One way to reduce the danger of injecting drugs, research suggests, is by creating spaces where people can take drugs under medical supervision. When provided with clean needles and monitored for signs of overdose, people are much less likely to hurt themselves—both in the short- and long-term. So-called supervised injection facilities or safe consumption sites can also help people get into treatment if and when they want it.
The idea has been used around the world, with consumption sites legally operating in more than 66 cities in Canada, Europe, and Australia—and even at a secret site in the United States. Research shows that they actually reduce drug use, reduce overdose deaths, help prevent the spread of bloodborne diseases such as hepatitis and HIV, and get more people into addiction treatment.
But in the United States, where safe consumption sites have been considered but not yet implemented, public support may depend on how we label them. In a new study led by researchers at the Johns Hopkins University Bloomberg School of Public Health, the authors surveyed nationally representative samples of Americans and found a stark difference in support depending on how the facilities were labeled.
Respondents received the same description of injection sites, but under different names. When they were called a “safe consumption sites," 29 percent of people supported legalizing them in their community. But when they were called “overdose prevention sites," that number jumped to 45 percent.
“This study really shows that it’s all in how things get marketed, and the importance of what we call things,” says study co-author Susan Sherman, a professor in the department of health, behavior, and society at the Johns Hopkins Bloomberg School of Public Health.
In this case, she suggests, including “overdose” in the name fixes people’s attention on what these sites hope to prevent—unnecessary trauma and death—rather than what they make safer, which is the injection and consumption of drugs.
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She compares it to Sarah Palin’s coinage of the term “death panels,” implying that faceless government bureaucrats would be deciding who lives and who dies. It was a potent (and patently false) framing, and it’s stuck with us, especially among conservative media. It’s evocative in the same way the term “death tax” activates different emotional responses than “estate tax,” even when they describe the same thing. Both are examples of political framing: choosing language to have the greatest impact when speaking to a particular audience.
“You in fact can make a difference in how people feel about something by virtue of what you call it,” Sherman says.
She says the new study suggests how injection sites should be framed for greatest public approval: by emphasizing overdose prevention right in the name, because people respond to that. For all the complexities around drugs, people can understand overdoses, and discussion can start there.
“This allows for a conversation about something that has been proven safe and effective in other countries,” Sherman says, “without starting with alienating language that takes you on a different course.”
In May, the New York City Mayor’s Office released a plan to open four safe consumption sites throughout the city and noted that they’d be called Overdose Prevention Centers. If this new study is any indication, that framing will help garner more public support.
Sherman also notes that harm reduction—the concept of mitigating the negative effects of drug use through things like opening needle exchanges and distributing anti-overdose medication—has become more mainstream. According to the Centers for Disease Control and Prevention, close to 50,000 people died from opioid overdoses in 2017, almost doubling since 2013. Those kinds of numbers have almost inevitably opened minds to other means for saving lives.
But these are ultimately political discussions, affected by how we frame them. As Sherman puts it, “this study shows that language matters.”
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