Drug Use Sites: Snake Oil Salesmen Come to Town

On January 10, 2022 I attended the Does Safe Consumption Work to Treat Drug Addiction? debate at Manny’s, an incredible community space in the Mission District of San Francisco, California. Terry Morris, who works with RTI international on syringe access programs, argued in favor. Cedrick Akbar of Positive Directions Equals Change, Inc, a support network for African Americans in recovery, took the opposing position. 

Candidly, I went to the event firm in my conviction that the answer to the debate’s question is a solid “no.” I had interviewed Akbar before, for a story about the TRP Academy, an alternative-sentencing, abstinence-based program that serves up to 84 formerly incarcerated men.

And for too many years I’ve listened to philosophical nonsense from radical harm reduction zealots as they ignore the reality in front of them. These do-gooders distribute needles, meth pipes, and fentanyl foil with blissful smiles. I know a lot of them. Mainly politically progressive, they talk of income inequality as being a reason for why people turn to drugs as a coping mechanism. Many are well-educated, with loving families and safe, secure homes. They’re helping the disadvantaged and the marginalized, you see. 

The irony is clear but lost on them. It won’t be on you. 

What Drug Use Sites Really Are 

There are several names for places where people can take heroin, meth, fentanyl and other illegal substances under the supervision of staff. Safe injection sites, safe consumption sites, and overdose prevention centers are among them. In the interest of accuracy, they are “drug use sites.” They don’t help addicts achieve health. Nor do they prevent overdoses from occurring, but rather revive people when they do take too much. Proponents emphasize the word “safe” because people don’t die in the sites. What happens outside, though, is not their concern.

Drug dealers are fond of these sites, whatever they’re called. After all, their customers need to feed their habit many times a day, and are just inside the door. They’ll come out soon. 

But what is frequently omitted from the conversation is that drug use sites are profoundly classist and inequitable. They are for the poor, the homeless, the lost, the discarded. Rather than being developed to help people overcome their dependency, they’re designed to perpetuate it. Suggesting treatment is stigmatizing.

So I sat in the audience, barely containing my disgust as I listened to the soft-spoken Morris carefully wording tired old tropes, such as “meeting people where they are.” It’s pretty obvious where they are, at least in San Francisco. The Tenderloin, Civic Center, Mission District, South of Market are the primary neighborhoods where thousands of people who are suffering from addiction are on the streets. 

People who are addicted to a substance require specialized medical and mental health care, not a place to do drugs “safely,” where they will overdose, then be revived again and again with naloxone. 

Ever Sliding into the Frozen Hole

To illustrate the ethical problem, picture a deep frozen lake with a hole in the center.

A woman stands on the edge, then falls in. Thankfully, another person pulls her out, but just far enough so the woman remains on the edge, soaking wet in the cold. The man says, “I’m meeting you where you are!,” then stands there as the shivering woman slips back in the icy water. Again the man drags her back out onto the ice, over and over. She receives no encouragement or assistance to leave the hole, but will be kept alive while she’s there. Thus, the man becomes the hero.

Now let’s get to what another person might do in that same scenario.

The man sees the drowning woman, and rushes to drag her out. He wraps her in a warm blanket, and strongly encourages her to get the care she desperately needs so she can leave the frozen lake. If she is incapable of making that decision, the man may even insist, and take action to make it happen. The man may do this repeatedly until the woman no longer gravitates to place that pulls her in and down.

Addiction recovery doesn’t always work, and often not the first time, but it gives the person a fighting chance. It also gives them hope. A belief that they can and will recover, and that a better life is in their future. 

Expanding Inequity 

Drug use sites create a two-tier system. Wealthy people get treatment to escape the bonds of addiction, while poor people are given places to maintain their addiction.

I made this comment in the Q&A portion of the debate. I’ve had it. It’s time to speak out, loudly and truthfully. People who can afford to spend upwards of $15,000 a month for private recovery will do so for their loved ones. They won’t wait months or longer for a bed at a public facility to open up, as people without the means must do.

It’s wild that some are falling for the dog and pony shows put on by the radical harm reductionists.

Morris is just one of many promoters in town trying to persuade people that drug use sites really are marvelous places. Sam Rivera, executive director of the New York’s drug use site business OnPoint, came to San Francisco for a Board of Supervisors hearing on the subject. It was quite a performance. With his tough-guy but down-home demeanor and naloxone earrings, he dazzled the gullible like a televangelist. 

The fact is, drug use sites secure the gap between the haves and the have nots. If the wealthy have immediate access to high quality recovery treatment, so too should the destitute and financially struggling.

Those who aren’t fighting for equal access aren't fighting against inequity.

And if you believe the claims that drug use sites create a cleaner and safer environment, step right up. I have a couple cool bridges to sell. 

Note: If you are seeking addiction care and can’t afford private services, contact the Salvation Army. They provide excellent residential recovery services at no charge, and have a remarkably high success rate.