In Lucas County, OH there were 227 opioid related deaths in 2018 increasing from 157 in 2017. People that overdosed in both years were majority White males averaging between 29-38yrs old that had an educational level of high school diploma or GED. Fentanyl, and others chemically similar, were the main opioids accounting for the most deaths in both years. There are toolkits and educational programs provided by the Lucas County Opiate Coalition (founded 2015) and the Northwest Ohio Syringe Services (NOSS founded 2017), which both operate under the umbrella of the Lucas County Health Department.
People with substance use issues have challenges finding judgment free care due to the stigma surrounding substance use. Synthetic opioids, such as fentanyl, are among the highest involved in overdose deaths. Interventions like Narcan training, needle exchange, and fentanyl test strips mitigate some of the risks such as blood-borne pathogens and infections. Additional harm reduction efforts regarding illegal substance use are attempted but do not often receive support from law enforcement, local governments, and members of the medical community. The US iterations also face ongoing legal battles in order to continue operating.
Safe Injection Sites, sometimes referred to as Safe Consumption Sites, already exist outside the US in at least 10 countries. US cities such as San Francisco, Philadelphia, Denver, New York City, and more have tried to implement such facilities. Lucas County could join the list of US cities attempting to start Safe Injection Sites and experience progressive harm reduction. With law enforcement and legal support, patients would feel more comfortable accessing sites without fear of ramifications. With added community support and medical supervision, the emergency response system would have less burden to reach the scene with all the right tools at precisely the right time.
I reached out to the Health Department which led to working with the Lucas County Opiate Coalition, DART (Drug Abuse Response Team), emergency personnel, and local politicians. My goal was to gain insight into destigmatizing drug use, reducing risk factors, and to provide my clients and others with judgment free treatment.
My interviews with DART and emergency personnel uncovered that they were stretched thin and burned out. I conducted journal reviews of existing Safe Injection Facilities, reviewed their statistical methods of reporting key factors such as overdose rates, death rates, member utilization, and emergency personnel response. I used news articles for attitudinal research to discover how local communities and media outlets were spreading the word about these facilities.
I synthesized the information into a PowerPoint presentation and presented it to members of the Lucas County Opiate Coalition, NOSS, DART, emergency personnel, and other members of the community. I appealed to the issues they faced by showcasing that Insite, the Vancouver Safe Injection Facility, saw a 35% decrease in fatal overdoses in the surrounding 500m area, supervised 3.6 million injections, responded to 6,000 overdoses, and experienced zero deaths. Site personnel were trained in Narcan use and resuscitation. With law enforcement and provider support, people were more likely to utilize the site. Media coverage demonstrated the viability and accessibility of the prospective sites by filming tours while discussing the various treatments one could expect to receive.
Local politicians found value in improving harm reduction strategies to improve community health. Emergency personnel voiced concern regarding use of illegal substances but were able to find value of on-site medical supervision reducing risk. Given the burden on emergency personnel and the community, stakeholders agreed that keeping people alive long enough to seek additional treatment potentially trumped the inherent illegal aspects of this method of harm reduction. Following the discussions, the Opiate Coalition created a mobile needle exchange, Narcan training, and resource hub to go out into the community. While Lucas County might not be starting a Safe Injection Site, they are at least continuing the discussion of how they can be impactful and lifesaving.
Frank Gibbs MA, LPCC
UX Researcher
Toledo, OH
