During a recent Q&A on Facebook LIVE, Dr. Jeff Duchin and Brad Finegood, co-chairs of the Heroin and Prescription Opiate Addiction Task Force, answered some questions about supervised consumption sites (also known as CHELs)—a public health service for people with substance use disorders. CHELs (Community Health Engagement Locations) are one component of a comprehensive approach that includes expanded access to treatment.
We received many comments and questions about this issue, but we weren’t able to address all of them during the session, so we are attempting to do that here.
Q: Can you talk about medication assisted services that will be provided at the site? How many people will be able to be in the program?
One goal of the CHELs is to connect individuals experiencing opioid use disorders with a full range of services when they are ready. We are currently piloting a program at the downtown needle exchange where buprenorphine (one medication used to treat opioid addiction) is available onsite.
At the CHELs, we will either provide treatment medications onsite, depending on the available space, or link people to low-barrier services in the community.
Q: Most people are familiar with INSITE – the supervised consumption site in Vancouver. Can you specifically describe other sites that have been successful?
- There has never been an overdose death at any safe consumption site worldwide.
- A study in Sydney, Australia found that the number of ambulance calls for opioid-related overdoses declined significantly in the vicinity of the supervised consumption site after it opened.
- A study of German drug consumption rooms showed a relationship between the opening of consumption rooms and a long term reduction in the number of drug-related deaths.
- Multiple studies in Europe have found a reduction in drug use, syringes and injection related litter as a result of drug consumption rooms.
For more information on other sites and their results please see the Taskforce FAQ.
Q: Some people have seen reports that overdose deaths and crime have increased in the areas surrounding INSITE. Why is this happening and how will we mitigate this problem?
While no overdose deaths have occurred at INSITE, overdose deaths have increased in Vancouver (not just around INSITE), largely because of a dramatic increase in illicit fentanyl use in that community. Fentanyl is a synthetic opioid that is about 50 to 100 times more potent than heroin and morphine and is highly lethal. Vancouver and other areas in Canada are expanding the use of supervised injections sites as one primary tool to address the growing numbers of overdoses.
At this time we do not have a high level of illicit fentanyl use locally, but we continue to monitor for this problem. We need to continue work in our community to increase awareness of the risks of overdose and the dangers of fentanyl use, expand treatment and continue to promote access to Naloxone, the medication used to reverse overdose. We believe that establishing CHEL sites to help reverse overdoses and connect persons with opiate use disorder to treatment will be even more important if we do experience an increase in overdose deaths in our community. The available evidence does not show that these sites increase the frequency or initiation of opiate injection.
To mitigate concerns of crime, the Taskforce recommended that CHELs include coordination with local police and emergency medical response who can attend to any issues such as loitering, dealing or behavior that interferes with neighboring businesses.
Q: How will law enforcement interact with these sites?
Law enforcement will enforce drug dealing and drug use in the areas around the site. They will not interfere in the operation of the sites and respect the goals and philosophy of supervised consumption sites. Law enforcement will also monitor and continue to evaluate any impacts on the surrounding neighborhood.
Q: Who is going to pay for this program? Which part of which budget?
CHELS will be funded by a combination of public and private funds. This includes funding through King County’s Mental Illness and Drug Dependency (MIDD) specifically for programs and services for people living with mental illness and chemical dependency.
Q: Where can people voice their concerns and support?
We look forward to continuing to provide information as planning continues. Please email us with any comments or questions at CHELInfo@kingcounty.gov
On buprenorphine: what does “available” mean? Are you going to write prescriptions (presumably for Suboxone)? Will people without insurance have to pay retail price? And: are you going to arrange places for them to live? Sober living / halfway houses generally do not allow buprenorphine users. Without the money to pay for the meds and a place to live, they’re going to be back on heroin in two days. Plus: how many be beds are there locally in detoxes and rehabs that countenance buprenorphine?
Thanks for the thoughtful questions.
We have a low-barrier buprenorphine program at Downtown Public Health now, and we hope to expand low-barrier approaches through CHELs or other programs. We will either prescribe Suboxone or refer to Suboxone providers. We already do this through the needle exchange.
When clients don’t have health insurance we will help them access health insurance or other subsidized programs. We can also refer them to housing placement assistance, but will not likely be able to provide this service through the CHEL.
We contract with 34 residential services across the state. Out of those facilities, 12 take people on Methadone and 18 take people on Buprenorphine. We currently contract with a 16-bed detox facility in White Center, which takes people on Buprenorphine, but doesn’t start people on it. There is another new 16-bed facility in White Center, but we are not sure of its protocol at this time. In October, a 33-bed detox center will open in Beacon Hill. This facility will start people on Buprenorphine. Early next year, a 16-bed facility is supposed to open in Kent, and this facility will also be able to start people on Buprenoprhine.
Those do seem like good practical questions above.
Do you have opiate addicts, particularly ones who are homeless, on an advisory panel?
Thanks for asking. Yes, we intend to involve opioid users in the program design.