To stop the spiral of overdose deaths, we need to change lives

The recent opening in New York City of the nation’s first supervised injection sites — where individuals can inject drugs in a safe setting — has been widely praised as a critical step to reduce the startling surge in drug overdoses. And with good reason: One person dies from drug overdose every four hours in the city, and there are some 275 drug-related fatalities every day across the country.

Yet, it would be a false hope to expect that these facilities alone will be the solution to the escalating addiction and overdose epidemic that killed a record 100,000 in the 12-month period ending in April. While such harm-reduction measures save lives by providing clean needles, medical care and overdose-reversal medications, they don’t focus enough on long-term outcomes.

At the two supervised sites in New York, those who enter the facility seeking a clean, controlled environment to inject the drugs are treated with the compassion they deserve, including being offered “options” for drug treatment services. Invariably, however, this means a return to the street and a life of drug use, trapped in a cycle of addiction dependency. In the current stage of the epidemic, fueled by the powerful synthetic opioid fentanyl, that often means overdose death. 

As cities and states reel from the spike in overdoses and health services are stretched to capacity, we have to go beyond saving lives for the moment to actually start changing lives permanently through treatment. Unfortunately, poor policy decisions and a severe lack of funding since the opioid epidemic began two decades ago mean addiction services are largely out of reach and too expensive for the overwhelming majority of people with substance disorders. 

Could supervised sites become pathways to treatment? Studies show that similar facilities that have operated in Europe for many years have led to a “greater uptake” in addiction services. Similarly, Pew Trusts concluded that consumption sites “ramp up participants’ engagement” with treatment as users build trusting relationships with staff. The full extent of this engagement isn’t clear, however, with a RAND report noting “serious gaps and flaws” in existing research that limit the quality and applicability of the results.

Still, supervised sites have the potential to engage patients on a continuing basis and therefore influence their decision to enter treatment. Mandatory treatment is frowned on as a coercive measure, but based on my extensive clinical experience — and that of drug courts, which give individuals the choice between rehab and jail time — incentives can and do work for most people.   

Given the scope of the addiction and overdose epidemic, we need first and foremost a massive infusion of government funding to significantly expand access to drug treatment for anyone struggling with substance use. The $1.5 billion for prevention and treatment included in the $1.9 trillion American Rescue Plan is simply not enough. 

In addition to drug courts, implement public-private initiatives that guarantee a stable job to those who successfully complete a course of treatment. And we need treatment programs in prisons and jails, where such services are severely lacking, and post-incarceration so that those re-entering society have a better chance to stay sober.  

Supervised injection sites like those in New York City have a critical role to play as well. They should be designed as a bridge to treatment as part of a continuum of care for addicted individuals. By significantly expanding the number of such sites, and launching pilot projects to determine what kinds of incentives might work best to encourage patients to enter treatment, we could better address this public health crisis that has been ignored for far too long. 

Mitchell S. Rosenthal, M.D., is a psychiatrist who founded Phoenix House, the national substance abuse treatment organization, and is now president of The Rosenthal Center for Addiction Studies in New York City.