"It feels wrong."
"It feels wrong letting people walk away with new needles, knowing we're helping them use. But Prevention Point has helped so many people stay safe from blood-borne diseases and live to see the next day."
Sam Hoegle, a medical student with Drexel Medicine's Streetside Clinic, is a patient advocate at Prevention Point Philadelphia, a needle-exchange site.
"Sometimes, doing the right thing to help someone is not a straight path."
In the face of the COVID-19 pandemic and the George Floyd protests across the country, the opioid crisis still lives and breathes. In fact, in Philadelphia to establish a safe-injection site, a successor initiative to Prevention Point where injection drug users can do so under medical supervision, continues to by political and community opponents, who say that it could facilitate illegal drug use and violence.
However, whether establishing a safe-injection site would be beneficial or not, people who (OUD) will continue to use opioids, especially now that the help they can get from . A better solution to fighting the crisis, which would address the root cause of the persistence of the opioid crisis, would be to make opioid use legal.
Yes -- legal. For all people to use freely.
Today's protesters are fighting racial injustice and making it clear that we need to remove federal policies that disproportionately affect black Americans. Advocates of safe-injection sites take the harm- to support their position, defined as policies, programs, or practices that aim to minimize negative health and social impacts associated with drug use and associated laws.
However, whether we want to see real change for the hundreds of thousands of black Americans incarcerated for every year, or implement that can save those facing opioid addiction, then we should agree that fighting federal regulations when we seek to establish a public health solution is not conducive to success. Instead, we should address the core issue and codify harm-reduction into law so that programs like safe-injection sites can exist without having to work against the grain. Knowing that the in the U.S., incarcerates blacks at of non-Hispanic whites, and that access to support and supervision for injection drug users across the country has taken a from the COVID-19 pandemic, there is a much more effective response in opioid legalization, which we must urgently enact to reach the very goals that safe-injection advocates and Black Lives protesters pursue.
Doing the most good requires embracing Sam's wisdom to veer off the straight path and legalize drugs of abuse for personal consumption. Legalization would return citizens' lives to them by eliminating the systemic racism inherent in the criminality of heroin use and lifting widespread restrictions on public health strategies including and beyond safe-injection sites.
Legalization would end our system of incarcerating victims of OUD.
We must recognize that OUD is the compulsion to continue to use opioids despite harmful consequences.
Yet, we have selectively criminalized OUD and worsened the lives of those struggling with this serious mental health issue by making use of heroin and fentanyl illegal. A found that only 11% of inmates with substance abuse and addiction disorders receive any treatment during their incarceration. However, among those who did receive medication-assisted treatment (MAT), which is the most effective form of treatment, reports from Rhode Island that 78% continued treatment in the community after release.
With serving time for a drug charge and the current fire behind the national push to release incarcerated , who are also at-risk of contracting the coronavirus, legalizing opioids would let people reclaim their autonomy while strengthening the case for the thousands incarcerated on drug charges to be released and saved from the cruelty of living in prisons because they are black.
But if we don't heed the protesters' message of systemic racism and instead stop our harm-reduction efforts at merely opening a safe-injection site, the systemic problems facing black Americans and injection drug users will persist.
Legalization would allow physicians to prescribe buprenorphine and methadone without arbitrary limits, increasing access to treatment.
Buprenorphine and methadone are opioid-based MATs used to wean patients off of hard drugs while preventing withdrawal symptoms.
, like hydrocodone, which have , are regularly prescribed legally for pain by clinicians without significant limitations. Yet fear surrounds use of , stemming from factors including the criminalization of opioid use and the misconception that substance dependency is a willful choice.
Evidence has shown that MAT combined with psychosocial therapy is the for treating OUD. However, of people with OUD ages 12 or older received treatment with MAT in 2018. A culture of fear has created artificial policy barriers to MAT, including limits on the number of patients to whom physicians can prescribe these life-saving drugs.
Regarding , physicians must apply for a waiver allowing them to treat only 30 patients at a time, which can be increased two years later to a 275 patient maximum. Additionally, the Federal Narcotic Treatment Act of 1974 mandates that another effective medication, methadone, can only be ordered and dispensed at federally-licensed "methadone clinics," further limiting treatment availability.
Thus, limits on prescriptions of proven medications for OUD treatment establishes another wall to tackling the opioid epidemic. Because MAT utilizes opioid medications, legalizing opioids would remove the stigma that currently maintains these arbitrary limits on MAT, saving many more lives than safe-injection sites alone.
Legalization would dignify Americans previously disadvantaged by short-sighted government policies.
Faith in the innate dignity of people drives our push for legalizing opioids. Of course, large distributors of these dangerous drugs should be prosecuted -- but the average citizen should not be imprisoned or face systemic barriers to care for struggling with a mental health issue. And they certainly should not be at risk of death in prisons where social distancing regulations per .
"Half the battle is having someone to listen," Sam Hoegle, the patient advocate at Prevention Point Philadelphia, says. "Becoming partners in your journey says that we will help you live through your current trauma so we can eventually make it through detox together. We care about you and believe in your determination to quit."
Instead of focusing only on safe-injection sites in tackling the ongoing opioid crisis and resulting racial injustice, we should recognize opioid addiction as the serious public health crisis it is and legalize opioids for personal consumption. Doing so would uphold Sam's belief in the human potential and remove key barriers to getting help in this uncertain age of racial divide.
and Troy Anlage are medical students at Drexel University in Philadelphia. Kaleem is assistant director of the Correctional Health Care Task Force at . Anlage was previously an advocate with Drexel's Naloxone Outreach Project.