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Safe injection sites in San Francisco could be first in the US (fox59.com)
86 points by sethbannon 11 months ago | hide | past | web | favorite | 120 comments

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.

> 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.

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.

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.

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

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.

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.

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.

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.

> 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?

> 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.

First problem - assuming I'm in SV or other high tech areas. I'm not. I'm in south Indiana. By definition, it's a flyover state at best. BTW, most of Indiana is "shithole towns". Thanks for playing.

> The jobs left decades ago and people are just scraping by. They don't have enough savings to pack up and leave.

That's most of the USA, except for the sweet money in those big city coastal areas. Mining is done gone. Manufacture is gone - where it has come back, is 95%+ automated. IT work is menial tier 1 call center jobs, if you can find them. Trucking is still prevalent, but we all know where that's headed.

There's service jobs. That's what those sweet sweet '60s, '70s, and '80s jobs turned in to. Work your ass off for what, $8/hr? Or maybe you're "lucky" and got a $2.35/hr server job. Or maybe you work healthcare service. Oh, so you're an in-home-health aide? You physically help people with many tasks to be functional? Well, you're worth $7.35/hr . And you get to drive to and fro clients houses. And they will want you to drive them places... That's commercial driving so you're driving uninsured. Enjoy those sweet benefits.

> 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.

Uh huh, like illegalization has made it impossible to get. Oh, that's right. That's why heroin is being cut with all sorts of shit, including fentanyl, strychnine, and other fun things. Many heroin users die cause their supply has been fucked with.

Legalizing it would provide a pure source, and accurate dosage. And it deprives criminal enterprises from capitalizing on these people. And people who are suffering real chronic pain can get their pain fix without dealing with a damned moralistic gatekeeper.

> 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.

More ass-umptions. I got in a nasty bike accident while working at starbucks. They put me on unpaid medical leave. Job didn't pay well to begin with, and their insurance ended up covering none of my physical therapy. Great insurance it wasn't. I was soon laid off for not being able to do the job. So yeah, I did over a year of opiates, while being unemployed and unemployable. Just blows your narrative all to hell, doesn't it?

> Addicts don't have a chance to just up and get a happier life.

Did it occur to you, that drugs provide a temporary "happier life"? Our society sure as hell isn't interested in fixing these chronic problems of homelessness, lack of food, poverty. They're still thrown away - out of sight, out of mind. Or, it's their problem for being lazy or laggard or making bad choices or getting the wrong degree or joining the military.

So yeah, if we're not willing to start providing ways up for these people, then yeah, provide drugs. It at least provides a snapshot of "not suffering", albeit for a while.

I knows several people that tried Heroin a few times and gave it up, but where addicted to cigarettes. Different people have different drug preferences ans I doubt we have good statistics on this stuff.

I like many people where given opioids post surgery and ended up tossing the pills vs finishing the prescription, yet people get really addicted to the same medication.

Indeed, it's entirely possible for people to take heroin at the weekends or similar, and put it down without problems, and I know several friends who do it irregularly without getting addicted - although only smoking, I've never heard of anyone injecting IV heroin who wasn't an addict...

Injections are apparently much more potent than smoking, so it makes sense that people already addicted prefer that to keep the required amount lower. For recreational uses, smoking would just be much more practical.

Indeed. The bio-availability from 'chasing the dragon' on tin-foil is something like 50% or even less, although in the UK at least powdered heroin is adulterated with things like caffeine (which causes heroin to vaporize at a lower temperature) to make smoking more effective. Obviously IV injecting gives 100% bio-availability, though.

I’d like to take the opportunity and thank you for posting here. It’s hard enough to find reports of people that are going through a withdrawal, so being able to engage in a discussion is a rare opportunity. I wish you all the best in that process.

> There aren't many people who try heroin a couple times then realize they're busy and drop it forever.

Millions of people have used legal opioid painkillers and moved on with their lives. Some people get addicted but for the legal opioids it's far from true that "once someone gets a taste of it, their life is forever changed."

Is heroin that much more addictive than the legal variants?

No it isn't. You don't get addicted straight away, you have to work at it.

Just like cigarettes, you have one and don't like. Tastes foul, gives you a headache. But if you persevere, smoke 1, then more then more. Then after 10 days / 2 weeks of daily smoking you are starting to get addicted, same for heroin. You use it once, and if is any good, you are sick, violently so (vomiting, not dope sick), but persevere for 1-2 weeks the addiction will take hold.

Addiction tends to happen more with heroin, because people who would tend to trying it have other issues on in their life to give them the impetus to keep on trying it.

Only about 10% of people who try heroin go on to become addicted.

The first few tries just aren't pleasant.

Cocaine or methamphetamine are probably more psychologically addictive, although not as physically addictive.

And, for addicts, coming off heroin is unlikely to kill you. Coming off alcohol might.

10% is not a number to trivialize.

I've noticed a lot of people on HN are for all drugs being legalized, but they look at it from the perspective of fairly wealthy and highly educated tech workers with stable lifestyles. Coming from a small town in the rust belt where people struggle to even imagine a future, heroin is way too easy of an escape.

I think helping people who've become addicted is good, but these aren't things that should be legal and accessible for people to start using.

10% is the rate of the people that ever try, and those are currently likely to be the people that are predisposed to develop an addiction. I don't think this can be generalized to the whole population.

> but these aren't things that should be legal and accessible for people to start using.

Then impose a full ban on alcohol as well? It's about as addictive and ranks higher in danger to health than heroin. And it's pretty much freely available to any adult. Well, the US tried, it didn't work out all too well.

> I think helping people who've become addicted is good, but these aren't things that should be legal and accessible for people to start using.

When addictive substances are illegal they're more accessible than when they're managed appropriately.

Johann Hari tells in Chasing the Scream about a city in the UK that used to have a legal heroin program. Addiction rates were a fraction of the rate of a nearby city with similar economic prospects. The difference was that the addicts who lived under prohibition had to advertise to their friends to support their habit.

Patients who could get what they needed from the NHS had no need to promote heroin/cocaine/etc to their friends.

I understand what you are saying. I agree that heroin by itself is not very harmful to the body relative to some other drugs.

But let me be more clear about what I mean by "death grip".

When someone cares so much about a drug that it becomes the focal point of their lives, where they become so utterly ruled by the object of their addiction that friends and family and all else not the drug become secondary fixtures in their lives, then they have become the walking dead and are very much in the death grip.

I have seen it with friends. Some are still breathing, some are not.

Sure people on medical grade heroin regimens can continue to exist, but the drug will kill them inside nonetheless.

Revitalization is possible of course, but it is exceedingly difficult.

The point of medical heroine is that people on that regime can and do become well-functioning humans again. It’s not the drug that kills them, it’s the loss of all social support network and the ill effects that come with the situation.

The point of medical heroin, or other harm reduction programs, is to allow people to get on with their actual life without the all consuming addiction being front and centre all the time. I'm currently on a methadone program in the UK (there aren't any heroin based programmes as far as I know here) and it lets me keep up my job as a software engineer without daily worries about having to make sure I can score and not be 'sick' (i.e. withdrawing) and unable to work or go to the office. A heroin prescription would accomplish the same thing for me, and for people in a worse situation - perhaps unemployed or homeless - it would mean even more, since they could devote their energy to rebuilding their life.

Personally, I don't really need a safe injecting space - I own my own home and have a pretty stable lifestyle, but again, I can see how for other addicts it would be incredibly helpful. Again and again, as seen in other comments, it can be seen how despite objections these places provide an objective positive benefit to society.

I'm curious to hear about your program. Is the goal to get you clean? Slowly wean you off heroin?

Heroin addiction is 90% looking for or doing something to get more. It’s an incredible time sink. It’s impossible to have a meaningful life like that.

What medically administered heroin does is allow people to get that time back so they can rebuild their lives. Once they see that things are better, they become more successful when finally coming off of it. Even if it takes forever, they are still productive members or society instead of a drain.

Like 'skellera says in the sibling comment, heroin is an incredible time-sink. The methadone programme I am on (provided free by the UK NHS) is something that will let me gradually reduce the amount of heroin I'm taking, and eventually yes, get clean. After a couple on months in, I'm down to ~25% of what I was taking daily before, and that should reduce further to zero over time.

A methadone maintenance program will gradually increase the amount of methadone prescribed, while the user reduces the amount of heroin they take, until the user is 'stable' and no longer using heroin. After that I certainly would like to then stop taking methadone too, but in some cases the maintenance can continue indefinitely and it would still be considered a net positive outcome...

Like others have said, folks won't actually stop using the stuff. Keep it illegal and folks have a higher chance of getting bad stuff, not injecting cleanly or properly, and increases overdose deaths.

At least with legalization, you get some science based education before you even try it the first time. For most folks, this is way before they start to inject. You can more easily have physicians and/or pharmacists having frank talks with patients about signs of addiction and have science-based plans to help folks wean off of the prescription drugs. You can have injections done by a trained professional, who calculates your dosage. You can make sure it is the strength on the package. You can be referred to a clinic for addiction.

Maybe we can even use some of that money we saved on incarceration to let folks rest at home after injury/surgery without losing their house or their job so that we use less pain medication and reduce risk. We can offer medicine-based addiction services as well instead of AA and NA being the standard treatments.

And sure, it won't stop everyone, just like cigarettes. But no one currently starts cigarettes thinking they are completely safe - I surely didn't and I started 20 years ago, though I'm down to 3-4 a day now. We can also not use as many of the scare tactics we use today and be honest about the positive effects folks get from this stuff along with the bad. For some, we might have better alternatives (different ways for coping with boredom and stress might help with things like boredom, which is what actually got me to start around 18).

And just to state things: I don't know how it is with heroin addiction, but not all addicts for other drugs are alike. Not everyone is an addict for life. Some folks can be alcoholics but then be completely able to drink casually like everyone else, without re-developing a problem. Others cannot, and I think we do a great disservice to people when we lump them together like this.

Legalize everything, and offer the appropriate counter-medication at a discounted cost. Heroine costs someone $20 per use? Methadone is $10.

You'll never keep drugs out of the hands of people who want them, all you're doing is creating artificial scarcity driving up prices and giving people like Mexican drug cartels huge financial incentives to run drugs into the country. Even if only 1/10th of their drugs make it into the US, as long as there's an demand, that supply will be exponentially worth more, and cause more harm than pharmaceutical grade heroine sold just like alcohol, tobacco, marijuana, etc...

Heh, heroin does cost about that much, same for methadone, at least in the UK. I can get 100ml of 1mg/ml methadone for GBP 10 which will keep me stable for a day or two; a GBP 10 (i.e. 'tenner bag' or 0.2g) of heroin is enough for a single IV shot for many users. Of course, depending on your tolerance, that may well not be enough, but my point is that 'legal' heroin would probably be much cheaper than current 'street' prices. I'm not sure how cannabis prices have varied in places where it's legal in the US, though - do taxes bring the price back to parity with the old 'street' level? I'm guessing it's going to be complicated by the fact that it's still illegal in other states?

So, turn the Mexican drug cartels over to america drug cartels? Until we fix the cartel problem in the US legalization will do nothing but bring down prices. Look at how it took 30-50 years for "education" in tobacco products. Yes there are examples of countries that have legalized drugs, but without a much better healthcare system in the US it would turn into a huge money grab.

No one is saying education and legalization will end addiction. Rather, it could make it safer and lead to less overdose deaths.

Would have loved for this to work, but there might be a few problems.

1. Some people might pass the test and sell it to others who didn't.

2. I'm not sure how education helps here. Everyone who takes heroin/cocaine knows how bad it is. I think people actually think it's much worse than it is.

After taking a "health" class in high school, my friends and I said "wow, I thought drugs are much worse". For example, they showed a recording of a lady taking MDMA and enjoying it in her room. From what I was taught before that, I assumed she must die or commit suicide immediately or must start craving another dose a day later. Same thing with marijuana.

"It's bad, but we can't tell you why except some potential side effects that may or may not occur"

>2. I'm not sure how education helps here. Everyone who takes heroin/cocaine knows how bad it is. I think people actually think it's much worse than it is.

Respectfully, you are wrong. Nothing wrong at all going to the pub, having a few beers with friends and sharing a gram of coke.

Heroin itself isn't bad, is actually quite useful medically.

Just like drinking a bottle of whiskey is not good for you, but has a tiny relation to have a beer after work, the same for coke / heroin.

> After taking a "health" class in high school, my friends and I said "wow, I thought drugs are much worse". For example, they showed a recording of a lady taking MDMA and enjoying it in her room.

That is 99% the experience people have with MDMA. They have fun and no problems. So if the result of truthful information is people go out and have fun safely with zero problems, then what is the problem?

Legalise all drugs without discrimination. Provide true information and have access to health, mentalhealth workers at the place of purchase. Most opiate addicts do not want the life they have, but when 100% of your waking day is spent searching for the money to get your drugs / using drugs / feeling the effects of the drugs you have next to no time to seek help for the root cause of your issues. Provide these people with free medical grade drugs and other a support system for helping them become a part of society with the honest admission some people will never get clean, but if can be funded their drug can leave (relatively) normal lives as a functioning member of society

1. So, it'd be like alcohol and tobacco, then? At least the product they are selling will have standards of purity and things like that.

2. Education that doesn't involve scare tactics provides things like proper expectations, safety on dosage, and things like that. MOst drug education in the US has scare tactics - like your reference to cocaine. Most healthy folks can do a little bit every once in a while and have few to no side effects. Same for MDMA, but folks should know that taking it too frequently can mess you and that you'll not be sober for a while. Folks get morphine and medical-grade heroin for pain without becoming instant addicts, so obviously it is safe in some situations. We can teach folks what to expect from pot edibles, mushrooms, and LSD. We can teach folks how to keep safe while doing a drug - how long before you should consider yourself no longer impaired, for example. Warning signs to seek medical attention are important to learn. Legalisation means folks aren't as likely to lie about it to cops and doctors.

> 1. Some people might pass the test and sell it to others who didn't.

How would this be worse than now?

And there would not be enough money to make for "full time" dealer.

There is a solution to the drug problem that is clear, simple, and wrong. As you put it, there is no magic bullet. However I hope we can all agree that the current war on drugs isn't working. We've been fighting it since (before) 1971, and prohibition isn't working. People are dying, and have been for decades.

Just like we admit that 100% uptime is impossible, and admit that there's no solution that will make that possible, we instead work to minimize 500s to an often respectable number of nine's. Similarly, there is just no solution to the evils of addiction.

What we can practice, however, is harm reduction, and injection sites have been one method that has been in use in Europe for decades.

Can we agree that the drug war is a failure, and work on supporting harm reduction techniques?

How about supplying heroin under strict conditions and medical supervision?

Switzerland went this route 20 years ago and I dare say it's pretty successful.

The cost to health insurance (yep, they pay for it) is pretty much negligable. Especially when compared to the cost to the addicts and society to keep that shit completely underground.

Not really entirely true. I was an IV drug user before the fentanyl analogs started being pumped out of China and "hot shots" were always a thing.

Thanks for commenting - as always, the devil is in the details.

Would any IV drug user risk getting a 'hot shot' if they had access to a supply of known potency?

There will always be people that push the envelope because they are suicidal. But funny enough buying pure fentanyl is one of the only ways to get a powerful opiate with a known potency.

You cant trust street dope because of the fentanyl, but if you order a pure fentanyl analog from China, and you are smart about dosing using volumetric dilution, you can be very aware exactly how much you are taking. Whereas with street dope, you will never know.

But by definition, a supply of known potency will never cause a "hot shot" as long as you are being smart and responsible.

The problem is some people don't "feel" high until they are pushing the limits of respiratory depression, so you will have people overdosing no matter what.

I've known people that overdosed, were revived at the hospital, only to go home and shoot up again and die. Its very sad.

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...

Chapter 2: https://www.tagesanzeiger.ch/extern/storytelling/needletraum...

Chapter 3: https://www.tagesanzeiger.ch/extern/storytelling/needletraum...

Chapter 4: https://www.tagesanzeiger.ch/extern/storytelling/needletraum...

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

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!

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.

You didn't see the Downtown Eastside before the safe injection site was opened. Needles filled the gutters. The alleys were where you went to get robbed.

There's a reason the Vancouver City Police support the safe injection site. Crime is down; incidence of AIDs transmission, Hepatitis transmission, STI transmission, down across the board.

I walk through the DTES every day between my home and work. It's ugly. It smells like urine. I walk past people shooting heroin several times a week. It's a hundred times better than it was 20 years ago. It's ugly from our perspective. It's vastly improved from the reality of junkie neighbourhoods when we refused to acknowledge how such communities work and how to help the people in them.

The DTES is a shit hole, but it was kind of engineered to be that way.

As for the safe injection site stuff, I lived and worked in the area around the time that place was opened.

It was a shit hole before it opened and continued to be so after it opened. I never went in the site, and never cared to. Nothing special around it. People shoot up in the streets all the time and I'd still be careful where you walk to not step on a needle and don't wear sandals ;)

But supposedly this: Rates of HIV infection dropped from 8.1 cases per 100 person-years in 1997 to 0.37 cases per 100 person-years by 2011. By 2015, the 40-block area surrounding the safe injection site had a 35% decline in overdose deaths.

The DTES in Van is a pretty interesting place. It's not as bad as it looks. I personally never had any problems in the area. But it's still a shit hole.

"But supposedly this: Rates of HIV infection dropped from 8.1 cases per 100 person-years in 1997 to 0.37 cases per 100 person-years by 2011"

I'd like to see a source on that; at minimum, I suspect those numbers would be for new, not total, infections, and I've never seen HIV stats narrowed down to the block level. Plus, sexual transmissions unrelated to the injection site should have accounted for more cases than that.

Hey! You’re talking about my neighbourhood. (Well, I live a few blocks away in Yaletown, but I’ve spent most of the last 12 years working in Gastown/DTES, since that’s where the startups can afford rent)

The neighbourhood has vastly changed due to condo development, gentrification and government programs. The DTES was really run down a decade ago ... now it’s hipsters everywhere. Great coffee!

The population that has mental health and drug abuse issues has been pushed into a very small area in this city, largely due to past political decisions. Most of the social housing and services are primarily centralized in the DTES. Other neighbourhoods don’t want the social housing and the hard-to-house residents.

I think the drug situation was getting better, but then cheap fentanyl hit, and it’s been tough. Fentanyl is a crisis everywhere.

“Harm reduction” is the only ethical way to go, IMHO. I have friends in nursing that work at the Crosstown Clinic, where they are doing hardcore peer reviewed clinical trials involving prescription heroine, and they are genuinely saving lives and even getting hardcore junkies off drugs completely. Every other city in North America is leaving those people to die.

I’ll take Vancouver, thank you.

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.


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

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.

I opened the article and immediatly thought "oh this is a plan straight from the wire"

Knew someone was going to mention it :)

But realistically that does nothing to solve the problem. We could just designate SF the safe injection site for the USA and the problem would be out of view for the rest of the population.

When it's concentrated in one neighbourhood, you can concentrate social services in that neighbourhood. The DTES has a bank dedicated to avoiding paying a percentage of welfare checks to check cashing businesses. Insite has a rehab facility attached to it with a higher rate of non-recidivism after one year than any other in North America. Safe injections sites work. The Vancouver City Police are one of the biggest supporters of the Vancouver safe injection site, which should tell you something.

I don't think safe injection sites solve that problem, it's about making a safe environment for junkies to safely take drugs in hopes they don't do it elsewhere littering needles and drug paraphernalia in other public spaces, especially around children.

Now for the junkies, needs to be more than a safe haven to shoot up and definitely agree with your sentiments. I know they offer more than that, but some people just want that and that's the problem

The hope is that the "junkies" don't die. If that is all that's accomplished, that's still a success. There doesn't need to be more. Obviously there should be an option for users to enter treatment or receive some sort of assistance, but addicts should definitely not be forced into anything just to satisfy some petit bourgeois stern moral impulse, because that will ultimately drive people away and cost lives.

"petit bourgeois stern moral impulse"

I don't know if you've ever met a working-class person, but I think you have things the opposite way round. It tends to be the middle-class petit-bourgeois who advocate a tolerant approach to the victims of drug abuse. Working-class people despise junkies because they are on the front-line of the associated crime, decay, danger, filth, child-neglect, disease etc.

That junkie has a mother who has spent 20 years of her life trying to get him treatment for his schizophrenia but there is no government support, and he keeps disappearing from home and winding up downtown where he finds more comfort from The drug and sold by predatory drug dealers and other people like him who will not judge him constantly.

His mother works harder than any “working class person” I have ever met.

I'm not sure how you've constructed morality in your mind, but if you choose to belittle people who want to protect innocent people from the ravages of heroin addiction, which is a lifelong sickness, then you are misguided.

The real measure of success is how few people become junkies in the first place.

>The real measure of success is how few people become junkies in the first place.

No, the real measure of success is how few peoples lives are ruined.

If a bunch of people end up addicted to heroin, but end up living fulfilling and productive lives regardless, that's a fairly good outcome. If implementing measures to reduce the number of addicts leads to the remaining ones living in poverty and overdosing, then that's not an improvement.

"but end up living fulfilling and productive lives regardles"

That doesn't happen though. Not because of existing drug policy, but because of the all consuming nature of addiction.

This isn't a sustainable solution to that problem. In Vancouver, rapid gentrification is simply pushing these people around once again anyway. We need long term solutions. Social nets which work to help these people get back on track, prevent people from getting on that track, and soften the blow of hitting rock bottom. I have a strong sense that supporting mental health issues more effectively is at the heart of this.

It didn't work for 'Bunny'.

SF's Tenderloin is the same though. If anything it seems worse.

> the safe injection sites

Very interesting, I wanted to fix your plural because I only knew of Insite but turns out there are now two, there's Powell Street Getaway since last summer. http://www.vch.ca/public-health/harm-reduction/supervised-in...

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.

"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

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.

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!

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.

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".

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

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.

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

What is the criteria for those "certain situations"?

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/


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.

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

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.

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

That's practically impossible. A much more realistic goal is to minimize hard drugs use, and to minimize the negative impact of that use which will stay on both the users and everybody else.

The problem of thinking about the "ideal solution", in this case, is that trying to reach it brings us to adopt policies that do the opposite of minimizing the negative impact of use, especially if you consider enriching and encouraging violent gangs and mobsters, corruptions, and ruined lives a negative impact.

> If it prevents me from stepping on needles and seeing blood from people shooting up on the street, I am all for it.

For that, all the addicts need to be aware that this center exists, be able to get there (while suffering from withdrawal and other maladies accompanying their addiction) and be motivated to get there as opposed to getting the high right here right now (opioid addicts aren't exactly known for their capacity in delaying immediate gratification). With proper information and enforcement it may happen, but given how the streets of SF look now, this also may not happen.

They mention Vancouver as an example. I've been in Vancouver a few years ago, and I must say, if we're talking about people living on the street and doing drugs there, SF has nothing on Vancouver. The site around where Insite is (according to it's Wikipedia article) was occupied by something that looks like a refugee camp in a disaster area, only with a lot of drugs. Maybe not Insite's fault, maybe they are placed there exactly because that's where people who need it are, but certainly it didn't fix it.

I mean, maybe this saves these people's lives and is worth it. Vancouver locals certainly think it's worth it. But if you expect not seeing people doing drugs or stepping on needless and other unappetizing stuff - nah, didn't happen.

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

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

"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?

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.

We're getting there. There are opiate maintenance programs that utilize diamorphine (obviously not in the USA). They will give you pure heroin and supervise you so you don't fall out.

That would be ideal, but probably not possible politically (at the moment, anyway). But this is a step in the right direction, and will hopefully lead to this in time.

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


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

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

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/

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.

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.

NRW borders the Netherlands, a country with easy drug access as well. And yes, deaths per capita are much higher in Germany's city-states (Berlin, Hamburg, Bremen). But please go ahead and compare numbers on a per-city basis (2016 numbers). You will note that Munich (62 deaths, 1.4m inhabitants, ~44 deaths per capita) is very much comparable to Berlin (167 deaths, 3.5m inhabitants, ~48 deaths per capita).

Sure, gaining access to drugs in the Netherlands is easy, but usually people go there to get some of the not-so-deadly drugs, like weed and not heroin or meth, like bavaria.

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.

>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.

It just seems like „my“ (the local) logic simply does not apply to Texas. Generalization oftentimes doesn’t work ;) For the bavarian part, there are certainly „Meth Cities“ right at the border.

> That’s because Bavaria is close to the Czech republic and the bavarian/czech border is a well known import corridor.

Most stuff coming over from CZ is meth and illegal tobacco and fireworks.

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?

> 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.

> 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.

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...

This comment shows two things, 1. how projects like this will always be blamed for quality of life problems in the area, and how 2. the problems of street people and drug addicts are often much more complex and rooted in previous political clusterfucks.

In the 1990s and early 2000s, the Gare du Nord was the main place that people smugglers would assist people in travelling from France to the UK. At the time you could walk onto a Eurostar without having your papers checked by a British border police (only French passport control, who tolerated migrants travelling to the UK with false papers).

Lots of desperate and often penniless people pitched up around that area. People smuggling was linked to other forms of criminality, including prostitution and robbery by people trying to get the money to make the trip to the UK.

When the border protocol changed, the main staging points for migrants moved to Calais. But that part of Paris remained a centre for migrants to meet and connect. It also remained a centre of street dealing, robbery, other forms of low-level crime like selling fake bags, scams and snatching. It is notorious for street harassment, mainly of women. As far as I can tell, there isn't a particular overlap between people doing this and hard drug addicts.

In practice, most cities have somewhere you go to buy drugs on the street in the middle of the night. No-one wants to be that area, but trying to get it to be somewhere else doesn't really solve the problem. There are lots of things which can make this type of area less upsetting for people who have to work, live and travel through it, safe injection sites might certainly be a part of this.

Source: have lived in Paris and travelled there extensively over last 20+ years. My friend was an asylum seeker in the UK who got the Eurostar from Paris.

As a counterpoint, the Medically Supervised Injecting Room in Kings Cross (Sydney) has quite radically transformed the area for the better - people who used to live there before it opened tell of sometimes walking over the bodies of addicts who'd OD'd on the streets, and of seeing used syringes everywhere. Now, you'd hardly ever see these things.

(I'd link to the Wikipedia article, but it seems to be the subject of an edit war between a couple of groups with agendas to push, so is best ignored.)

I don't know much about the site in Paris but I do have experience living nearby Vancouver's first of now two safe injection sites. In my experience what you describe did not happen in Vancouver. Safe injection sights save lives by providing a clean, safe place to minimize harm.

That's Vancouver. Even the druggies are reasonably civilized.

Not sure if your comment is snide or just humourously dismissive. The homeless, drug addiction and mental health issues experienced in Vancouver, especially in the DTES are very real, and very serious. I don't think Vancouver's homeless population is significantly different than Paris'.

Glad to hear Canada apparently has a good reputation abroad.

Don't we already have all of those problems though? Or is this saying this increased those issues? If so I'd love to see the data, maybe it can provide some lessons for SF as it experiments with this.

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

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...

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

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

I've never seen sources backing up what he says. According to this source results are positive in term of reducing consumption in streets and syringes found in streets. It also allowed to diagnose users with transmissible diseases and provide treatments.

Neighbours of the injection site do complain of increase disturbance in the area but it seems due to the fact that it's the only site in Paris.

Since the one opened in Paris, another one opened in Strasbourg and one is gonna open in Bordeaux this year


There must be a lot more data from sites in Germany, Netherlands and Switzerland that has been opened for much longer.

Sources are very hidden : first result page on google (I'm talking for french people)




to sum up : the neighbours are very unhappy about it. The area was already largely insecure, though (heaven of crack-heads).

I don't think the principle of safe site is bad, but it needs a good management team because - by definition - you can't expect any well disciplined behaviour from drug addicts.

I recommend the rue de Maubeuge. It's just miserable, always a few crackheads hanging around and dealing or whatever. In one article [0], I read that the police deliberately don't act there. The videosurveillance is broken atm anyways.

Maybe the nurses and the psychological aid they can freely ask for in the shooting room will save these poor souls so we don't need the police to intervene. But I go by everyday and there's no diminution.

[0] https://www.streetpress.com/sujet/1463153023-drogue-paris-cr...

It's interesting, I never heard about such results before (and I live in Paris). Would you care to share some links for further reading?

I'm also curious to know why and how the political orientation of the mayor is relevant?

There's a safe site in Geneva (quai 9) near the train station, and none of the effects describe can be seen there.

Hamsters "The Wire".

The article comes from https://www.cnn.com/2018/02/07/health/safe-injection-sites-s..., which has the better title but also an autoplaying video, so we'll use the title but stick with this URL.

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).

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.

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

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