PROVIDENCE – Rhode Island is set to become the first state in the nation to open harm reduction centers - safe spaces where substances can be consumed under medical supervision - after the General Assembly last week passed legislation authorizing such facilities, and Gov. Dan McKee signing the bill into law Wednesday afternoon. A goal of the two-year pilot program set as a trial period for the sites is preventing and reducing overdoses.
“The opioid epidemic has become a tremendous public health crisis, with overdoses of prescription and non-prescription opioids claiming a record number of lives,” said Representative John G. Edwards (D-Dist. 70, Tiverton, Providence), who sponsored the legislation. “Not only do harm reduction centers severely mitigate the chance of overdose, they are a gateway to treatment and rehabilitation of people with substance abuse disorder. These locations will be under the supervision of trained medical staff who can direct addicts toward substance use disorder treatment. It’s a way to tackle this epidemic while saving lives in the process.”
Ten countries, including Canada, Germany, France and Switzerland, currently sanction the use of harm reduction centers. If Rhode Island follows through on the recently passed legislation, it would become the first state in the nation to open such facilities. In 2018, the City of San Francisco came close to claiming that title, with California lawmakers approving the Bay Area city’s plan to open a drug consumption room in a three-year pilot program in response to the rising number of drug-related overdoses in the nation. However, then-California Governor Jerry Brown, a Democrat, vetoed the bill after a warning from the Trump White House promising “swift and aggressive action” toward any city that opened a harm reduction center or similar site.
The data originating from where the concept has been tried, however, points to success. In a 2012 study, the International Drug Policy Consortium (IDPC) found that harm reduction centers had a positive impact on reducing drug overdoses, provided a gateway for addiction treatment, significantly reduced the “security problems related to injecting in public settings and discarded needles,” improved the overall health status of people who use drugs, contributed to a decline in new HIV and Hepatitis C infections and could “reduce drug use in open spaces and related nuisance” if the measure was part of a comprehensive local strategy.
“In many instances, the driving forces behind the opening of [harm reduction centers] were people who use drugs, harm reduction service providers or outreach workers, but also local authorities and law enforcement agencies,” reads that 2012 study. “From the very beginning, [harm reduction centers] were regarded as serving two main objectives: to reduce individual health risks associated with drug use, and to reduce public disturbance.”
The Rhode Island bill would also create an advisory committee to make recommendations to the state’s Department of Health on ways to maximize the potential public health and safety benefits of harm reduction centers, as well as the proper disposal of hypodermic needles and syringes, the recovery of people utilizing the centers, and ways to adhere to federal, state and local laws impacting the creation and operation of the centers.
HIV and Hepatitis C are infections that spread, in one way, by the sharing of needles. In addition to providing a medically and professionally supervised space where drug users can consume substances in an effort to reduce overdoses, harm reduction centers also aim to reduce the risk of disease spread by supplying clean needles and other supplies. Studies have also shown that such facilities also reduce stigma and provide drug users with more direct access to healthcare and treatment.
“Most [harm reduction centers] are therefore embedded in a wider range of service provision and are implemented in collaboration with a variety of stakeholders, including local authorities, law enforcement officers and social and healthcare service providers,” reads the study, which analyzed a number of drug consumption rooms in Luxembourg, Australia, Germany and other countries, from IDPC. “In addition to the core services provided in the [harm reduction centers] – supervised injection, basic healthcare and social and educational interventions – the visitors can also be referred to more extensive support services if necessary.”
“Depending on the local circumstances, some [harm reduction centers] may focus more intensively on a medical approach and choose to include medical doctors and nurses in their staff, while others may choose to play a ‘social function’ and focus on community outreach,” the study continues. “All [harm reduction centers] have established admission criteria and set out strict house rules. A number of [harm reduction centers] have developed participation and peer-support models in order to include people who use drugs in service delivery and decision making processes.”
At one such facility in Paris, France, drug users enter the site from a separate entrance just across from a popular cafe. Visitors must present the drugs they intend to use within the space, be 18 years or older and sign an agreement stating they will not share, sell or buy substances inside the consumption room. First-time patients spend time with medical staff, who get to know the patient’s drug use habits and educate the patient about the risks of contracting HIV and other diseases through drug use. After hand washing and obtaining clean supplies and equipment, patients can go to desks, some walled and some not, that resemble personal workspaces in a library, and inject or consume the substance. Then, visitors can relax as long as they would like under medical supervision.
According to the National Institute on Drug Abuse, more than 70,000 Americans died from drug-involved overdoses in 2019, nearly double the rate of drug overdose deaths in 2010.
“If we are truly going to rein in the drug overdose epidemic, we must recognize drug addiction as the health problem it is, rather than as merely a crime,” said Senator Joshua Miller (D-Dist.28, Cranston, Providence), who chairs the Senate Committee on Health and Human Services and sponsored the legislation. “People who are addicted need help and protection from the most dangerous possibilities of addiction. Having a place where someone can save them from an overdose and where there are people offering them the resources they need for treatment is a much better alternative to people dying alone in their homes or their cars. Especially as overdose deaths have climbed during the pandemic and fentanyl-laced drugs continue to pose a lethal threat to unwitting users, we could prevent needless death and turn lives around with a program like this.”
The initial bill in the state Senate received widespread approval and passed the body on Feb. 23 by a vote of 34-3 with one abstention. All local senators, except Elaine J. Morgan (R-Dist. 34, Charlestown, Exeter, Hopkinton, Richmond, West Greenwich) voted in favor of the bill. The legislation passed the House on June 29 by a vote of 63-9 with three abstentions. All local representatives except Patricia Morgan (R-Dist. 26, West Warwick, Coventry, Warwick) voted in favor of the bill.
Once the program is up and running, municipalities will have the ability to control if such centers will be allowed in town.