When “saving lives” isn’t enough
By Sara Veltkamp —
Our country is experiencing a cultural shift in how we think about addiction and the people who use drugs. Seattle and King County are at the forefront of this change, and we see it happening through the current heated debate over the piloting of safe consumption sites – locations that would allow the use of illegal substances, primarily heroin and other opioids, to reduce overdose deaths.
The opioid epidemic is a problem that desperately needs addressing on multiple fronts. According to the Center for Disease Control and Prevention, starting in 2008, more people in the US have died from drug-related overdose than from auto accidents. Most of the people who die or seek treatment in Washington are young; many start using drugs as early as 14 or 15 years old. In other words, this is a problem that will only get worse.
Despite some opposition, the broad support of King County public health professionals for the development of safe consumption sites signals a changing attitude toward people with addiction. These professionals are largely united in their resolve to test safe consumption sites as part of a multifaceted solution to the overdose epidemic. Many cite the success of Vancouver, British Columbia’s Insite facility in saving more than 5,000 lives in 2017.
But I worry that these advocates, in attempts to influence public opinion, are stressing messages that use fear to inspire action and encourage support. On billboards or media reports, fear abounds: Do you want to find dirty needles in your children’s playground? What if you encounter someone who overdosed in a public bathroom? What if HIV/AIDS resurges because of shared needles?
These questions are legitimate and they should be addressed in the broader debate about safe consumption sites. But fear shouldn’t be the number one motive to embrace a smart public health solution that’s proven to save lives.
Why isn’t saving lives enough?
One reason is that fear works; it is a strong motivator and often an expedient one. But fear-based narratives require constant up-keep – the creation of new things to fear – to function effectively, and do not drive compassionate, long-lasting change in the way we see people who use drugs. Due in part to the influence of the “war on drugs” discourse, many people have internalized the narrative that drug users are criminals who deserve what they get – even if that means death.
But the practice of criminalizing drug use shows a misunderstanding of the nature of addiction. For people with substance use disorders, using drugs is not a choice or a way of life. It is a medical condition that causes a physiological imbalance in the brain, and requires medication and mental health support to manage.
Washington State Senator Mark Miloscia demonstrated his ignorance in this interview with Al Jazeera in April of 2017: “We need to stigmatize the people hooked on heroin who refuse to go into treatment, to save their lives. We need to push people into treatment, with cultural values and cultural pressure.”
Numerous studies like this one have documented the amount of stigma that already exists against people with addiction, and have concluded that stigma is a barrier to recovery, rather than a motivator.
Al Jazeera followed up Miloscia’s statement with the view of a doctor who has worked with people with substance use disorders for decades:
“The concept that drug use alone results in addiction – and should, therefore, be criminalized and stigmatized to keep people safe – is what physician Gabor Mate called ‘one of the bedrock fables sustaining the so-called war on drugs.’”
Dr. Mate believes that trauma can heavily influence whether people develop an addiction when using substances; it is not drug use alone that drives addiction, yet that is too often what we punish instead of addressing the more complicated mental health issues.
To truly address the issues that underlie addiction, we need to start valuing drug users lives. We need to do this by keeping them alive. This is what safe consumption sites are for; when people live through overdoses, they can get treatment, and get their lives back.