Saint Joseph’s University Bioethicist Calls for Safe Injection Sites

A medical bioethics expert at Saint Joseph’s University led an interdisciplinary group that published a model for safe injection sites designed to prevent the deaths of thousands of Philadelphians vulnerable to an opioid overdose. The paper, published in the Internet Journal of Public Health, examines issues related to the implementation of sites, while also recommending a series of practical solutions.

“The research from Canada and Europe is clear – safe injection sites save lives,” says Peter Clark, SJ, PhD, first author on the paper and director of the Institute of Clinical Bioethics at Saint Joseph’s. “The next step was to propose a model that will save lives in Philadelphia. By not implementing a safe injection site, we are choosing to stand by and watch as our neighbors, family members and future die due to overdose.”

The Institute of Clinical Bioethics research team, comprised of SJU undergraduates, medical residents from Mercy Catholic Medical Center and students from Philadelphia College of Osteopathic Medicine, propose comprehensive user engagement sites (CUES), which will offer services designed to reduce the harm associated with substance use disorder including wound care, hepatitis C and HIV screening, needle exchange, naloxone distribution and education, and peer counseling on rehabilitation and detoxification.

Heroin still ranks as the number one drug circulating through the streets, but fentanyl has flooded the illicit market, proving to be a more lethal alternative to heroin. The paper states it was found that 84 percent of opioid-associated deaths in Philadelphia were associated with fentanyl or one if its derivatives. The group suggests distributing fentanyl testing kits at CUES to prevent deadly overdoses.

Uniquely, the CUES model emphasizes involvement of people in recovery and early education for new and future healthcare professionals with the goal of decreasing the stigma associated with substance use disorder.

The proposed model for Philadelphia favors following Canada’s safe injection site paradigm rather than Europe’s, as the culture and socio-political climate are more comparable. The recommended location for the safe injection site in Philadelphia is the Kensington neighborhood because of its similarity to Downtown Eastside, the neighborhood in Vancouver where the Canadian site is effectively operated.

“While there are numerous criticisms against the implementation of CUES, we thoughtfully address those with statistical data and push for research to continue to be conducted,” says Clark. “The support of the City of Philadelphia's leadership is imperative to making this proposed model a reality.”

In addition to the proposed CUES, the authors emphasize the need for efforts to reduce stigma, stricter government regulations on opioid prescriptions and evidence-based protocols to treat those suffering from substance use disorder. If implemented, Philadelphia would be the first city in the United States to authorize a site. Other cities across the nation are considering sites including New York City, San Francisco, Seattle and Denver.

Source: Saint Joseph’s University