In Canada, Supervised Injection Sites Aim To Prevent Overdose Deaths : Consider This from NPR As record numbers of people in the U.S. die from drug overdoses, communities are searching for tools to prevent them. A new program in Canada could serve as a model.

Over the past few years, government-approved clinics have opened across the country, where people can use street drugs under medical supervision. If they overdose, they can get life-saving care immediately. Some doctors are even prescribing powerful opioids to patients to keep them from using street drugs that may be laced with deadly chemicals.

It's a controversial program, and some in the medical community argue that it could encourage drug use.

NPR's addiction correspondent Brian Mann visited some of those supervised injection sites in Ottawa, to see how the program is working.

In participating regions, you'll also hear a local news segment to help you make sense of what's going on in your community.

Email us at considerthis@npr.org.

The Experiment Aiming To Keep Drug Users Alive By Helping Them Get High More Safely

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JUANA SUMMERS, HOST:

Inside an addiction treatment center in Ottawa, Canada, half a dozen people sit in little booths.

UNIDENTIFIED PERSON: I thought you're going to check my heart and...

SUMMERS: They look like the kind of study desks you'd see in a library. But here, the people are injecting opioids and methamphetamines purchased from street dealers. A team watches them on closed circuit television.

ANN MARIE HOPKINS: He's taking a look right now. He's watching somebody inject.

SUMMERS: Ann Marie Hopkins runs this clinic.

HOPKINS: If he were to see, like, say, for example, this gentleman not doing well, he would yell out to the staff on the floor, hey, go check eight, make sure they're OK.

SUMMERS: It is troubling to watch. Overdoses happen here all the time, just like they do out on the street. But in this clinic and similar clinics across Canada, nurses stand by, ready to help. Soon, a woman slumps forward in her chair.

HOPKINS: The individual in that booth is under, like, a very mild overdose. We're just going to pop her on just a little bit of oxygen, probably a very low level, just to make sure that she doesn't dip down further.

SUMMERS: Street drugs in Canada and the U.S. are far more deadly than they used to be, often laced with synthetic opioids like fentanyl or other toxic chemicals. So addiction treatment providers are trying to adapt to meet that new reality. In some clinics, physicians even prescribe opioids to patients as a safer alternative to those street drugs. Hopkins says her philosophy of addiction care is simple.

HOPKINS: There is no recovery if you're dead.

SUMMERS: CONSIDER THIS - as overdose deaths rise, a controversial experiment is underway in Canada. It aims to keep drug users alive by helping them get high more safely. We'll go inside these new treatment centers and see how Canada's experiment and harm reduction may provide a model for public health officials in the U.S. From NPR, I'm Juana Summers. It's Tuesday, September 20.

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SUMMERS: It's CONSIDER THIS FROM NPR. A record number of people in the U.S. are dying from drug overdoses, more than 100,000 deaths every year.

RAHUL GUPTA: We have an American perishing every five minutes around the clock, and that's unacceptable.

SUMMERS: Dr. Rahul Gupta leads the White House Office of National Drug Control Policy.

GUPTA: There's a lot of progress that is being made, but we know that there's so much more we need to do, making sure that we can save lives first with harm reduction approaches such as Naloxone.

SUMMERS: Naloxone is a drug that helps reverse opioid overdoses. And the U.S. has been slowly adopting other harm reduction strategies. But supervised injection sites are still controversial and, for the most part, illegal in the U.S. People like Keith Humphreys, an addiction researcher at Stanford University, are skeptical.

KEITH HUMPHREYS: When you start distributing opioids in the community, including to people to stop overdose, they will, in some cases, sell them and initiate new people onto drugs, and those people will overdose. If you just say, we're just going to supply these drugs, like, what is the end game?

SUMMERS: So Humphreys thinks it's better and ultimately safer to focus on ending addiction, not helping people use drugs more safely. Plus, there's not a lot of data showing whether the benefits of supervised injection outweigh the risks, since it's such a new idea. But that may change soon because of the experiment that's happening in Canada. Over the last three years, government-approved clinics have opened all across Canada, where people can come in and use street drugs under medical supervision. Chad Boutier (ph) used to be addicted to cocaine and fentanyl. Now, he works with patients at one of those supervised injection sites in Ottawa.

CHAD BOUTIER: The clients are choosing what success means to them at that moment. If it's coming to get clean gear - success. If it's coming to use while being supervised - success. And they can build on those successes.

SUMMERS: So let's get back to that clinic in Ottawa. I'm going to pass off this story to Brian Mann, NPR's addiction correspondent. He went to Canada to see how the experiment and supervised injection is going.

BRIAN MANN, BYLINE: Some forms of harm reduction have been around for years in the U.S. and Canada. More communities are distributing naloxone. It's a drug that reverses opioid overdoses. They're handing out clean needles to help people with addiction avoid diseases like HIV and hepatitis. The harm reduction experiment here in Ottawa is more radical, more controversial. In most of the U.S., this kind of care would be illegal. But the people who come here to use drugs say it's a lifeline.

SHELLY: The staff here are very special people to come and be here with us, for us.

MANN: Shelly (ph), who doesn't want to share her last name, just finished injecting opioids in one of the booths. She says using drugs outside on the streets is frightening. She tells me about a recent overdose that happened in a place with no medical care, no safety net.

SHELLY: I was thrown in a bathroom with cold water, and when I came to, my friends were smoking crack. And I could have probably died in that bathtub. I see it every day. I see overdoses. And I have - many, many friends have lost their lives.

MANN: I want to pause here and acknowledge this may sound a little crazy. If people experience this much danger using drugs, why don't they just stop? Why not get the kind of addiction treatment aimed at full recovery? But studies show tens of millions of people in the U.S. and Canada who use illegal drugs either can't quit or aren't yet willing to try. So the question is how can the health care system help people who are still using these high-risk drugs?

MAX: Hi. I'm Max.

MANN: I meet Max at another Ottawa clinic a half-hour drive away. He's sitting with a fantasy novel, waiting for a session with one of his caseworkers.

MAX: I used to be a complete mess before I got on this program.

MANN: He's 26 years old and tells me he's used methamphetamines since he was 12.

MAX: I used to be a very heavy meth user. I used to inject a gram of meth in a shot every day, three times a day.

MANN: So Max now comes to the pharmacy in this clinic every week for another form of experimental harm reduction not available in the U.S. It's called safer supply. With a doctor's prescription, he gets enough Ritalin that he can inject it to get the high he craves without buying high-risk meth on the street. He joined the program after an overdose nearly killed him.

MAX: I spent three months in the ICU. And that's when I got on safe supply, is when I came out of the ICU. And it - basically, I'm pretty sure it saved my life.

MANN: So that's the big win. Max is still alive. He says he's also using smaller doses of drugs, trying to taper his addiction. And while he's here, he gets other kinds of medical care, and he's working with a social worker to find permanent housing. Dr. Charles Breaux (ph) is the man who writes the prescriptions for Max's medications. He says he's convinced he's doing the right thing.

CHARLES BREAUX: It's about survival.

MANN: Breaux is one of a growing number of physicians across Canada prescribing opioids and other drugs to patients who use the medications to get high. He believes this kind of safer supply - an alternative to toxic street drugs - is long overdue.

BREAUX: This should have happened at the start of when the overdose epidemic started.

MANN: But Breaux says even now, when so many people are dying after buying street drugs, he faces criticism within the medical community.

BREAUX: Even within my colleagues, I get stigmatized or the odd jokes here and there about prescribing drugs.

MANN: Breaux says he became convinced that for millions of people in addiction, most treatment models now in use don't work because they require people to give up getting high before they get health care.

BREAUX: We've seen the abstinence being forced on people before, and it just doesn't work. It's based on misconception, misinformation. And it creates policies that don't work for people.

MANN: Now, here's why addiction experts in the U.S. are paying attention to what's happening in Canada. The U.S. is seeing an even bigger surge of drug overdoses. And public health officials are embracing this idea that helping people with addiction survive has to be a first step. Dr. Brian Hurley is with ASAM, the top organization in the U.S. pushing for better addiction care.

BRIAN HURLEY: There is a tremendous number of Americans at risk for overdose that are not going to go into treatment, or at least they're not going to go into treatment right now. And if we say, well, wait until they're ready, they might be dead.

MANN: ASAM hasn't taken a position on doctors prescribing drugs to people who use the medications to get high. Hurley says they need more data first, more research. But ASAM supports the idea of supervised drug use clinics, like the ones in Canada, opening across the U.S.

HURLEY: I think that we should see more communities start and test safer consumption sites, see what works and what doesn't and make modifications in order to bring these to scale.

MANN: It's common for Americans to romanticize health care in Canada, so a note of caution is important here. People working in Ottawa's harm reduction network don't claim their programs offer anything like a quick, easy solution. Yes, services and health care for people using drugs have gotten better, but street drugs also keep getting more powerful, more toxic. Ann Marie Hopkins says even with their best efforts, a lot of people are still dying.

HOPKINS: It's completely exhausting for the team. We have a very high rate of burnout. Yeah, it's definitely very emotionally taxing on the staff.

MANN: But Hopkins is convinced that with more clinics like hers and better public health care for people still actively using drugs, a lot more lives could be saved, both in Canada and in the U.S.

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SUMMERS: That was NPR's Brian Mann reporting from Ottawa. I caught up with him after his trip, and I first asked him whether he thinks we'll see more of these kinds of harm reduction strategies in the U.S. soon.

MANN: A couple years ago, I would have said no. You know, there are still big ethical debates even within the addiction and health care communities over some of these approaches. But these drug deaths just keep rising astronomically. The medical journal The Lancet has predicted that another 1.2 million Americans will die from overdoses by the end of this decade. So we're seeing more public health responses that once seemed impossible, they're now on the table.

SUMMERS: And at one of the clinics you visited, there were people who were injecting street drugs under medical supervision. Is there anything like that now here in the U.S.?

MANN: Yeah. We've seen two supervised injection clinics open in New York City last year. People in other states are considering similar pilot programs. A big question now is what position the Justice Department will take on this kind of harm reduction. Right now, what's happening in Canada would be illegal under U.S. law, but the DOJ is doing a policy review right now. If they allow safe injection sites to open, that would be a game-changer.

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SUMMERS: NPR's Brian Mann. You can read more of his reporting at npr.org. It's CONSIDER THIS FROM NPR. I'm Juana Summers.

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