Opinion: CT needs an overdose response center

Employees Yucef Colley, left, and Rayce Samuelson, center, clean up in the overdose prevention center area at OnPoint NYC, a supervised drug injection site in Harlem on March 24 in New York.

Employees Yucef Colley, left, and Rayce Samuelson, center, clean up in the overdose prevention center area at OnPoint NYC, a supervised drug injection site in Harlem on March 24 in New York.

Gabrielle Lurie / The Chronicle

The daughter did not know what happened. Her mother had gone to the bathroom, and a little while later, there was the sound of a crash. She called 911. After two rounds of CPR, her mom arrived to the hospital with paramedics breathing for her, unresponsive but heart beating. In the trauma bay, she was promptly given naloxone - and within a minute, she opened her eyes. Within a few minutes, she asked me where she was. This story is unusual for one fact: this mom would live. Many before her did not. And, without a significant shift in the way we address the opioid crisis in the state of Connecticut, many more daughters (fathers, brothers, sisters, neighbors, friends) will wait breathless in the halls of our emergency departments as loved ones hang in the balance between life and death.

It is time for an overdose prevention center in Connecticut.

Overdose prevention centers (OPCs), also known as safe consumption sites or supervised injection sites, are facilities that provide patrons with sterile supplies and medical supervision for safe consumption of pre-obtained drugs. If the trained staff recognize someone at risk of overdosing in their facility, they administer overdose prevention measures, including oxygen and naloxone if necessary, to save the person’s life. Since people who use intravenous drugs are also at high risk for infectious diseases and underinsurance, these centers also often serve as a point of contact for delivery of other needed services to this population, such as health care screenings, peer counseling, wound care, social services, and more.

The first OPC opened in Switzerland in 1986; now, there are more than 75 in operation in seven different countries in Europe alone. The best-studied OPCs in the world are in Vancouver, Canada and Sydney, Australia. Studies of these sites have found OPCs to be associated with a reduction in hospital admissions for skin infections amongst people who inject drugs, a two-thirds local decrease in monthly ambulance calls for opioid overdose, and a decrease in number of new HIV infections per year. In fact, multiple studies conclude that OPCs pay for themselves on the basis of decreased HIV transmission alone.

Opponents of OPCs argue that a dedicated space to inject drugs might bring crime to an area or facilitate continued substance misuse, but the data tell a different story. A recent systematic review of published data found no increase in local crime nor public nuisance around OPCs. Indeed, if anything, an OPC moves drug use from parks and streets to inside a (nice, clean) building, away from the public eye. Moreover, utilization of detoxification services in Vancouver increased by 30 percent in the year after its OPC opened. Why? Because OPCs bring the people who could benefit most from detoxification and other social services to a building where information on and access to these services is readily available. For some patrons, the OPC may be their only point of contact with the medical system. It may be the only place where they discover that people care, that there is a system in place to support them.

After more than 30 years in other countries, America is starting to catch on. New York opened its first two sites last year, and they are already heavily utilized and effective. Rhode Island authorized a two-year pilot program last year in a law which came into effect this past March. Let Connecticut follow our neighbors and lead the country in harm reduction policy, as we did when we implemented syringe exchange programs back in 1990.

The time to pass legislation in support of OPCs is now. Connecticut is working with its biggest surplus and rainy day fund in years. Momentum is building. Our Public Health Committee just had a hearing on this very issue on July 28, where testimony was overwhelmingly positive; where Sam Rivera, executive director of New York’s OPCs (OnPoint NYC), spoke a little to the finances of his centers (a good investment however you look at it) and at length about the humanity of them: where people in their darkest times go to “be treated like humans.” And with those words, Mr. Rivera touched on the heart of the opioid epidemic.

The reason why opioids continue to kill Americans at the rate of one every five minutes is frustratingly simple: stigma. From April 2020 to April 2021, more than 100,000 people in the most resourced country in the world died from an opioid overdose, despite widespread access to an effective, instantaneous, cheap antidote. People all around us are drowning, and we have a surplus of life jackets. Why does the drowning continue? Because stigma and law compel those who are drowning to swim out of reach and out of sight, in bathroom stalls and alleyways. Our current approach to this epidemic — shielding our eyes and buying more life jackets — is clearly not working. More people are dying every day. It’s time to change our approach, and look the people we are trying to help in the eyes. Aren’t their lives worth it?

Dr. Daniel Kerekes is a surgical resident at Yale, where his experiences in the trauma bays of the Yale-New Haven Health System have made him a strong advocate for harm reduction legislation.