A key advisory group on state drug policy says it is “virtually impossible” to open a safe drug-injection site in Vermont due to legal obstacles.
A new report from Gov. Phil Scott’s Opioid Coordination Council also raises several other concerns about the feasibility and effectiveness of such sites, which proponents view as a way to prevent overdoses and open up more options for treatment.
The council concludes that Vermont’s money would be better spent on other initiatives including enhancing the state’s syringe service programs.
“Safe injection facilities are presently not a viable option for Vermont,” the council’s report said. “They are illegal under federal law and highly controversial. Cost-effectiveness and neighborhood impacts are unknown. Most importantly, they have an unproven track record of harm reduction and for providing a pathway to treatment.”
As Vermont continues to struggle with the opioid epidemic and a still-rising number of fatal opioid-related overdoses, the idea of opening safe injection sites — in which drug users could inject under supervision while also receiving information about treatment — has gained currency.
Chittenden County State’s Attorney Sarah George has thrown her support behind safe injection facilities. And a majority of Burlington City Council members recently endorsed the exploration of a possible safe injection site.
Also, state legislators introduced a House bill and a Senate bill during the past biennium intended to “limit drug-related criminal liability and civil forfeiture actions against persons associated with an approved safer drug consumption program.” Those bills did not advance.
The threat of legal problems is one major obstacle for safe injection sites, and it has hindered the opening of such facilities in cities like San Francisco. There currently are no safe injection sites operating in the U.S., though there are injection sites in areas including Canada, Australia and Europe.
In Vermont, U.S. Attorney Christina Nolan has issued a statement warning of federal prohibitions against safe injection sites.
“It is a crime, not only to use illicit narcotics, but to manage and maintain sites on which such drugs are used and distributed,” Nolan said in December.
The governor’s Opioid Coordination Council examined the issue at the request of the state Senate Judiciary Committee. Council members say they “spent the last several months reviewing information, research and studies.”
“Based on its review, the (council) concludes that the legal obstacles alone, including potential federal criminal prosecution and civil liability of anyone involved in the operation of a (safe injection facility), make the opening of a (facility) in Vermont virtually impossible to accomplish legally,” the council’s report says.
The report features other objections and concerns, including:
Outcomes: The outcomes touted by safe injection site advocates can be achieved via syringe services programs, officials say. Those programs — which include Safe Recovery in Burlington — are legal under federal law and offer services including needle exchange, counseling, overdose-reversal drugs, HIV and hepatitis testing, and fentanyl-testing kits.
The state Agency of Human Services will ask for an additional $1 million from the state’s tobacco settlement money to expand syringe services programs during the mid-year budget-adjustment period in January, the report said.
Evidence: There is a lack of evidence, the council says, that safe injection sites can do what proponents claim.
Injection sites require “significantly more independent scientific study before their effectiveness can be determined and a meaningful cost-benefit analysis can be completed,” the report says. “In fact, the most recent meta-analysis studies examining the effectiveness of (injection facilities) found they had no effect on overdose mortality or syringe sharing and only a small positive effect in some health outcomes.”
Population: Most safe injection sites are in “densely populated, urban environments,” the report said.
“The difference in population size, density and geography between Vermont and cities in which (injection facilities) currently operate raises significant questions whether the experiences in these locations would be fully relevant to a (facility) in Vermont,” the report said. “These differences also present Vermont with other challenges not currently faced by (injection facilities) operating in an urban environment.”
Transportation: Transportation also may be an issue in Vermont, the council said.
Members cited a New York report saying many potential safe injection site users wouldn’t travel more than a few miles to use the facility.
“This raises questions about the viability of a (injection facility) in a rural environment such as Vermont, where many potential participants would have to travel significant distances,” the report said.
While the council’s report has not yet been widely distributed, its conclusions likely won’t be surprising to those who have participated in the injection site debate or in the fight against the opioid epidemic in Vermont.
In an interview on Monday, Burlington Mayor Miro Weinberger said “all options need to be on the table” in confronting the epidemic, including safe injection sites. But he also expressed concerns, particularly due to federal law.
“Our position has been, we’re open to it. We think it’s a strategy worthy of serious consideration,” Weinberger said. “At the same time, we should not let it distract us from strategies … that we think have the potential to have a much greater impact in bringing down overdose deaths.”
Bob Bick, who serves as chief executive officer of the Howard Center and also is a member of the Opioid Coordination Council, has two perspectives on the issue. The Howard Center has posted a recent panel discussion of the injection site issue on its website.
Bick said he’s concerned about federal prohibitions on injection sites. He’s also not yet sure whether they would be the best use of limited resources.
“I don’t believe that there’s a viable philosophical opposition. Nobody is going to start injecting drugs because there’s a safe injection facility,” Bick said. “And I do believe that there is some data to suggest that it saves lives. But under current federal regulation, it can’t happen.”
He added that the issue is worthy of further, future consideration. “To say we can’t do it today doesn’t mean we can’t do it tomorrow,” Bick said.