With tens of thousands of people dying every year of opioid overdoses, some advocates are calling for safe injection sites where addicts can inject themselves with illegal drugs using clean needles with a health care worker nearby.
A "mock drug consumption room" set up in Lafayette Square in downtown Buffalo Wednesday afternoon offered a glimpse of how such a site would operate.
In an asymmetrical, turquoise tent, visitors were invited to see what would be provided: sterile supplies including syringes and a "consumption station" where the user would inject drugs like heroin. The drugs would not be provided by the facility. A health care worker would be there to administer naloxone in the event of an overdose, as well as provide other medical treatment. The user also would have the opportunity to meet with social workers who could connect them to services ranging from housing, health care and addiction treatment.
The idea is to keep addicts alive until they're ready to be treated for their addictions.
"We need to stop people from dying. Right now," said Kassandra Frederique, state director of the Drug Policy Alliance, who was in Buffalo Wednesday promoting the injection sites.
Right now, there are no legal safe injection sites in the U.S. Earlier this year, Seattle passed legislation paving the way to open the nation's first safe injection sites. New York City and Ithaca have raised the possibility of opening such sites.
Across the border, Toronto approved three safe injection sites slated to open this year. Vancouver opened North America's first safe injection facility in 2003.
The exhibit in Lafayette Square wasn't meant to show exactly what a safe injection facility would really be like. No one is advocating for temporary safe injection sites. It would most likely be in a clinic type of setting.
The advocates' hope was more about getting the public talking about them.
"So much of this conversation is in people'e heads," Frederique said. "We created this pop-up exhibit to show people what it would be like."
The exhibit, a project by VOCAL-NY and the Drug Policy Alliance, is traveling around New York State. It was scheduled to go on display in Rochester Thursday and Syracuse Friday.
But is it feasible?
Last month in Amherst, town residents, joined by the town supervisor and police chief, raised concerns about Catholic Health's plans to open a chemical dependency treatment center – where methadone would be provided to patients – on Millersport Highway, near Sheridan Drive. Neighbors objected to the location, saying it's too residential.
"Because of intense community opposition, intense neighborhood opposition," Amherst Town Supervisor Dr. Barry Weinstein, said at an April 5 Town Board meeting, "I'm taking a position that this is not a good site for it, and I'll do whatever I can to discourage it."
And that's just a clinic, not a site where addicts could shoot up heroin.
Advocates for safe injection sites expect opposition – comments posted by the public on articles about the topic show deep skepticism – but they argue that lives are at stake and direct action is necessary.
Last year in Erie County, there were 288 confirmed opioid overdose deaths with another 14 suspected cases. As of May 1 of this year, there have been 24 confirmed opioid overdose deaths and another 114 suspected overdose deaths for which toxicology reports are pending. An increasing number of the fatal overdoses in Erie County over the last couple of years have involved fentanyl, a synthetic opioid that is many times more potent than heroin and much cheaper to make. The drug, manufactured in clandestine labs in China and smuggled into the U.S., is often mixed in with heroin or sold as heroin. Just one tiny grain can cause an overdose and and there's no way to see the difference between heroin and fentanyl.
Advocates say a safe injection facility would provide drug users immediate help in the event of an overdose, as well as help prevent the spread of blood-borne diseases including HIV and Hepatitis C.
"People are already doing this in bathrooms of restaurants, coffee houses, health facilities," said Emma Fabian, director of substance abuse health policy at Evergreen Health Services, which provides health care and support to underserved communities in Buffalo, including a syringe exchange program.
Evergreen, the local sponsor of the tent exhibit, has no plans to open a safe injection site. However it would like to get a community conversation going about safe injection facilities and other harm reduction measures.
New York politicians are taking note. Manhattan Assemblywoman Linda B. Rosenthal is drafting legislation that could pave the way for legal safe injection facilities in the state.
Assemblyman Sean Ryan D-Buffalo, said the possibility of safe injection facilities "warrants study."
"It's something, at first glance, you think is a crazy idea and then you realize with or without that, people are dying every day," Ryan said.
Just a couple of decades ago, the notion of clean needle exchanges was shocking, he pointed out. Now, they are accepted and found in many cities.
"Right now we're losing two people a day – in Erie County," Ryan said. "But for Narcan, we'd have bubonic plague numbers."
If the fatal overdoses continue, Ryan believes it's not out of the realm of possibility that the state takes up the issue.
Ryan doesn't expect the state to quickly begin regulating or funding such facilities, but he believes there's an openness to discussion. "Desperate times call for desperate measures," he said. "It's a radical harm reduction strategy."
That said, Ryan believes in the importance of concentrating on measures like needle exchanges and distributing opioid antidotes like Narcan, as well as putting pressure on the pharmaceutical and health care industries to stop overprescribing prescription opioids.
State Sen. Timothy Kennedy agreed that the topic "merits greater discussion."
"I continue to have conversations with medical professionals, drug treatment experts, and families who have lost ones to the opioid and heroin epidemic to get their feedback about safe injection sites," Kennedy said. "I firmly believe that first and foremost we need to ensure that we're providing sufficient funding to prevention and education resources, as well as treatment programs."
Erie County Health Commissioner Dr. Gale R. Burstein, who has been at the forefront of the county's battle against opioid addiction, acknowledged that safe injection facilities "are one of the harm reduction tools in the toolbox to prevent opioid related overdose deaths."
But she said they're expensive and, at least for now, illegal in the U.S.
"These sites are currently not legal or supported by New York State," Burstein said.
She pointed to Vancouver's facility, which costs more than $3 million a year to operate. According to the facility's operator, Vancouver Coastal Health, more than 18,000 people have made use of the safe injection site since it began 14 years ago. There have been just shy of 5,000 "overdose interventions with no deaths" at the facility.
Erie County is already taking aggressive measures to combat opioid addiction and stop overdose deaths, Burstein said, including training and distribution of naloxone to more than 15,000 first responders and residents; a hotline that has fielded nearly 2,000 calls since August 2016; training and mentoring to expand medical assisted treatment capacity; and a program that allows law enforcement to connect addicts with treatment instead of jail.
The hotline number is 831-7007.