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The Department of Justice Is Totally Wrong About Supervised Injection Sites

There are real reasons to debate whether it's worth opening these facilities in communities, but Deputy Attorney General Rod Rosenstein instead relies on unscientific fear-mongering.
Deputy Attorney General Rod Rosenstein listens during a news conference about fentanyl and other opiate substances on October 17th, 2017, in Washington, D.C.

Deputy Attorney General Rod Rosenstein listens during a news conference about fentanyl and other opiate substances on October 17th, 2017, in Washington, D.C.

Some American cities have spent months or years debating whether to open supervised injection facilities for drug users, and one big national voice finally weighed in this week. Rod Rosenstein, the deputy attorney general, argued in the New York Times that supervised injection is dangerous and sites offering the service shouldn't operate in the United States.

Supervised injection facilities are clinics where people can bring in drugs, such as heroin and cocaine, and use them under the oversight of staff who are trained to treat overdoses. The clinics are intended to prevent overdose deaths. No such facilities currently operate legally in the U.S., but cities such as Philadelphia and Seattle have projects in the works. Because it's still unclear how law enforcement will approach supervised injection, Rosenstein's—and the Department of Justice's—views on the issue will be closely watched.

Many of Rosenstein's arguments in the Times about supervised injection facilities aren't supported by the science, however. Here are three claims Rosenstein makes that don't line up with what we know about opioid drugs and supervised drug-use sites.

1. Supervised injection sites "create serious public safety risks" because they could expose community members to illicitly produced fentanyl, a powerful opioid. "A bystander or emergency medical worker who comes into contact with such drugs can be gravely harmed," Rosenstein writes.

It's true that fentanyl and similar chemicals have made their way into the U.S.'s illicit drug supply over the past few years. And fentanyl-laced drugs are the main driver of overdoses in America. But do they really pose a risk to community members? There have been news reports of police officers and paramedics needing treatment for intoxication and overdose symptoms after handling fentanyl drugs, or helping overdose victims. But the overall risk of fentanyl to emergency responders is "extremely low," as the American College of Medical Toxicology and the American Academy of Clinical Toxicology said in an official statement. Nitrile gloves—and, in "exceptional circumstances," a special mask—provide enough protection for folks whose jobs require them to handle fentanyl, the statement says. As for the chances that a community member will be incidentally poisoned by fentanyl? They're nearly nil, as one emergency room doctor told CBS News last year.

2. "Injection sites destroy the surrounding community."

Here, Rosenstein argues that supervised injection sites attract crime. No studies have found that the clinics attract drug dealers and increase crime in the surrounding area. A 2006 study, which was later deemed high quality by this analysis, offers typical results: Sydney, Australia, police records indicate no increases in theft, robbery, narcotics trafficking, or narcotics possession in the area surrounding a supervised injection facility, compared to the rest of the city.

Rosenstein cites an op-ed by a city council member from Washington state who visited the neighborhood of a supervised injection facility in Vancouver, British Columbia, and complained about seeing people openly dealing and using drugs in the streets. I visited the same neighborhood in 2016 and saw the same things. But that doesn't mean the facility made things worse than they would have been otherwise; since at least the 1960s, five decades before the facility opened, Vancouver's "Downtown Eastside" neighborhood has struggled with crime and social problems. It makes sense to locate supervised injection facilities in neighborhoods where there are already many people using drugs in public.

3. "[Supervised injection sites] would only make the opioid crisis worse."

If "making the opioid crisis worse" is defined by leading to more overdoses and deaths, there's no evidence that supervised injection sites will do this. Some studies have found that the facilities may reduce ambulance calls for overdoses and overdose deaths. However, one recent, rigorous meta-analysis does call those results into question. In the studies the authors of the analysis deemed quality enough to be included, supervised injection facilities didn't make a difference in overdose deaths.

That doesn't mean the clinics definitely don't work as intended. It may mean that the analysis' authors excluded too many studies, leaving their conclusions shaky, as one researcher told Vox. It may also mean that supervised injection facilities would need to do more to make a difference at a population level, which is what the authors themselves write in their paper. They might need to be bigger, open for longer hours, and reach more people. Whether that's possible depends on what resources are available to them. But they definitely don't make things worse.

Bonus: Here are the real reasons to debate supervised injection.

As that meta-analysis suggests, there are evidence-based arguments against supervised injection facilities. Do they make enough of a difference to justify their costs? Are there other measures governments could take that might be more effective? These are reasonable questions to debate, but Rosenstein's Times op-ed instead leans on arguments that aren't supported by science and seem designed to instill unnecessary fear into people about the clinics'—and their users'—"public safety risks" and potential to "destroy the surrounding community."

Ultimately, though, even if Rosenstein's views on supervised injection are inaccurate, he has the power to shut them down. "Because federal law clearly prohibits injection sites," Rosenstein writes in the Times, "cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action." That's a powerful disincentive to cities, no matter what the science says.