Supervised Drug Injection Sites to Treat Drug Addiction 1

[Title Here, up to 12 Words, on One to Two Lines]

Rodriguez, Carl Matthew D.

Student of Ateneo de Manila University

Supervised Drug Injection to Treat Drug Addiction 2

Abstract

The war on drugs has been a pressing issue in numerous countries around the world, including

the Philippines. In most cases, narcotics are the drugs most commonly concerned with the issues

of addiction. The long-standing approach to the issues on drugs have been mainly prevention,

detention, and rehabilitation through stricter implementations of drug policies promulgated

around the world. However, these methods have yielded more problems economically and

socially for nations rather than drastic improvements to community welfare. Despite these

common, conservative approaches to drug-related issues, some European countries and a few

states of the US have opted to try supervised drug injection sites as a means to alleviate or cure

addiction in communities (Kral & Davidson, 2017). Given this newfound and unconventional

method, the study aims to analyze how it can be used as a more beneficial alternative to the

current programs for drug-related problems. The study made use of various research done in the

past. First, the concepts of drug addiction and the psychology of drug users are evaluated.

Likewise, the current and most common implementations done for drug policies are evaluated

based on its problems and benefits to society. Finally, research on how supervised injection sites

have faired in resolving the issues on drugs was divulged to understand how it could be a viable

alternative to the drug war. The study found that the problems brought about by the current

methods of prevention, detention, and rehabilitation outweighed the incremental improvements,

while supervised injection sites yielded greater improvements to the quality of life in affected

communities. The study concludes with a recommendation for lawmakers to approve the

establishment of supervised drug sites, especially in underdeveloped areas.

Supervised Drug Injection to Treat Drug Addiction 3

[Title Here, up to 12 Words, on One to Two Lines]

Introduction

For the past few decades, the war on drugs has led to thousands of arrests around the

world. In America alone, arrests had tripled between 1980 and 2000, mostly due to drug-related

conduct (Patten, 2017). This rise in incarceration happened in line with former US President

Richard Nixon’s administration associating drugs with crime, and in doing so, he had initiated

the war on drugs. His strict demeanor towards law enforcement, especially in drug prevention,

led to drug users and addicts being permanently associated with danger since they had been

treated with the same prejudice as criminals. This was because of his approach to treating

abusers being parallel to managing prisoners (Raz, 2017). America’s approach to drug abusers

had been followed around the world in matters of drug policy, including the Philippines.

Currently, the Philippine government under Pres. Rodrigo Duterte has opted to murder anyone

associated with drugs with extreme prejudice. In fact, the police had killed nearly 2500 people

for the sake of drug suppression. (KINE, 2017) However, some countries in Europe as well as a

few states in the US have opted instead to distribute controlled doses of recreational drugs, as

well as designating safer facilities for recreational drug usage. (Kennedy & Kerr, 2017)

This study hopes to tackle how not banning drugs is the key to solving drug addiction. To

do so, various studies done in the past will be reviewed to create an in-depth analysis of the

issue. The history of the war on drugs will introduced, along with the current procedures on

handling drug users, but it will be coupled afterwards with the psychology of addiction and drug

abuse to understand the implications of drugs on behavior. Then, reviews of recent studies made

on programs of government-sanctioned drug injection sites will be divulged and juxtaposed to

what is done instead. In this study, the implementation of sanctioned drug sites will be
Supervised Drug Injection to Treat Drug Addiction 4

highlighted as an alternative solution to the war on drugs. It also hopes to bring clarity on the

situations of drug users and addicts.

Drugs and the Psychology of a Drug Addict

To begin, Chapman (1962) defines addiction in the book, Problems with Addiction:

“Drug addiction, though encompassing by definition the repetitive

and compulsive use of some natural or synthetic substance to the

detriment of self or society, is usually limited to the use of drugs of

the opium family – the narcotics.”

Narcotics refer to drugs that are meant to numb the body, in order that pain is not felt

when administered. For some individuals though, their bodies react with pleasurable sensations,

described as something of a calming effect. (Chapman, 1962, p.157) That being said, the most

common drugs used illegally in recent times include marijuana, heroin, cocaine, and

methamphetamine. (Kilmer, 2012)

What is interesting to note is how drug addiction is not so much a safety problem for

communities but a social problem concerning the addicts. Chapman’s study shows that most

drug addicts begin young and come from difficult circumstances. Their dependence on drugs as

their vice stems from problems in their emotional development, especially growing up.

(Chapman, 1962, p.159)

What goes on in the mind of a drug-user who turns addict is best explained in Adams’

(p.21, 1978) book Psychoanalysis of Drug Dependence:

“Rado (1931, 1933) recognized the important role that frustration

of gratification plays in addiction to drugs and alcohol (‘morbid

Supervised Drug Injection to Treat Drug Addiction 5

cravings’) and the ‘special types’ of emotional reaction that

individuals are prone to addiction have to frustration that he

designated ‘tense depression.’ In simple terms, drug addiction

represented to Rado the attempt by the individual to overcome the

state of ‘tense depression’ by seeking a state of ‘elation’ artificially

induced by the effects of the drug.”

Given the information on the context of drug users, the effects of popular narcotics, and

the state of mind involved in drug dependence, the idea can be drawn that drug-addicts are not all

dangerous criminals but perhaps people who need help. Chapman (p.160, 1962) mentions that

one of the biggest misconceptions of drug-addicts is that they are killers, but in reality, the

knowledge of the relaxing effects of common narcotics contradicts the kind of violent behavior

associated with the addicts. Although addiction to drugs also does a part in crime rates, it is the

same for alcohol. Furthermore, these cases of crime by drug addicts account only for the

minority of drug addicts who are actually violent, in contrast to the rest of drug users that are a

mix of all kinds of people. Chapman further explains that the drug users involved in criminal

mishaps are often those with psychopathic traits and tendencies. In fact, most criminal acts occur

during withdrawal, in which aggressive addicts react violently during withdrawal, especially

when access to drugs is greatly out of reach (Chapman, p.160, 1962).

Problems in Drug Policy and Prevention around the World

The most propagated approaches to drug-addicts around the world, particularly in the US

and a number of Asian nations, are briefly detention and rehabilitation (Tanguay et al., 2015).

According to the study by Tanguay (2015), many countries, such as the Philippines, have opted
Supervised Drug Injection to Treat Drug Addiction 6

to arrest any offenders of the current drug laws, mostly dealers and abusers. Aside from

detention, offenders are sent to mandatory centers for rehabilitation through either methadone

therapy or pure abstinence to relieve their dependence. Furthermore, the study explains that the

approach is aimed at alleviating unease within communities in which drugs-related activities

occur. However, the researchers have also found that despite the hundreds of thousands each

behind bars in several nations, not much improvement has been observed in terms of drug-

related cases such as traffickers, dealers, and abusers. (Tanguay et al, 2015)

Although Tanguay’s study briefly mentions the redundancy observed from the current

approach to drugs, the study by Kilmer (2012) goes further into detail on the results of the

detention-rehabilitation treatment. The effects are mainly economic and social. (Kilmer et al.,

2012)

The first is the weight of expenses allocated to drug-alleviation, especially in from

national funds. To put into perspective, the National Drug Intelligence Center mentioned in

Kilmer’s study mentioned that nearly $200 billion was spent on drug policy implementations in

2007. These losses in funds are not so much from an excess of resources used by drug-abusers

but by the cost to implement the drug policies themselves, such as the rehabilitation facilities, the

equipment, the detention centers (prisons), and the departments in-charge of action, such as the

police. Although the government’s expenses bear the heaviest on national financial losses, the

drug-abusers and dealers themselves also contribute to the money lost. This part is mostly due to

the lack of productivity of the drug-users who do not perform much function in their respective

communities. (Kilmer et al., 2012)

On a social aspect, the implementation of current drug policies has brought about

widespread violence in various sectors. For example, research has shown 0.15% of the
Supervised Drug Injection to Treat Drug Addiction 7

population in Mexico had been killed in drug-apprehension operations since 2006. (Kilmer et al.,

2012) Even in the Philippines, the police have murdered as many as 2500 and counting due to

the war on drugs. (KINE, 2017)

Aside from the punishments done on offenders of drug laws, action is also taken towards

prevention around the world, mainly through the spread of awareness and tackling the supply of

drugs themselves.

First of all, schools are the primary venue for informative lecture. It has been made

mandatory for various schools to allot time for lectures on the issues on drugs. However, Kilmer

comments on how the implementation of these lectures has been quite poor, due to the

insufficient funding, the narrow scope of information dispersed, as well as several other aspects

vital to executing this successfully. Likewise, he kinds of activities executed in schools were

limited and equally ineffective in informing the students (Kilmer et al., 2012).

The other mode of prevention is by addressing the source, or the supply, of drugs.

According again to Kilmer (2012) a large fraction of imprisoned drug law offenders had a

connection to delivering, sharing, or supplying illegal drugs, so reducing drug transporting could

potentially reduce the growing number of incarcerations. Within a country, the reduction of drug

supplies is done by drastically increasing the costs for trafficking drugs between different states,

as well as by sequestering large amounts of the illegal drugs themselves. On one hand, the

increase in costs to discretely distribute drugs becomes highly cost-ineffective, with expenses

ranging from $10,000 for a kilogram of substances. On the other hand, acquisition of the drugs

themselves in large amounts does cause incremental decrease in the net usage of drugs all

around. (Kilmer et al., 2012) Despite the observable results, Kilmer comments on the same

inefficiency in this method because of how incremental and counter-intuitive it is in the long-run.
Supervised Drug Injection to Treat Drug Addiction 8

The costs to implement increased distribution expenses and sequester large supplies of drugs

results in relatively insignificant rates of improvement to the drug situation, namely the vast

number of drug dealers and abusers.

Supervised Drug Administration Facilities as a Progressive Alternative

With the continued rise in death counts related to the war on drugs, entering the 21st

century, a new, more progressive approach to alleviating drug addiction is introduced in the form

of supervised drug-administration sites, also known as supervised injection sites. (Kennedy &

Kerr, 2017)

In her study, Potier (2014) explains what exactly supervised drug facilities are and how

they work. To begin, this method had first arisen in the last two decades of the twentieth century,

parallel to the rise of HIV cases particularly in European nations, primarily because of the usage

of unsterilized or reused syringes to apply injected drugs (Potier et al., 2014). Drug prevention

policies at the time were not quite effective in resolving the issue, so to address this, some

countries in Europe came up with facilities that provided a medically supervised environment

with sanitized equipment, with the aim of drastically reducing the risks that come with taking

drugs. (Potier et al., 2014) These facilities were more focused on servicing the more rural areas

with the less fortunate who were more susceptible to disease, and by doing so, the overall health

of communities would vastly improve. Among the nations that have recently adopted these

supervised drug sites include the Netherlands, Spain, Switzerland, Canada, Germany, Norway,

and Australia. (Kral & Davidson, 2017)

Despite the growing support for this method of approaching the issues on drugs, the most

pressing concern is in acquiring the approval of the governments in question. Kennedy and Kerr
Supervised Drug Injection to Treat Drug Addiction 9

(2017) describe the situation in the US, in which legislators highly doubt the benefits of these

supervised injection sites. When the first supervised injection site called Insite in Vancouver was

established, the state government gave conditional approval, such that the establishment be

observed, whether it does indeed improve the situation of drugs in the community or not. As

many as forty studies were published showcasing the positive effects brought about by Insite to

the community. For one, the community had seen more than 30% decreased in the number of

deaths from substance-overdose. There was also an indirect improvement to the situation on HIV

due to a great decrease in shared needles and improperly disposed injections and equipment.

Contrary to the assumptions made initially about supervised drug sites, the community around

Insite did not experience any rise in addiction and crime, nor an increase in beginning drug users.

In fact, various sectors of the Canadian government, such as the Federal Minister of Health and

the Canadian Medical Association, praised Insite for the quality of their facilities and equipment,

which have prevented many deaths. The government of Canada even commissioned several more

supervised injection sites to be established around Vancouver and other communities around the

country. Despite the outcome of Insite, as well as what has been done in numerous European

nations prior, senators and legislators persistently refuse to sanction these kinds of drug sites in

America. (Kennedy & Kerr, 2017)

The study by Ng (2017) laid out the outcomes of the supervised injection site in

Vancouver more specifically. For one, deaths by overdose were reduced to 165 from 253 per

year. Before the establishment of the site, 35% of drug users were confined in hospitals for

illnesses due to improper injection usage in the course of three years. However in the four years

following the establishment of the supervised injection site, the number was reduced to 9% as

more drug users made use of the site. Likewise, the study showed a 67% decrease in risk of
Supervised Drug Injection to Treat Drug Addiction 10

opioid overdose, as shown by the number of ambulances called per month for opioid-drug

overdose being reduced by two-thirds. The study also claims that as many as 57 HIV cases were

prevented yearly because of the site (Ng et al., 2017).

Aside from the medical benefits, the study done by Irwin (2017) shows that supervised

injection sites are also cost-efficient because of cheaper facility maintenance and saved expenses

due to reduced cases of illness. This study focuses on the costs saved by a single supervised

injection site in a year in terms of five categories: facility maintenance, HIV and HCV cases,

skin and tissue infections, and deaths by overdose. In terms of cost, findings showed that a

supervised injection site would cost $2.6 million a year, compared to the average rehabilitation

or medical facility costing just $2 million. However, the finances saved due to the medical

benefits help to outweigh the losses from maintenance expenses. First, roughly 5-6% of the total

cases of HIV and HCV infections, involving 22 types of HIV and HCV, were reduced, saving

about $1.3 million. By providing sterilized equipment and professional supervision for drug

administration, the site reduced hospital confinements due to skin and tissue related infections,

saving around $2.5 million in a year. Finally, overdose deaths went down from 120 a year to 13 a

year over the course of a decade, saving ann estimated $425 000. In conclusion, the study

showed that a single supervised drug injection site could save a state in America between $2-3

million a year. (Irwin et al., 2017)

Conclusion

Although the current, conservative methods of drug alleviation have yielded gradual

improvements to communities in various nations, it has been shown to be mostly impractical and

counterintuitive due to the economic and social detriments outweighing the incremental benefits
Supervised Drug Injection to Treat Drug Addiction 11

yielded. Likewise, lawmakers, especially in Third-World countries such as the Philippines,

should consider establishing and legalizing supervised drug sites, as well as making progressive

reforms on drug laws to focus on promoting care in communities rather than fear-mongering

with debunked stigma.

Supervised Drug Injection to Treat Drug Addiction 12

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Supervised Drug Injection to Treat Drug Addiction 13

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