Fighting addiction and overdose in NYC (photo: Edwin J. Torres/Mayoral Photo Office)
In recent weeks, news broke that according to provisional figures from the National Center for Health Statistics, more than 100,000 Americans died of overdoses within a 12-month period ending in April 2021. For the first time in history, overdose deaths in the United States have exceeded 100,000 in a year, a value greater than the toll of car crashes and gun fatalities combined during the same period.
Unfortunately, New York City residents are a common victim to this crisis: every four hours, someone dies of a drug overdose in New York City. We are in the midst of a national health threat. The United States has unequivocally lost its longest war, the 50-year-long “war on drugs.”
While the war on drugs campaign was exceedingly effective at perpetuating institutionalized racism and decimating communities of color, America's streets are flooded with more potent and dangerous drugs than ever before—primarily methamphetamines and the synthetic opioid fentanyl. The belief that trillions of tax dollars spent on harsh law enforcement action, coercive suppression of production, and criminalization of drug use, possession, and supply would lead to a diminished market for controlled drugs such as heroin, cocaine, and cannabis has been total deception.
The war on drugs was waged largely in the name of public safety, not public health. The “safety,” however, of the substance user who was sick and suffering was never centered in this war. Instead of making people safer, punitive drug policies have stimulated violence, instability, and mental, emotional, and physical pain.
Nearly half of the inmates in federal prison are held on drug charges, sending a message to individuals who struggle with addiction that they are inherently bad, and that having a substance use disorder is criminal. This, in turn, perpetuates shame and stigma, and hinders the substance user from making the courageous step to ask for help.
The war on drugs failed to understand human behavior, as well as the power and root causes of addiction. Substance users experience extreme and unbearable shame and trauma daily at the hands of their addiction. Shame is a persistent companion for a substance user, yet it is isolating and causes a profound sense of separation. Shame is debilitating, traumatizing, and causes chronic feelings of self-doubt, inferiority, hopelessness, inadequacy, and worthlessness. It can become a barrier to seeking and accepting help, as one feels they are not worthy of help and attention or love and support. Shame can drive a person’s sense of self into hiding, and also feed compulsive behaviors as a way to escape pain and feelings of worthlessness. Shame perpetuates the cycle of addiction and can become its own prison.
With this in mind, how can we as a society help to make meaningful changes in the lives of those who struggle with addiction? The opposite of addiction is not recovery — it is connection. When policies cause people to feel shamed, othered, outcasted, criminalized, or punished, those who are suffering from addiction will not feel empowered to connect to treatment providers, community support networks, resources, loving family members, spiritual advisors, friends, or themselves.
As we look forward, we need interventions that step away from shame and stigma and instead lean into connection, compassion, and understanding. Safe injection sites do exactly this and will be vital in the fight against overdose deaths.
As noted by the American Medical Assocation, safe injection sites save lives. Research indicates that safe injection sites reduce the amount and frequency of drug use, public injecting, drug trafficking and crime (in areas where the facilities are located), HIV and HEP C high risk behavior, and overdose/overdose deaths.
In 2020, a study in the New England Journal of Medicine found that there had been no overdose deaths at an unsanctioned supervised injection site (at an undisclosed location in the United States) from 2014 to 2019. Likewise, the National Institute of Health acknowledged that while more rigorous research on overdose prevention sites needs to be done, drug use supervision and overdose management have the potential to provide health benefits to those at-risk and bring "economic advantages to the larger community.
Perhaps most importantly, safe injection sites are official health-care settings that are non-judgmental and do not stigmatize drug use or drug users. Individuals are treated like human beings and accepted for who they are, regardless of where they are in their recovery process.
For many substance users a visit to a safe injection site may be their first time interacting with compassionate and caring health-care providers, who inspire them to connect or reconnect with society and substance use treatment services. For every addict who is able to summon the courage to ask for help and seek treatment, there are thousands who silently struggle in isolation and shame, never accessing help. While opponents of safe injection sites argue that public funds are better spent on addiction treatment and that safe injection sites encourage continued drug use, I counter that safe injection sites meet many substance users where they are and provide a powerful entry point into the recovery process.
To the parents who fear safe injection sites in their neighborhoods will be harmful to children, I would challenge you to teach your children not to turn their heads when they see pain and suffering, especially in the form of mental illness and substance use disorders. Rather, model and explain how to be compassionate and empathic towards those who are sick and suffering. Talk to your children about substance use and let them know that you are a safe person to have hard conversations with about drugs and alcohol. There is no doubt that your children will see drugs and alcohol at social events in middle school, high school, and college. Not teaching them about the dangers of substance use and arming them with social and emotional coping skills will put them at risk of experimentation and addiction but seeing or living near safe injection sites will not.
As a substance use treatment provider and as someone who is in recovery from addiction, I would love to see every individual suffering with a substance use disorder embrace abstinence and become freed from the shackles of addiction. I want to see those with substance use disorders enter detoxes, rehabs, and long-term treatment and realize the new freedom and happiness that comes with abstinence. However, recovery is a journey—not a destination—and we need to respect that every individual is entitled to their own unique journey. For many, visiting a safe injection site will be the first step in their recovery journey.
We must remember that every individual who walks into a safe injection site is saying that they love themselves just a little more than they love a substance, that they value their life, and that they do not want to die. For someone addicted to substances this is monumental. From there, we need to love and embrace the user until they are capable of loving and embracing themselves on their own, as our government simultaneously establishes policies and institutions that are truly understanding of the initial issue.
Our country needs to connect with and deliver compassionate services to the 21 million Americans struggling with a substance use disorder in this country, if we ever intend to combat addiction and its root causes.
Amanda Fialk, PhD, LCSW (She/Her/Hers or They/Them) is a licensed clinical social worker and Partner and Chief Clinical Officer at The Dorm, a young adult mental health treatment community based in NYC & DC. On Twitter @AmandaFialkPhD.