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Why supervised drug consumption sites aren't coming to Hamilton County any time soon

Meeting of support group sitting in a circle - defocused in a modern mental health facility
Vladimir Vladimirov
Meeting of support group sitting in a circle - defocused in a modern mental health facility

Hamilton County saw roughly a 20% decrease in drug overdose deaths over the past four years, while nationally, deaths increased during the pandemic. County officials point toward harm reduction efforts, like Narcan distribution and fentanyl test strips, as key to saving lives.

But one controversial harm reduction method isn't on the table locally: supervised consumption sites that allow for the safe use of drugs under the careful watch of medical professionals, peers or both.

Jennifer Mooney, assistant health commissioner at Hamilton County Public Health, says supervised consumption sites are rooted in the fabric of harm reduction, which aim to mitigate the effects of addiction instead of cure it.

"I would say that the proponents of this model would say that this is a public health model. Somewhere along that continuum of how you view harm reduction, it mitigates the spread of disease, and it can give people another chance," she said. "So the one thing we do know in this work is that people aren't ready when we say they're ready [to enter rehabilitation]. They're ready when they're ready. And so every chance that that person gets to live their life might just be another opportunity for them to be tapped into other kinds of services, and maybe eventually climb out of that despair of addiction."

The first legal safe consumption site opened in New York City in November, though it's not federally legal. But the sites have operated in other countries for years. The first legal site in North America, called Insite, opened in Vancouver in 2003.

Insite's website says it's had 3.6 million visits from people needing to inject illicit drugs, 6,440 overdose interventions, and no deaths.

Mooney says the safe consumption sites may be successful in large cities like Vancouver and New York City, but it's not clear how well it would work locally. Factors like costs and effectiveness need to be considered, she said, adding that the biggest obstacle is the lack of political will for supervised consumption sites.

"I think that in the perfect world, if we had data, if we had unlimited funding, and we had a place to operate, some of these things could be possible with political will. However, I do think that the thing that gives me pause is thinking of what the end goal is — is it to save lives, reduce overdoses?" she asked, noting there's no one solution to achieve those goals. It has to be a multi-pronged approach.

'It's really tough to understand'

Richard Ryan is a physician at UC Health and vice chair of emergency medicine. He works with people struggling with addiction and says political will and stigma could be changed if people understood the nature of addiction better.

"When we talk about injection sites, we have to understand that, as far as I know, I've never met a patient or a friend or a person that had chosen to be an addict. I really never met a person who chose to be a hypertensive diabetic or have asthma either … And it's really tough to understand from a lay person that it's beyond a choice at this point [when people become addicted]," he said. "People choose their drug over families and jobs and all that. That's how powerful this is. So when you look at injection sites, you say, this is another opportunity to give that person that lives with addiction another chance at recovery."

He says it's the same reasoning that goes into providing people who are overdosing with Narcan, a lifesaving substance that stops the overdose and is readily distributed to people in Hamilton County. He says opponents of funding Narcan distribution say the same people have to use it again and again without seeking help. Ryan says that may be true, but it's not the entire story.

"I've worked in this field and taken care of patients that, on the ninth time, they're sitting with me a year or two into recovery," he said. "So these are opportunities to help the person that has this disease of substance use disorder."

Ryan says reducing the number of overdose deaths in the county is reliant on some of the same things Mooney mentioned: funding, political will, data. But he also says it's essential for community members to communicate about what's best when it comes to opioid treatment.

He says a recent settlement with opioid manufacturers could provide that opportunity.

Hamilton County is receiving over $55 million from a national opioid settlementwith Johnson & Johnson, AmerisourceBergen, Cardinal Health and McKesson. The latter three companies are considered the “Big Three” drug distributors who had the legal responsibility to monitor the distribution of opioids and flag suspicious orders and did not.

The massive distribution of opioid pills throughout the country created a prescription and heroin drug surge in the country that, at its height, killed more people in a year than throughout the entire Vietnam War, according to national data.

The money from the settlement is allocated for addiction treatment, prevention, education and safety.

The Hamilton County Addiction Response Coalition is responsible for creating a regional fund to determine how to spend the money.

Jolene Almendarez is the granddaughter of Mexican immigrants who came to San Antonio in the 1960s. She was raised in a military family and has always called the city home. She studied journalism at San Antonio College and earned a bachelor's degree in Journalism and Public Communications from the University of Alaska Anchorage. She's been a reporter in San Antonio and Castroville, Texas, and in Syracuse and Ithaca, New York.