From ‘Just Say No’ to ‘No Big Deal’

Drug addicts are shooting up at supervised injection centers across Canada, and there’s a push to imitate them here too, The New York Times reported. A one-year pilot may open at least four sites in New York City with the full support of Mayor Bill de Blasio. Proponents say the sites make cities safer, but they delay or prevent addicts from finding the recovery and redemption they desperately need.

Trained health workers at injection centers can help an addict inject “safely” and recover from drugs the user supplies. The worker also helps the user avoid or deal with overdose, which causes huge expense for cities responding to 911 calls. Cities and states across the U.S. have sued drug companies over the financial strain put on them by the epidemic of overdoses caused by opioids.

Some Canadian injection centers also do needle exchanges and provide facilities for users to “cook” their drug. “Don’t do it alone” is the purported safety-minded slogan.

Vancouver established the first of its half-dozen injection centers in 2003, when they were still illegal. Now legal, Health Canada inspects them, and Canada’s two biggest metropolitan areas, Montreal and Toronto, have four and six centers respectively. Those using Toronto’s injection centers are 75 percent male, many are homeless, and 10 percent are not first-time visitors, according to health department data.

“Every injection that takes place in our facility does not take place in the street, in the alleys, public spaces,” said Sandhia Vadlamudy, speaking to CBC as executive director of Cactus injection center in Montreal.

The U.S. cities considering safe injection centers are also dealing with huge homeless populations—New York, San Francisco, Seattle, and Philadelphia among them. The rationale for supervised injections is the scale of the opioid crisis and the need to save lives. The San Francisco Chronicle reported last month a huge number of opioid deaths in the past year: 1,882 people overdosed and died, including a record 746 using fentanyl, a synthetic and highly dangerous opioid. In July, when it plans to open its first injection center, the city’s Department of Public Health intends to defy federal law, which “prohibits possessing illicit drugs” and also “maintaining or providing access” to such locations where they are used.

Whether or not U.S. centers are legal, cities cannot ignore the effects of drug users’ congregating at an injection center. Area quality of life decreases and drug dealing increases, according to evidence from Toronto sites. Speaking of his city’s experiment, Mark Garner, the head of a Toronto local business improvement area said, “I think we’re at a time when the Giuliani mentality needs to come to Toronto.” That mentality was the former mayor of New York’s method of preventing bigger crime by keeping the city clean and in repair and reducing smaller crime. Garner added that “the perception of safety” declined because of an injection center, as drug dealers followed their market.

Tommy Turpin, 47, battled a 30-year addiction to alcohol and later opiates. He works at Changed Lives Ministry in Moncks Corner, S.C., after graduating one year ago from the treatment program he now manages. A native Floridian, he told me that supervising people’s drug injections is “giving them the right to use illegal substances” and only prolongs their misery. “I moved forward only after repentance of sin” he said, “coming to the end of myself.” He said only a relationship with Christ combats addiction: “The so-called fix [of supervised drug use] is encouraging behavior by assisting it.”

Prescription quandary

New rules some insurance companies are introducing could slam patients with unexpected bills for prescription medicines.

Traditionally, drug manufacturers have subsidized the cost of many expensive medicines through copayment offset programs or coupons. The manufacturer covers the patient’s copayments, which count toward the patient’s deductibles and out-of-pocket maximum amount. The insurance company pays the rest.

But this year, some insurance companies are introducing new accumulator plans that don’t let the manufacturers’ payments cover patients’ deductibles. Proponents say the change will lower overall drug costs because patients will buy cheaper substitutes, saving the insurance companies money.

But many drugs don’t have a cheaper substitute. Out of America’s top 200 drugs (by spending) in 2014, 90 came with copay coupons, according to a study by the University of Southern California’s Schaeffer Center. Out of these 90 drugs, 51 percent didn’t have a generic substitute.

Patients who don’t have a cheaper option either have to pay thousands of dollars up to their plan maximum or go without medicine. And those who go without could have medical emergencies because they aren’t getting the treatment they need.

Insurance companies blame drug makers for inflating drug prices and then subsidizing them with copay coupons. And they say the unfair system means that some patients have to pay their deductibles when others don’t. Steve Miller, the chief medical officer for the Express Scripts plan provider, called on drug manufacturers to lower the cost of drugs in a blog post. “We believe all patients should have access to affordable prescriptions and care, not just those using a medication with drug maker copay assistance,” he wrote. “To that end, lowering the cost of drugs to increase access is the best thing pharmaceutical manufacturers can do.”

But drug manufacturers blame insurance companies for ignoring the needs of patients. “Copay accumulator programs are nothing more than an insurance scheme that leaves patients financially exposed while benefiting payers’ bottom lines,” said Stephen J. Ubi of the Pharmaceutical Research and Manufacturers of America (PhRMA) in a March 2018 statement. —Aspen Daniels

Border wall rising

U.S. Customs and Border Patrol began new construction projects on the U.S.-Mexico border last week following months of debate over President Donald Trump’s plan to create a wall spanning the entire Mexican border. Fencing and walls now cover 654 miles of the nearly 2,000-mile stretch.

An agency statement said 14 miles of ramshackle sheet-metal fencing in San Diego County will get replaced with a more solid bollard-style wall up to 30 feet tall. The 60-mile-long San Diego sector is a “top priority” because of the high number of illegal entries and drug smuggling there. In fiscal year 2017, agents there apprehended 26,086 illegal immigrants and seized 10,985 pounds of marijuana, 2,903 pounds of cocaine, 4,123 pounds of methamphetamine, and 5,707 ounces of heroin. Last year there were also 83 assaults against Border Patrol agents in the area. The San Diego wall begins a half-mile from the Pacific Ocean and extends to the base of Otay Mountain, a wilderness area east of the city. New construction is rising farther east in Calexico, Calif., and Santa Teresa, N.M., as well. —R.H.

Happy campers

Crime decreased in two U.S. cities whose neighborhoods hosted communities for homeless people, The Guardian reported. The findings came from analysis of 11 city-sanctioned tiny home or village communities for homeless people in Seattle and Portland, Ore. Five neighborhood areas saw crime decrease after the establishment of a sanctioned and planned village. Another four districts saw very little change, and in only two neighborhoods did crime increase. The data somewhat contradicts the prevailing idea that a homeless camp always generates crime, though unsanctioned camps do not seem to provide the same resulting stability. Othello Village, a 29-unit tiny home community for homeless people in Seattle, was a derelict property until March 2015. Now figures show an average 31 percent decrease in crime in the two districts around Othello in contrast to a 4 percent rise in the city as a whole. —R.H.

Seattle loves tiny houses

Seattle mayor Jenny Durkan unveiled plans last week to speed up the movement of homeless people into tiny houses. Her 90-day strategy earmarks $6.3 million from the sale of city property to move 522 more people into tiny houses as an alternative to packing them into city shelters. Advocates believe having an address brings security as well as a community feeling for those living in the 120-square-foot heated dwellings like the new ones in Crown Hill neighborhood. Low-cost, at around $2,200 per unit, tiny house communities can function as a short- or long-term solution.

Seattle’s 2,032 shelter beds stay nearly full each night. The mayor’s strategy also includes increasing the number of shelter beds, authorizing more homeless encampments, and creating a 24-hour shelter open to all. —R.H.