”Opposing needle exchanges and insisting people with addiction must hit “rock bottom” flies in the face of reality.
By Maia Szalavitz March 13
Maia Szalavitz is a journalist and author, most recently of “Unbroken Brain: A Revolutionary New Way of Understanding Addictions.
SIFs, also known as Overdose Prevention Sites or Supervised Consumption Centers, have operated for years in at least 66 cities in Europe, Canada and Australia. They reduce overdose mortality, cut transmission of HIV and hepatitis C, decrease public injecting and the presence of dirty needles in streets and parks, and even reduce local crime and violence rates — all while improving health. Despite millions of injections carried out by thousands of people, no one has ever died of an overdose at an SIF, according to Brandon Marshall, an associate professor of epidemiology at Brown University, who has studied these programs.
Instead, opponents argue that SIFs “enable” addiction — and that by mitigating risk, they prolong drug use by preventing people with addiction from suffering the consequences needed to motivate them to recover. In 2017, anti-SIF residents and politicians in Seattle organized a ballot initiative to block the city’s SIF plans, which garnered more than 47,000 signatures and qualified it for a vote. (The referendum was later blocked by a judge for procedural reasons).
In an op-ed laying out his opposition, Redmond, Wash., city council member David Carson put it this way: “It’s difficult to see how enabling addicts to continue a terribly destructive lifestyle is compassionate. Every recovering addict will tell you that they had to hit rock bottom before they wanted to change and that desire must drive their recovery.” Similar comments have been heard from opponents in San Francisco, Philadelphia and elsewhere.
The concept of “enabling” comes from 12-step recovery, based on the self-help group Alcoholics Anonymous. The idea is that friends and family must not support loved ones while they continue to use drugs or help them avoid dangerous consequences — otherwise, they might delay “rock bottom.” The vast majority of addiction treatment providers in America teach this perspective, even though there’s no research to support the idea that “enabling” is harmful.
Gigabytes of real-world data show the opposite. In the 1990s, the “enabling” argument was used to fight clean needle programs to prevent the spread of disease — and it helped delay their implementation. Even today, states with growling levels of IV drug use, such as Indiana and Florida, continue to have fights over these programs. Officials in Indiana have shut down several because of moral fears about enabling.
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