ASAM Weekly Editorial Comment
William Haning, MD, DFASAM, DFAPA
A considerable dollop of this week’s contents bear on the effort to control the consequences of drug misuse, and of addiction. One topic coming increasingly to these pages is the provision of supervised injection facilities (SIFs), as a means of diminishing the risk both of unintended fatality from over-estimation of dosage; and of co-morbidity from shared injection devices – e.g., hepatitis, HIV, or even as-yet-unrecognized infectious agents that will become the HIV of the 2020s. It is difficult to know toward which end of the field to run, in this case. To provide an SIF is to risk accusation of “enablement.” To fail to do so is to implicitly encourage the illness and deaths of many whose judgment is impaired. Unfortunately, in the latter case, there will be injured bystanders, as well.
The solution of relying on long-term clinical trials for guidance is not yet at hand.Clinical Trials are cumbersome and dependent on Federal funding is wishful. And, of course, no one likes injection drug users (IDUs). It is the ultimate confound in trying to diminish the tide of illness, that our patients are unattractive. They do stupid and larcenous and sometimes harmful things, to others as well as themselves. So enlisting sympathy and cooperation on their behalf asks a lot of the many, those who do not use drugs and yet have difficult lives.
Sir Max Hastings, in Winston’s War (2009, p.483), writes in the context of apologizing for Winston Churchill’s racial and class biases: “…almost all of us are discriminatory, not necessarily racially, in the manner and degree in which we focus our finite stores of compassion.” Advocacy for crippled children, for veterans, and for those with cancers is not so difficult; it takes special forbearance, intelligence, and energy to advocate for those with addictions. The SIF should be understood in this connection, that it is an expression less of cynicism than of compassion.
Editor-in-Chief: William Haning, MD, DFAPA, DFASAM
Sam Quinones in Dreamland delves into this as an option. Giving addicts a place to shoot up with medical supervision onsite to prevent OD’s and clean needles/syringes to use. I personally think Buprenorphine is the answer, but clearly we’re losing the “war on drugs”! I don’t see state medical boards being forward thinking enough to allow this!
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