Harm Reduction or perpetuation of harm? Unsanctioned drug consumption rooms from a social work perspective
Safe consumption rooms are facilities where individuals administer drugs in an environment which provides medical oversight for mitigating adverse reactions during and immediately after drug consumption. The effectiveness of safe consumption rooms has been determined and documented in several industrialized nations which feature fully sanctioned and operational facilities. In the US however, evidence is lacking and discussions are ongoing since such facilities are not considered legal. Safe consumption rooms would face federal scrutiny under the Controlled Substance Act and be shut down. In fact, legal battles have commenced with US prosecutors shutting down safe consumption facility “Safehouse” located in Kensington, Philadelphia, an area known for drug use.
What do social workers, and local community healthcare providers do to save lives during the litigation period? As of July 2018, there are at least 13 proposed sites seeking approval for safe consumption rooms, including in New York City, Philadelphia, Boston, San Francisco, Seattle, Denver, Vermont, and Delaware. Simultaneously, there are reports of dozens upon dozens of unsanctioned safe consumption rooms in the US, all on a mission to save lives.
But could unsanctioned safe consumption sites perpetuate harm as opposed to reducing it?
Sanctioned facilities in other countries implement models of care which entail qualified medical professionals providing supervision when a drug is administered. These professionals have undergone extensive training for responding to medical emergencies. The path to a nursing profession usually takes anywhere from 2-4 years, with specialized training in triage. While it has been confirmed that Narcan (overdose reversal drug) training helps mitigate negative consequences, it is limited when faced with serious medical complications, for example seizures.
Harm Reduction is a set of practical strategies and ideas aimed at reducing negative consequences with drug use. Naturally, safe consumption rooms are a modality of harm reduction, where there is potential for mitigating life-threatening circumstances including reversing overdoses and creating windows of opportunity for implementing treatment interventions through education.
But Harm Reduction is more than that. It is a movement for social justice which believes in, and respects rights of drug users. The concept of social justice is one of fair, just, and equitable relations between individuals and society. The question evolves into one of a global society, where some individuals engaged in safe consumption have access to medical professional handling when consuming drugs, while others have access to Narcan trained laymen. The differences in quality of service at safe consumption rooms between a nurse triaging medical complications and a layman are yet to be examined, but it would be safe to assume that if given a choice, the majority would prefer a nurse, or other qualified medical professional to respond.
From the social work perspective, we must consider the NASW code of ethics concerning practicing only in areas of competence; providing services and representing ourselves as competent only within the boundaries of our education, training, license, certification, consultation received, supervised experience, or other relevant professional experience.