the population-level effects of overdose prevention sites and supervised consumption sites in British Columbia, Canada: Controlled interrupted time series examined changes in rates of opioid-related mortality and health service use between communities that implemented any variant of OPS/SCS (Overdose Prevention Sites/Safe Consumption Sites) with communities that did not. 

The author whose work explores the care provided to vulnerable and marginalized groups, including persons living with HIV/ AIDS, hepatitis C, mental health and substance use disorders, hypothesized that OPSs and SCSs would reduce opioid-related mortality and health service use.

"We found OPSs and SCSs reduce opioid-related paramedic attendance and emergency department visit rates but no evidence that they reduce local hospitalization or mortality rates." 

Dr. Dimitra Panagiotoglou, an Assistant Professor in the Department of Epidemiology, Biostatistics and Occupational Health, is a health services researcher, with expertise in health services delivery and performance measurement.

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During the study period, twenty-five OPSs and SCSs opened across fourteen of British Columbia’s 89 Local Health Areas (LHAs). Results from analysis of LHAs with matched controls (i.e. excluding Vancouver Downtown East Side) were mixed. Significant declines in reported overdose events, paramedic attendance, and emergency department visits were observed. However, there were no changes to trends in monthly hospitalization or mortality rates. Extensive sensitivity analyses found these results persisted.

"Our results echo findings reported in other evaluations of OPS/SCSs locally and internationally. A 2007 Australian report by the National Centre for HIV Epidemiology and Clinical Research for the New South Wales Department of Health found 'no statistically significant differences in the rates of decrease of opioid-related deaths between Kings Cross [where the SCS was implemented] and the rest of [New South Wales]' but did observe a significant decrease in ambulance attendances during the six years of follow-up..."

Although evidence demonstrates safe injection facilities (SIFs), and by extension OPSs and SCSs, help reduce the spread of blood borne infectious diseases (e.g. HIV, hepatitis C) and prevent accidental overdoses and consequent morbidity (e.g. anoxic brain injury, rhabdomyolosis) and mortality, they remain politically controversial.

Some policy makers, residents and business operators continue to vehemently oppose their implementation on moral grounds, and beliefs that these harm reduction interventions: 

  • encourage drug-related crimes and public consumption
  • condone rather than treat addiction
  • burden limited health resources

Critical gaps in the literature contribute to the underrating of OPSs and SCSs as crucial health services. Much of the evidence is specific to the concentrated drug use epidemics of Vancouver’s Downtown Eastside (DTES) and Sydney’s ‘red light’ district, predates the current opioid overdose epidemic, and is specific to injection drug use. This leaves the effects of OPSs and SCSs unclear in contexts where the population is diffuse (i.e. geographically scattered), services are not restricted to people who inject drugs, mobile rather than fixed sites are offered, and during periods of intervention scale-up. The recent implementation of OPSs and SCSs across a variety of settings in BC and over time presents an excellent natural experiment to evaluate the population-level effects of this harm reduction intervention.


Harlem's Black Middle Class Pushed to the Brink

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Current discourse and scholarship around mass incarceration of the 1970's and beyond has routinely discounted the experience of working- and middle-class black people who lived and  experienced the consequences of drugs and crime in the 1960's and 70's. It frequently overlooks the power of their activism and obscures the important role they played in bringing about mass incarceration.

In speaking about his book Black Silent Majority, Professor Michael Javen Fortner (CUNY Graduate Center) notes that, “The idea that black folks played a role in mass incarceration sounded ludicrous to most people.”

Fortner tries to correct that narrative. In his book from Harvard University Press Fortner focuses on black activism and narcotics-policy development in New York in the decades leading up to passage of the Rockefeller drug laws in 1973, which he identifies as a turning point in the spread of punitive sentencing practices. The book looks at how growing disorder and addiction drove many working- and middle-class people in Harlem and elsewhere to mobilize for tougher crime policies.

Fortner writes about churches forced to reduce services and events because residents feared going out after dark. He also cites: 

A 1973 New York Times poll that found 71 percent of blacks supported life sentences without parole for drug dealers.

A significant portion of anti-drug activism occurred in Harlem in the years leading up to the Rockefeller drug laws. It was there that residents were besieged by heroin addiction and social disorder — what a late-1960s NAACP report called a “reign of criminal terror.” And it was there that a “black silent majority” of working- and middle-class residents rallied to reclaim their streets. New York’s white, ambitious governor seized on their discontent to push for harsh narcotics policies that would enhance his standing within the Republican Party. The result: some of the strictest drug statutes in the country, mandating long minimum sentences for a variety of drug crimes.

One very active anti-drug activist - Rev. Oberia D. Dempsey - asked simply:

“Why Should Harlem Be Destroyed by Narcotics Peddlers?” 

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The MAT Act

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