Supervised Injection Facilities a Rational Response to Drug Problem, County Med Director Says

Categories Health Care, Ithaca, Law Enforcement

By Josh Brokaw

When the Ithaca Plan drug policy was rolled out in February 2016, the one idea among its many recommendations that grabbed headlines nationwide was the idea of a supervised injection facility [SIF]. The idea of giving needle drug users a supervised place to inject heroin has been tried in many other countries, but never in the United States.

The idea of a supervised injection facility “came to me as a very foreign concept,” Dr. William Klepack told the Tompkins County Health & Human Services committee on Monday, October 16.

Klepack, medical director for the Tompkins County Health Department, said that when the idea of SIFs was presented to him, he felt the need to educate himself on the concept. He’s since shared his findings in recent months with the county Board of Health and the Community Mental Health Services board.

Dr. William Klepack, Tompkins County Health Department medical director, at an October 16, 2017 committee meeting. Josh Brokaw/TruthSayers

Klepack emphasized throughout his presentation that all opinions are his own; the Tompkins County Health Department has no official position, as of yet, on the desirability for a supervised injection facility here.

Based on his reading of the research literature produced about supervised injection sites worldwide, Klepack addressed several questions that have come up repeatedly about what would happen if a SIF were put in Ithaca.

The substances that a user might inject or inhale, Klepack said, “are pre-obtained by the client.”

“The intent is not to have people coming there for a first time use,” the medical examiner said. “As with tobacco use and other issues, some clients are not ready to change.”

Research and data from other SIFs suggests that offering other services and counseling at the sites can lead needle drug users to make changes, Klepack said, whether that’s getting medically assisted treatments like Suboxone or methadone, or going into detox.

“No injectors have been found to be attracted to the community from the outside,” Klepack said, addressing a commonly voiced concern that people might come to Ithaca to shoot drugs. Those SIFs that have succeeded have had an open, lengthy dialogue with law enforcement to ensure that both health care and law enforcement are on the same wavelength.

The target population of SIFs, Klepack said, are usually people who are homeless or on the borderline of homelessness, usually male, in their mid-20s through 50s.

Figuring out how many hours a facility would be open and how many people should staff it would be one of the challenges to opening a SIF here in Tompkins County.

“When we talk about our region,” Klepack said, “we need to talk about scalability … Most of the global data comes from urban centers.”

Klepack compared the political reaction to the idea of supervised injection sites to that against needle exchanges about 20 years ago. While more data is needed, the medical examiner said, the concept of harm reduction for opioid addiction is the same as for diabetes or Alzheimer’s, Klepack said.

“Substance abuse is a slightly different flavor, but [harm reduction] is something we practice in medicine all the time with conditions we might not be able to cure,” Klepack said.

One of Klepack’s slides summarized the argument he would make for supervised injection facilities: “If we are sincere about reducing harm to fellow human beings and believe the data that shows the medical model can be superior to the law enforcement model … Then Supervised Injection Facilities are a rational component of our overall approach to drug addiction.”

Scroll down for most of the slides from Klepack’s presentation.

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Featured photo: Sharps drop box at Southern Tier Aids Prevention Point. Photo: Josh Brokaw/TruthSayers

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Josh Brokaw is an independent reporter based in Ithaca, N.Y.
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