
Safe injection sites in San Francisco could be first in the US - sethbannon
http://fox59.com/2018/02/08/san-francisco-to-open-nations-first-heroin-injection-sites/
======
tcj_phx
In days gone by, heroin addicts knew how much heroin they needed to 'stay
well'.

A major factor in the escalation of deaths in the modern era is the
contamination of the street pharmacy's heroin supply with more potent
synthetic opioids (fentanyl, etc).

Overdoses happen when street drugs are more potent than the user expects, or
when the user's tolerance has changed. Two factors in my girlfriend's OD were
having been sober for 5 months and having been made addicted to clonazepam (a
benzodiazepine that increases the potency of opiates - she'd only wanted this
'as needed', but the professionals at the hospitalization preceeding her OD
thought she needed to take the full dose every day). That batch of heroin
could also have been contaminated...

A clean supply of heroin would be quite helpful in preventing people from
killing themselves while self-medicating. Until the politicians find courage
to acknowledge that it was a mistake to trust organized crime to control the
supply of addictive substances, at least 'safe injection sites' is an
intervention that can actually prevent people from causing their own premature
expiration.

~~~
blauditore
> Until the politicians find courage to acknowledge that it was a mistake to
> trust organized crime to control the supply of addictive substances, [...]

What would be a better solution in your opinion? Legalizing it, or allowing it
with prescription? I see some problems with those alternatives as well;
there's probably no magic bullet here.

~~~
colechristensen
Make everything legal to obtain or manufacture with a license attainable
though education and certification – something in between what it takes to get
a driver's license and an AA degree.

If you want to buy heroin you have to understand it's addictive qualities, how
human biology is affected, and how to recognize the negative consequences.

Attach liability to the licensee for anything purchased that resulted in harm
and to distributing substances with incorrect descriptions.

~~~
meri_dian
Education will not stop people from getting caught in the death grip of
heroin. Just as education does not stop people from smoking cigarettes today.

And once an addict is born, as they say, that person will struggle with
addiction for the rest of their lives even if they manage to abstain.

I'm all for legalization of marijuana, but legalization of heroin is a very
poor idea. Heroin must be kept out of the hands of the people.

~~~
Xylakant
The death grip of heroin is mostly unrelated to the actual medical properties
of heroin (or most opioids). The worst health effects come from the impurities
in the substance (Strychnine, a common additive, is generally speaking not a
substance beneficial to your health), the conditions under which it's used
(shared needles, lack of hygiene) and the treadmill of having to organize
funds for the next shot. Medically speaking, heroin is less harmful than
alcohol. It's very hard to actually overdose if the purity is constant. It's a
preferred drug for pallative care in many countries since it's effective and
relatively easy to use (similar tor morphine).

Heroin addicts on a constant regime of pure heroin can be well-functioning
members of society. See [https://en.wikipedia.org/wiki/Heroin-
assisted_treatment](https://en.wikipedia.org/wiki/Heroin-assisted_treatment)

So if you truly care about the health of the afflicted persons, legalization
with a strict control is the most effective option that is currently on the
table.

~~~
fiblye
Heroin wasn't historically a problem because the users died. Heroin's been a
problem because of just how far people will go to get it, and how a massive
amount of people will drop everything else in life just to get a steady supply
of it.

Opiates are the most addictive substances in the world. Once someone gets a
taste of it, their life is forever changed. People can smoke a cigarette a
couple times and decide it's not for them. People can have beers once in a
while and move on. There aren't many people who try heroin a couple times then
realize they're busy and drop it forever.

~~~
crankylinuxuser
Oh please. Enough of your DARE rhetoric.

I've been on hydromorphone. It's 8x more potent than morphine on a gram basis.
Heroin is only 3x more powerful than morphine. I was on hydromorphone for 4
months, and then went DOWN to oxycodone for another 6 months. After 6 months,
went on hydrocodone. By all measurements of addition, I was 100% addicted.

Yeah, it felt good having the drugs. But I also quit taking them sooner
because I felt my mind fogging up. I didn't like that, and took more pain to
be able to think clearly. But no, your assertions that people will just drop
everything to get it is blatantly false.

Homeless people will go after heroin, if they can afford it. But those that
choose this route are trying to numb the fact that people don't care about
their condition, and that they have very little chance to raise themselves up.
It's a social reason - if I cant have a better life, I can check out with
drugs.

~~~
fiblye
And the problem is the people that are dying of heroin aren't the Silicon
Valley tech workers with good jobs and homes that make up the majority of
hacker news. They're people living in shithole towns like my hometown. The
jobs left decades ago and people are just scraping by. They don't have enough
savings to pack up and leave. I've got friends and family dying because it's
way too accessible, and the idea of making it legal and even more accessible
doesn't appeal to me or my common sense. I trust the average person to use
heroin as responsibly as they'd use a military helicopter if they could afford
one from a day's work--and that's not at all.

So congrats on being able to take opiates and not have a problem. If you have
stable employment, your situation is in no way relevant to the people this
problem is afflicting. We already know that soldiers who abused drugs during
the Vietnam war were able to quit them easily upon returning because their
lifestyle improved. Addicts don't have a chance to just up and get a happier
life.

~~~
tcj_phx
> And the problem is the people that are dying of heroin aren't the Silicon
> Valley tech workers with good jobs and homes that make up the majority of
> hacker news.

My girlfriend grew up in a "1%" household. She developed substance abuse
problems because she was born premature, because she was adopted, because of
some "adverse childhood experience", and because her doctors thought she was a
candidate for chemical castration with Provera (which makes some women
suicidal).

"Stress" is the main factor in addiction. For some people stress is emotional,
for others it's economic, and for others it's biological...

> I trust the average person to use heroin as responsibly as they'd use a
> military helicopter if they could afford one from a day's work--and that's
> not at all.

Do you trust organized crime to provide heroin to people who are going to use
it anyways?

------
folli
A well written chronology of the rise and decline of the Needle Park in
Zurich, Switzerland:

Chapter 1:
[https://www.tagesanzeiger.ch/extern/storytelling/needletraum...](https://www.tagesanzeiger.ch/extern/storytelling/needletrauma/chapter1/)

Chapter 2:
[https://www.tagesanzeiger.ch/extern/storytelling/needletraum...](https://www.tagesanzeiger.ch/extern/storytelling/needletrauma/chapter2/)

Chapter 3:
[https://www.tagesanzeiger.ch/extern/storytelling/needletraum...](https://www.tagesanzeiger.ch/extern/storytelling/needletrauma/chapter3/)

Chapter 4:
[https://www.tagesanzeiger.ch/extern/storytelling/needletraum...](https://www.tagesanzeiger.ch/extern/storytelling/needletrauma/chapter4/)

Methadone programs and safe injection sites were crucial elements in resolving
the tragedy.

------
Phanyxx
Here in Vancouver the safe injection sites have saved countless lives and
drastically lowered needle sharing. There's a big misconception that safe
injection sites somehow promote drug use. They save lives and give people a
legitimate pathway to get clean if they choose to. Do the right thing, SF!

~~~
AnabeeKnox
It might be a hard sell to use Vancouver as a model. It has an area which is
perhaps the most public display of social decay I've ever encounted in a
first-world city, principally from drug abuse.

~~~
ggg9990
As someone with no stake in this, I would rather have all of that decay in one
place I can avoid rather than strewn about my city.

~~~
lostlogin
Hamsterdam.

In all seriousness, watch The Wire. It gets you thinking and covers the topic
well.

~~~
ggg9990
The Wire is fiction. The best place to observe the reality is Kensington
Avenue in Philadelphia. I have driven through and parked and observed but
never gotten out. The one thing the Wire got wrong was how densely packed
everyone is... in Kensington Avenue people are only out and about to transact.

------
meri_dian
We are caught in an ideological chasm in the US. On one side is a harsh
society wide approach like that of the Chinese. On the other hand is complete
tolerance and legalization, which is more compatible with a Western social and
political values. We are in an awkward spot somewhere in between.

Unfortunately we must measure success of our national drug programs by the
number of people who do not become junkies. I say unfortunately because it
seems that many people self medicate to deal with sadness or emptiness in
their lives, which makes dealing with hard drug use a daunting task. How do we
remove sadness from people's lives? How do we heal the abscess of loneliness?

Unfortunately people do not always make good decisions, even if they are
content, well adjusted people. If we legalize heroin in the manner I believe
we should with marijuana, I fear many more people than now will stumble into
heroin addiction.

So caught in a valley between two extreme responses, one which is antithetical
to our Western social constructs and another which does not adequately protect
people from themselves, what do we do?

Perhaps the case of Portugal represents an alternative. While not legalizing
the all drugs - you won't see commercials for Black Tar™ brand Heroin -
Portugal has decriminalized all drugs, meaning that while they haven't granted
heroin the tacit acceptance that comes with legalization, they have made life
easier for those who inevitably do become addicts. Perhaps this is the best we
can hope for.

~~~
arca_vorago
"Does not adequately protect people from themselves, what do we do?"

What we do as a society founded upon the principles of natural rights and
liberties is stop trying to protect people from themselves. It always was, and
always will be, a slippery and dangerous slope to collectivism and
totalitarianism. The government has absolutely no right whatsoever to tell me
what I can and can't do with my body, whether that is drinking beer, coke,
smoking weed, or cigars, or eating lettuce. For by accepting the encroachment,
you open the floodgates for arbitrary decisions on what can and can't be done.

It's not even that these thing need to be "legalized". It was never the right
of the government either federal or state to determine them one way or the
other. All the proper medical care, mentally and physically, and education
about substances, would then be free to do its good work without the
interference of lawyers attempting to legislate our lives.

This silent acquiescence of increasingly overreaching government must stop. It
is anathema to everything America was founded upon.

"...a long habit of not thinking a thing _wrong_ , gives it a superficial
appearance of being _right_ , and raises at first a formidable outcry in
defense of custom. But tumult soon subsides. Time makes more converts than
reason." \- Thomas Paine _Common Sense_

~~~
meri_dian
I don't accept the slippery slope argument. But, let's entertain your line of
thinking.

Let's get rid of the speed limit everywhere. We don't need the stinking
government telling us how fast to drive! Oh, looks like traffic deaths are
going up. Hm, maybe we should institute a speed limit...

The point is that people do need to be told what to do - with an enforced
penalty - in certain situations.

~~~
arca_vorago
Roads are a public place, subject to constitutional reasonable regulation (by
the states, not the federal government) as long as not in violation of our
right to travel. So you picked a bad example. Case in point, if I own a
vehicle that never leaves my ranch property it doesn't need license plates,
insurance, or a drivers license to operate it, and I can go as fast as I damn
well please.

What I do in the privacy of my own home is none of yours nor the governments
fucking business.

>"people do need to be told what to do"

This is a disgustingly subservient slave mentality. Enjoy your self-forged
shackles. The worst part is you would put them on others and tell them it is
for their own good!

~~~
meri_dian
If you think being told that people can't go above a certain speed on the
highway to make highways safe enough to drive on makes you a "slave", I would
tell you that you're being melodramatic.

Civilization is a set of rules, either informal or formal, that we obey. We do
this so we can live peaceful and comfortable lives. If you think that's
slavery then I feel bad for you.

~~~
crankylinuxuser
You seem to not understand the difference between private and public property.
I have nary a issue to say "You have to follow the speed limit on public
roads", or "No guns can be brought into the courthouse".

But once we step foot into your own property, I can take my guns anywhere I
want. As long as I guarantee the bullets don't leave the property, I can shoot
what I want. I can take any sort of vehicle I want at whatever speed I want.
I'm the king of my castle and the land that surrounds it.

Now, as per drug usage - the bigger _public_ health crisis is people ODing on
the streets, urinating/defecating on the streets, needles exposed for people
to get jabbed _on the streets_... Notice a trend here? "On the streets" is in
public. Therefore public health crisis.

If I want to do drug, one of, in my own property, there should be no good
reason for a government to say "You don't know your body well enough, so we
have to tell you no". The result is a bunch of nanny-state politicians who
want to dictate your body on your private land.

And, slippery slope? Well, tell that to NYC who can no longer sell larger than
12 oz sodas. Or other jurisdictions that enforce usage, rather than
information. Nanny state at its best.

EDIT: So, what gives? Why is this "government knows best" idea so prevalent?
The choice of how I treat my own body goes all the way to choosing to commit
suicide. Most jurisdictions, even that is "illegal". Harming others directly -
whole different story and that should have state "interference".

~~~
arca_vorago
Maybe more EU people on the board than US people at the moment... otherwise
the downvotes (especially without explanation) baffle me.

~~~
crankylinuxuser
I'm not entirely sure how true that is. We do have an awful lot of statists in
this country as well. And there's also a healthy faction that are hell-bent on
setting their "ethics" up as laws for the states too.

Then again, I'd much rather have discourse than simple -1's applied by random
peoples. Even kuro5hin told whom up/downvoted content. But still, responses
are intriguing. Sometimes, I've even changed my own views since underlying
assumptions I had were false.

Oh well. I'd attribute it to a corollary I heard with voting systems - no
matter the comment and moderation system, there will always be defects for
each method.

------
IdontRememberIt
In Switzerland, we have that kind of structure since ages. They are effective,
lower criminality, decrease neigboorhood issues, decrease criminality rate,
health issues and lower the medical costs supported by the public hospitals.
Of course, it does not solve the major issue: how to make them stop taking
drugs. See that one in the center of Geneva:
[http://www.premiereligne.ch/quai9/](http://www.premiereligne.ch/quai9/)

[https://www.google.com/maps/contrib/102904556286110178389/ph...](https://www.google.com/maps/contrib/102904556286110178389/photos/@46.2093191,6.1398544,17z/data=!3m1!4b1!4m3!8m2!3m1!1e1)

~~~
skellera
Being someone who benefited from needle exchanges, it’s a step in the right
direction. It’s a place where users will be exposed to options for getting
clean. Ultimately they are the ones who need to come to that decision but
having options positively shown to them will help.

Addiction becomes a cycle of negative reinforcements and being able to put a
possible break in that will make a difference. Many have mental health issues
that they are self medicating for. Hopefully there are counselors there to
help those who want it.

~~~
IdontRememberIt
Oh, yes. They provide a lot of services. Very good and positive structure.

------
Cofike
The individuals who are using these drugs already use them openly in the
street. I see them daily on my way to work as I work in a popular area for
vagrants/homeless.

If it prevents me from stepping on needles and seeing blood from people
shooting up on the street, I am all for it. These individuals will use one way
or another if they want to so giving them a place to do it safely off the
street seems acceptable.

Of course, the ideal solution will be to eliminate heroin and other hard drug
use but this is a start.

~~~
zanedb
Well of course people want to eliminate it, but how?

Is this not at least a step in the right direction?

------
sfstreet
"The facilities provide a safe space where people can consume previously
obtained drugs"

That seems strange. If you actually tolerate drug use why not go the full way
and provide clean versions of the drug on prescription, driving illegal
dealers out of business?

~~~
smsm42
Because then the organizers of the site would be in jail for drug trafficking,
and so would be any doctor who prescribed those. That could happen only if
drugs are legalized, and not only on the state but on federal level. You can
judge how far we are from there if you notice that DOJ, under Sessions, is
still battling the benign marijuana, even for medical use (which makes me
seeing red and my blood pressure skyrockets each time I think about it - ffs,
we use chemicals in medicine that can are like a nuclear weapon compared to
marijuana's zippo lighter, and still these people refuse to see the case for
even prescribed medical use!). And you're talking about legally dealing out
the real bad stuff, which _is_ dangerous. We are decades from that, at the
very best.

------
eddieh
I thought the first of these sites in the US were going to be in Seattle?
Seems like San Francisco is closer now.

[https://www.seattletimes.com/seattle-news/crime/seattle-
king...](https://www.seattletimes.com/seattle-news/crime/seattle-king-county-
move-to-create-2-injection-sites-for-drug-users/)

~~~
icelancer
The citizens of Seattle are fighting back against it pretty hard.

~~~
aaronbrethorst
A group of Seattle NIMBYs are fighting back against it pretty hard. For the
sake of _my_ city, I hope they lose.

------
acoye
I lived in SF for a couple years near TL and I saw people doing it on the
streets.

To me this site is a good thing, harm reduction policies have shown good track
record. They work.

A good exemple is the "première ligne" association in Switzerland. They have a
big site in Geneva, you can see the building for the train station.

I would recommend a read of their website.
[http://www.premiereligne.ch/](http://www.premiereligne.ch/)

------
zenbit
In 2016 there were 204 deaths due to substance abuse in North Rhine-Westphalia
(NRW), with ~17m inhabitants Germany's most populous state. That same year
there were 321 deaths in Bavaria. Bavaria has a population of only ~12m and in
general has a much lower crime rate than NRW. The difference in deaths is
often attributed to the fact that there are safe injection sites in NRW while
there are none in Bavaria.

~~~
Jdam
That’s because Bavaria is close to the Czech republic and the bavarian/czech
border is a well known import corridor. Google further info on that, if you’re
interested. Also, I invite you to compare the NRW numbers to the Berlin ones.

~~~
tobltobs
The drug importers don't sell their stuff along their import corridors. They
bring it to next distribution center before they start splitting it up.
according your logic Texas would be one of the states with a high drug
overdose mortality. You are confusing small scale crystal meth smuggling with
large scale opiate importing.

~~~
bfuller
>The drug importers don't sell their stuff along their import corridors.

This lacks perspective. Border states have "black tar" heroin, which comes
from mexico, and is less pure than northeast heroin which is purer and in
powder form instead of tar.

------
smsm42
The article starts with "to open what could become the nation’s first legal
safe injection sites aimed at curbing the opioid epidemic". How that should
work? I understand that it may help existing drug addicts and reduce mortality
from opioid abuse (which by itself is a good thing) but how can it curb the
opioid epidemic? I may be that it achieves many other benefits, but what would
be the way it may achieve this one? By logic if opioid use becomes easier and
less dangerous (which, again, may be a very good thing for current addicts) it
would not make people less willing to take opioids, so how that is supposed to
work? Is there some component of it that I am missing?

~~~
birken
> have consistently shown them to be effective at reducing overdose deaths,
> preventing transmission of HIV and viral hepatitis, reducing street-based
> drug use and _linking people to drug treatment and other services_

There are a lot of people addicted to drugs that don't want to be. In a safe
injection site, you have a bunch of health professionals around who are
experts at treating addiction.

I'm not an expert on opioid addiction but I'd wager that the ease or
difficulty of injecting the drugs isn't a major factor for opioid usage. I
think the people who are addicted will get and take the drugs by any means
necessary, and people who aren't addicted to opioid's probably aren't going to
try them all the sudden because there is a safe injection site.

~~~
smsm42
> you have a bunch of health professionals around who are experts at treating
> addiction.

That'd be nice but the article doesn't say anything about health professionals
- it looks like there are just organizations dedicated to supplying clean
needles, etc. - which is completely different level of investment than having
a doctor specializing on addiction and involved with long enough term that it
could actually make a dent. From the article, the most they can do is provide
referrals.

------
formol
The very lefty mayor of Paris launched one « safe site » in the city. Results
: disneyland for drug dealers and addicts in the area, dead people (OD) in the
street, noise, fights...

~~~
Andrex
Sources for this would be very helpful. Always interested in alternative
viewpoints!

~~~
zapita
Here is a recent study of drug consumption room programs across Europe
(including the one in Paris), and their impact so far.
[http://www.emcdda.europa.eu/topics/pods/drug-consumption-
roo...](http://www.emcdda.europa.eu/topics/pods/drug-consumption-rooms)

Their analysis seems pretty balanced, and seems to skew positive. It
definitely contradicts the negative comment you're responding to.

~~~
chx
The truthiness of that comment can be pretty safely derived from the derisive
word "lefty".

------
tmoneymoney
Hamsters "The Wire".

------
dang
The article comes from [https://www.cnn.com/2018/02/07/health/safe-injection-
sites-s...](https://www.cnn.com/2018/02/07/health/safe-injection-sites-san-
francisco-opioid-epidemic-bn/index.html), which has the better title but also
an autoplaying video, so we'll use the title but stick with this URL.

------
ananab
Sounds like we're conflating 2 issues:

(1) How we can we let addicts shoot up in a way that is safe for them

(2) How can we let addicts shoot up in a way that is safe for their community

Pardon my ignorance, but I think we should be focused on the safety of the
community (2), more than how addicts can continue to abuse drugs safely (1).

People have abused drugs for a long time (alcohol included), which results in
self-inflicted repercussions. Natural selection tends to weed these genes out
if such people don't exert self-control and make a permanent clean break, as
difficult as it may be.

My solution: legalize all drugs in limited geographic areas — far away from
society at large (along the lines of Vegas). What happens there stays there,
and feel free to stay there forever if you'd like.

I don't say that to be insensitive. I myself enjoyed alcohol too much, until
it got me in enough trouble enough times that I decided the pain it caused my
family & friends wasn't worth it. I had 2 choices in front of me: drink my
life away and drag the people I care about with me through it all, or man up
and swear it off for good.

I chose the latter. No therapy, AA, etc., just a deep sense of the injustice
and lack of empathy in my actions, and living (and dead) examples before me in
my family.

Had I been so weak to continue favoring my short term pleasure, it would serve
me right to die early and put an end to everyone's pain (my own included).

~~~
hycaria
But you realise they can't be on their own, without society and its working
businesses to feed themselves, its healthcare facilities to care for them, its
giving inhabitants to sustain their addiction... I also really wish I would
not have to see the worst humanity and its hopelessness everytime I pass the
nearby hospital that has a safe and free injection site, but sadly as a
society we can't just give up on those people even though a ridiculous
proportion is making it in the end.

------
coolspot
It is like they are testing there how far they could go.

