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The first needle I used was a clean one. I got it from a pharmacy. It was still in its plastic wrapper, orange cap covering the sharp. I shot up, copying the YouTube tutorials I’d been watching. Clean cotton ball, freshly washed spoon, alcohol swab. Band-aid to cover the dot of blood that percolated out of the injection site. I pretended it was insulin: I was like a diabetic, but dependent on a highly addictive substance that could end my life with every shot.
I survived multiple overdoses by pure luck. However, there were other issues that came with being an intravenous user. As my heroin addiction progressed, those clean needles got few and far between. So did the other supplies. I had to keep using, even when the only needle available was still full of someone else’s blood. I didn’t know where to turn.
By the time I was able to find help, I had track marks and infections. I was desperate. A decade in active addiction had reduced me to rock bottom. I wanted recovery. What I learned, after getting help, was that I couldn’t completely leave my addiction behind me. I couldn’t start fresh. I tested positive for hepatitis C.
Tens of thousands of dollars later, I’m still undergoing treatment for this highly preventable, bloodborne illness. The medication is covered by my insurance, and I had to fight tooth and nail to get approved for the treatment because it’s so incredibly expensive. It took over a year of constant asking, advocating for myself, and talking to doctors to get treated for Hep C. That’s right: Even in recovery, when I’m no longer using heroin, I’m still dealing with the consequences of my illness.
Hep C and other addiction-related illnesses, like HIV, are one of the blind spots in President Trump’s war on people with substance use disorder. The Trump administration emphasizes fighting against the opioid crisis. However, what that really means is cracking down on people who need the most help by denying access to safe injection sites, supplies, and prolonging the period of active addiction. The outcome? People get sick, stay sick, and die.
Extermination is not liberation: Dead people don’t recover. Last October, President Trump promised to "liberate" Americans from the "scourge of addiction." However, instead of declaring war on addiction, the Trump administration is threatening cities that support safe substance use or harm reduction.
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Allowing people to manage their chronic disease with dignity saves lives. We need compassion, not more crackdowns. The payoff isn’t just keeping people on the right side of the dirt. It also relieves an immense burden on public resources, like our healthcare and criminal justice systems.
Overdose prevention sites (OPS), also called safe injection sites or supervised use facilities, are a critical step in the recovery process for many people. They’re places where people with substance use disorder can go to get clean needles or other supplies, test their substances, use in a safe environment, pick up naloxone anti-overdose kits, and get connected with resources that support recovery. Although we focus most of our efforts on preventing addiction or getting people into treatment, the fact is that OPS are more effective, and save more lives. They are a front-line response to the drug epidemic.
We know OPS work: They have existed around the world for more than 30 years. Millions of medically supervised injections have taken place in about 100 facilities worldwide—and zero overdose deaths have been reported in medical literature. Zero. Compare that to the rest of the United States, where overdoses killed more Americans in a single year (72,000 in 2017) than died in the entire Vietnam War (58,000).
In other countries, OPS and medically supervised substance use are working to keep people alive and healthy. Heroin is available in England by prescription for patients who didn’t succeed with methadone or other treatment. The substance is not legal as a street drug, but medically supervised substance use helps people with opioid addiction stay alive, with the goal of eventually stopping use. England’s death rate is far lower than the US, according to a 2017 study by the Glasgow Caledonian University, School of Health and Life Sciences.
Switzerland is an even more striking example. In the 1980s, Switzerland let people who registered access sterile injection equipment, along with pharmaceutical-grade heroin. Rates of HIV infection fell by 65 percent and more than half of the people given monitored prescriptions were drug-free in three years. By comparison, we have more than 2 million people with an opioid use disorder in the US, most of them needing addiction treatment. Using the Swiss approach, we could potentially move tens of thousands of people from active, potentially fatal addiction to recovery.
Harm reduction works in North America, as well. Canada opened a safe injection site in Vancouver in 2003. It has been so successful that by 2015, the staff intervened in more than 4,900 overdoses without a single death. The Canadian Health Ministry has greenlit additional sites in Toronto and several other cities.
It is a known fact that crime rates don’t increase in areas with OPS. And a person with medically managed addiction does not have to steal or engage in prostitution to support their habit. People can hold jobs and accept access to additional health services.
So, why doesn’t the Trump administration support harm reduction? There are currently zero city-sanctioned OPS in the United States. They’re illegal. Yet, it’s clear that harm reduction methods are both effective and safe.
We can look at national HIV statistics released in 2017 to see how medical interventions, education, and awareness are helping keep people healthy, even when they’re not ready to stop using heroin. From 2008 to 2014, HIV infection rates fell for people injecting drugs, according to the Centers for Disease Control and Prevention. However, the opioid crisis may reverse that and bring back not only a resurgence of HIV, but other illnesses—like hepatitis C.
“The opioid epidemic in our country is jeopardizing the dramatic progress we’ve made in reducing HIV among people who inject drugs,” Jonathan Mermin, the director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a press release. “We need to expand the reach of comprehensive syringe services programs, which reduce the risk of HIV infection without increasing drug use, and can link people to vital services to help them stop using drugs.”
Denying that harm reduction efforts save lives and are a gateway to treatment is how conservative politics and religious leaders fight progress. They’ve successfully created the myth that OPS might encourage or condone immoral behavior. President Trump, whose “emergency declaration” of a public health crisis was disorganized, underfunded, and essentially meaningless, is only compounding the crisis by refusing to invest in solutions that are clearly shown to work.
It’s like the worst possible '80s flashback: a public health crisis, with leaders judging from the sidelines. Seattle, New York City, Philadelphia, and San Francisco have all expressed an interest in opening medically supported OPS to combat the overwhelming number of overdose deaths. But, instead of backing these initiatives, US Deputy Attorney General Rod Rosenstein wrote in the New York Times last week that “cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action.”
Treating people with a life-threatening disease like criminals only increases the death toll. Instead of more body bags, we need common-sense solutions that keep people alive and connect them with life-saving resources. Although President Trump made those exact points in his October declaration, his words were hollow. We need action, and we need a radical approach to stop the epidemic that’s killing Americans.
There were no harm reduction measures available to me when I was in active heroin addiction. If there had been, I might have a different health outcome than I do today. One clean needle, when I needed it, would have made the difference between starting my life in recovery in good health, and spending tens of thousands on treatment for a new chronic illness. If I’d had access to recovery resources before I hit bottom, I might have found my way out of addiction much earlier. My experience is not unique.
Trust me, the people who would rely on OPS or harm reduction support are aware that they have a problem. If they’re showing up to an OPS, they’re willing to receive help. That’s a good sign.
OPS are arguably the most important part of the recovery process. People who use them are more likely to be open to interventions or other resources that will help them stop using. Offering that support isn’t encouraging drug use. It’s encouraging people to stay alive, stay safe, and come back when they need help. And, like the Swiss example, we could help as many as 50 percent of OPS patients into recovery. Once again, that could be tens of thousands of people in the US.
To end the drug epidemic, we need to get over our prejudice about harm reduction and invest in solutions that are practical, humane, and safe. Overdose prevention sites are a common-sense solution. It’s about the long view. Let’s set people up to recover in good health—and stay that way.
Ryan Hampton is a person in recovery from heroin addiction and author of American Fix: Inside the Opioid Addiction Crisis—and How to End It published by St. Martin’s Press. He’s a nationally recognized activist and founder of the nonprofit advocacy organization The Voices Project.
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