Amid doubled overdose deaths since last year in Lorain County, there have been discussions about the need for better treatment.
None have covered a controversial approach: supervised injection sites.
In Europe and Canada, they have been used to reduce fatal overdoses and the spread of disease while encouraging addicts to seek treatment.
Vancouver’s Insite Clinic is a model for several U.S. cities considering opening sites. Among them are Ithaca, N.Y., and Seattle, Wash.
Despite being located in a 20-block neighborhood saturated with heroin addicts, fatal overdoses dropped 35 percent in the area between 2003 (when the Vancouver clinic opened) and 2011, according to the Lancet, a British medical journal. Fatal overdoses dropped nine percent in Vancouver during the same time period.
At the site, there are 13 booths where addicts, who take in their heroin, are allowed to inject. They are closely monitored by nurses who provide naloxone, an overdose antidote, when they overdose.
Last year, the site averaged about 440 injections daily and there were 768 overdoses, according to Vancouver Coastal Health, the public agency that runs the clinic.
There were no fatalities.
Despite thousands of overdoses since the clinic has opened, no one has died, said Gavin Wilson, a Vancouver Coastal Health spokesman.
Deaths have been avoided despite a spike in heroin being mixed with fentanyl, a synthetic opiate 50 to 100 times more powerful than heroin. The clinic started testing for fentanyl this year. Of the 6,532 addicts who visited the site, 464, or seven percent, sought detox at Onsite, the clinic’s drug treatment center.
Wilson said because there’s concentrated drug use in the area, having a site strictly for supervised injection makes sense. The Canadian government gave the site an exemption preventing prosecution of anyone carrying heroin into the site or using it there. Staff is also protected from prosecution.
Besides a federal exemption, Wilson said if supervised injection were to be done in smaller communities like Lorain County, it would probably make more sense to have it at existing hospitals and clinics. That would avoid clustering addicts in one area alleviating concerns of neighbors.
“If you perhaps open up a smaller service where just only a couple of individuals are using it any given time, that might be something the community might find much more acceptable than a larger facility that would attract hundreds of drug users in a day,” he said.
Lorain County prosecutor Dennis Will said due to the state cutting back state taxpayer money to local governments, the county lacks the money necessary to start a supervised injection site.
Will, whose office has been overwhelmed with drug-related cases since the epidemic began, said he doubts his office could even afford to provide legal advice.
“It takes resources,” he said. “And so far I have not seen a lot of resources being brought to the table for those types of programs.”
While the county is cash-strapped, Vancouver Coastal Health is able to provide the necessary money for the Insite and Onsite clinics to operate. Canada has a single-payer, nationalized health care system
Insite’s annual budget is about $2.9 million and Onsite is $1.4 million. Vancouver Coastal Health said it spent $231 million in the last fiscal year on drug and mental health treatment, including the money spent on the clinics.
Besides more money for supervised injection to be feasible, Will said Congress and the state legislature would have to agree to provide legal immunity for those injecting at sites and those treating them.
Will said having federal approval would make more sense than a patchwork of state laws like for medical and recreational marijuana use.
“You can’t just wave a wand to do this and say, ‘OK, everybody’s clear and free to do this,” he said. “I‘m not opposed to listening to anybody’s ideas, I just think you need to look at a wide range of repercussions that are going to happen. ”
Lorain County commissioner Matt Lundy said before he would consider supporting supervised injection, medical professionals would have to come forward expressing support for it and providing evidence that it works.
“It’s quite an extreme measure,” he said. “We’d have to see some true demonstration that it saves lives.”
Evan Goodenow can be reached at 440-775-1611 or @GoodenowNews on Twitter.