Safe Sites for Heroin Injection

So the latest and craziest chatter right now is safe sites for heroin injection. (THANKS Marty for bringing up this topic) So as usual there are lots of pros and cons with everything and heroin injection sites are no different. On the pro side it offers a safe and secure place where people can inject their heroin in a supervised
fashion with guaranteed clean needles the chance to do some education and perhaps counseling and the chance to give them access to other resources to help them through their addiction.

If they stay at home there is a higher risk that they may die an overdose especially with all the fentanyl out there and of course they are all alone with no one else encouraging them to move forward. Are there benefits to this type of system? Yes I suppose there are. While we talk about limiting the damage from intravenous drug use such as HIV and other diseases I am just worried that were not talking enough about the actual problem.

So what is the actual problem? The actual problem is that there is not enough medical and psychiatric and addiction care for these patients and this seems to be a stopgap for fixing the actual problem. I suppose if there is no ability to get people medical care the next best thing is to provide a safe place for them to treat their depression in a suboptimal manner i.e. injecting heroin. Let us be real about this. The reason many people to opiates in the first place is to treat their depression and anxiety and the reason they continue to do opiates after years and years is to prevent getting sick and live in withdrawals. Many of these patients have not felt a high or relief for years all they do is chase of the way the withdrawals for a few hours at a time. So why cannot we simply focus on the underlying problem?

  1. Get more physicians trained in the field of addiction medicine ( I am a great example of how family medicine is an excellent avenue to adding addiction medicine.)
  2. Retrain physicians to show more compassion and be able to refer or treat patients with addictions.
  3. Learn how to recognize and treat common psychiatric conditions as quickly as we can train a physician how to treat an ankle sprain.
    This is not rocket science. Sprained ankle deserves such quick and rapid care you would think a sprained brain ( which is your hard drive) probably deserves the same respect and care right?
  4. Restrain the ridiculous government restrictions on things such as patient limits per doctor. or methadone clinic limits per city.

It takes an act of Congress to open a methadone clinic and each physician is only limited to 1 to 200 patients But weed shops and liquor stores are allowed to open dime a dozen on every street corner.

Do we not see the irony in this? I am not even asking everyone to think outside the box. I am simply asking them to think. If you ask the class of high schoolers they could probably come up with a better solution to our addiction problem then the government has with all of the restrictions.

So are heroin injection sites a good idea or not? They might be able to help save patients from overdose in a controlled setting and provide some emotional support but why not just stick an addiction specialist physician such as myself into each one of these injection sites so that we can actually start talking about the problem. Diabetics are welcome to eat Oreo cookies in my office while we talk about treatment and attack patients are welcome to eat cheeseburgers in my office while we talk about their treatment. I have no objection wants to use while we talk about their treatment.

Rule #1. Gotta meet the patient where THEY are at right? (NOT where the doc is at)
Rule #2. Gotta make rapid progress
Rule #3 Gotta have quick and efficient followup and communication. (we use video chat and texting in my office)
Rule #4 Gotta celebrate every single tiny step of progress
Rule #5 repeat the above steps a million times until the patient is 97 years old and dies a natural death having lived a fulfilled and awesome life

NOT rocket science right?

Stay alive Andreas J. Edrich MD FASAM ADM MRO “the addiction doc”