Special Topics in Pain: Opioids

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Another Senseless Death---The Case for Supervised Injection Facilities.

Author(s): Wakeman S E, et al.
Journal: N Engl J Med. 2017; 376(11):1011-1013. 5 references.
Reprint: Sarah E. Wakeman, MD, Medical Director, Substance Use Disorder Initiative, Massachusetts General Hospital Assistant Professor of Medicine, Harvard Medical School, Boston, MA.
Faculty Disclosure: Abstracted by N Walea, who has nothing to disclose.
Objective: Review and evaluate the latest advances and newest information in the area of Opioids


Editor’s Note: Here is an article which elates an idea that is good but is going to be a “hard sell”. Injection facilities where one can safely “shoot up” under supervision and Naloxone availability.” In spite of all the time and money invested to stem the epidemic of opioid overdoses, the deaths keep mounting. The cruel reality of opioid addiction is that any episode of use can be immediately fatal. Supervised injection facilities have been proven to save lives, improve health, increase neighborhood safety, reduce cost, and ultimately increase engagement in treatment. It is time to think instead about how to enable people to stay alive and recognize that people who use drugs have not forfeited their human rights, including the right to safety and health.’

Class: Pharmacology-opioid overdose

About 129 Americans died each day in 2015 from drug overdose even with all the efforts of doctors, families, and politicians working to stem the epidemic of opioid overdoses. In spite of all the time and money invested, the deaths keep mounting. The cruel reality of opioid addiction is that any episode of use can be immediately fatal.

Even when recovery is the goal, the path to reach it is circuitous, and most people with addiction have recurrences along the way. The odds of dying before arriving at the goal are tragically high. But, this reality is not the only option. Supervised injection facilities have been proven to save lives, improve health, increase neighborhood safety, reduce cost, and ultimately increase engagement in treatment.

These facilities are monitored spaces, staffed by medical professionals, where people who use drugs can do so safely. Insite, a supervised injection facility in Vancouver, has seen thousands of overdoses since opening its doors but not a single death, thanks to the nurses and naloxone on site. Research findings on supervised injection facilities have been overwhelmingly favorable, and several countries in addition to Canada, including Australia, the Netherlands, and Switzerland, have adopted this model. Studies have demonstrated that supervised injection facilities not only reduce overdose deaths, but also increase linkages to addiction treatment, reduce public-order disturbances, and are cost-effective.

This sort of harm reduction, in years past, was often viewed as "enabling" continued drug use. If the current epidemic can teach us anything, it's that drug use is soaring unassisted. It is time to think instead about how to enable people to stay alive.

There has been growing support for a U.S. supervised injection facility. Boston took a first step by opening Supportive Place for Observation and Treatment (SPOT), a drop-in facility for people who are at risk for overdose. In January, Seattle approved the opening of two supervised injection facilities that will be located in the city and the surrounding county. This important step recognizes that people who use drugs have not forfeited their human rights, including the right to safety and health.

Important Points:
In spite of all the time and money invested to stem the epidemic of opioid overdoses, the deaths keep mounting. The cruel reality of opioid addiction is that any episode of use can be immediately fatal. Supervised injection facilities have been proven to save lives, improve health, increase neighborhood safety, reduce cost, and ultimately increase engagement in treatment. It is time to think instead about how to enable people to stay alive and recognize that people who use drugs have not forfeited their human rights, including the right to safety and health.

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