The Need for Safe Consumption Sites in Maryland

What disappointed you most about the 2018 legislative session in Annapolis? The suffocation of the $15 minimum wage bill? The lack of progress on police accountability and criminal justice reform?

Those are both plausible answers. But the defeat that sticks in my gut is the failure of Senate Bill 288, which would have authorized a vital experiment in Maryland: two pilot supervised consumption sites for drug users.

What are Safe Consumption Sites?

Such sites have existed for decades in more than 60 cities worldwide, including Vancouver, Copenhagen, and Sydney. Evidence from those cities demonstrates that safe consumption sites can reduce many of the harms associated with opioid use. They slow the needle-sharing transmission of HIV, hepatitis, and other illnesses; they reduce street violence associated with drug use; and they help people with substance use disorders move into treatment and recovery.

Most importantly, safe consumption sites save lives. Trained clinicians are always present, and they can respond immediately when users suffer respiratory depression or other severe symptoms. There has never been a documented fatal overdose at a supervised consumption program.

A Program Maryland Desperately Needs

Maryland’s rate of fatal overdoses of course continues to skyrocket. In 2016, the last year for which full statistics are available, there were 2,089 intoxication deaths in Maryland, up from 1,259 the previous year. Eighty-nine per cent of those 2,089 intoxication deaths were opioid related. At least a handful of those deaths could have been prevented if users had had access to supervised injection facilities.

No U.S. jurisdiction has yet established a safe consumption site, but momentum is building. In the last year, municipal authorities in Seattle, San Francisco, and Philadelphia have authorized funding for the creation of such sites. (The Trump administration is threatening to go after these projects, and we should probably steel ourselves for federal pushback even under a Democratic president.)

In Maryland, the fight for supervised consumption sites has been led by the Baltimore Harm Reduction Coalition (BHRC) and the Baltimore Resources for Indoor Drug Use Grassroots Education (BRIDGES) Coalition, which include housing advocates, health professionals, and other activists who want to promote dignity and respect in the treatment of drug users. Since its inception in 2010, the BHRC has won several victories in Annapolis, including support for naloxone access and syringe exchange programs. But the campaign for a safe-consumption-site pilot program has met frustration at least in the 2018 session.

Senate Bill 288: An Unfulfilled Promise

Senate Bill 288 would have invited community-based hospitals, clinics, or social service organizations to apply for permission to establish safe consumption spaces. In order to win such permission, the applicant organization would need to demonstrate its capacity to provide a range of services, including substance abuse counseling, HIV testing, and wound care. No sites would be authorized in residential neighborhoods.

The bill’s primary sponsor was Sen. Brian Feldman (D-15). The companion legislation in the House of Delegates — House Bill 326— was championed by Del. Dan Morhaim (D-11), an emergency-room physician who has introduced similar legislation in each of the last three sessions, with a growing number of sponsors each time. (This year’s House bill had 31 co-sponsors.)

Beyond Sen. Feldman, these bills had significant support from the Montgomery County delegation. The senate bill was co-sponsored by Sen. Roger Manno (D-19), and the House bill’s co-sponsors included Aruna Miller (D-15), Marc Korman (D-16), Bonnie Cullison (D-19), and Marice Morales (D-19).

The Future of SB 288

The 2018 legislation was always a long shot. It’s unlikely that Gov. Hogan would ever sign such a measure  he called the concept “absolutely insane” in 2017  and unlikely that a veto-proof majority could be put together in the Assembly. Even so, activists were frustrated by the bill’s fate this year. In mid-February, Senate Bill 288 was favorably voted out of the Finance Committee and sent to the full Senate floor. But then the Senate leadership leaned on the committee to reconsider. On a second committee vote, the bill was squelched.

The activists in the BHRC and the BRIDGES Coalition aren’t giving up. They understand that this fight could take years. “We know that Maryland will eventually see the demonstrated benefit of safer drug consumption spaces and pass the legislation necessary to establish them here,” says Harriet Smith, the BHRC’s executive director. “We need brave policy makers who are willing to set aside their fears of reelection and do what’s right for Maryland.”

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