New York City recently opened the United States’ first official supervised consumption sites (SCS), also known as overdose prevention centers. At these sites, people can bring previously purchased illegal drugs to the site and use them under the supervision of medical professionals. These sites will also serve as access points to a variety of additional medical and social services.
SCS have long been considered in violation of federal law — Safehouse, a similar site set to open in Philadelphia, was blocked last year by the 3rd Circuit Court of Appeals. The Biden administration has not yet stated whether it will continue this legacy of opposition, but Safehouse’s appeal to the Supreme Court — which declined to review the case — will force the administration to state its position early this year.
It isn’t clear which direction the administration will choose: The SCS strategy is well accepted in some countries with over 120 sites officially operating across the globe. In 2017, the American Medical Association reviewed available literature and concluded:
Studies from other countries have shown that supervised injection facilities reduce the number of overdose deaths, reduce transmission rates of infectious disease, and increase the number of individuals initiating treatment for substance use disorders without increasing drug trafficking or crime in the areas where the facilities are located.
Still, SCS are controversial in the United States. Why? I believe opposition to them is rooted in mistaken Christian moral assumptions in regard to drugs — and the people who use them.
Myth 1: Drugs Are Evil
More than 100,000 people died from drug overdoses in the United States in the 12-month period ending in April 2021 — a 28.5 percent increase over the previous year. With this tragic loss of human life, it would be easy to believe that the drugs themselves are evil.
John Wesley called for complete abstinence from alcohol and decried those who sold alcohol as “poisoners” and “murderers.” (Wesley also believed tea was “poison” and believed in complete abstinence from that drink as well.) Over a century later, Billy Sunday, the baseball player turned prohibitionist preacher, taught his followers that the only proper place for alcohol was in “hell.” The operative belief was that any consumption of alcohol was morally corrosive and evil was always inherently present in the substance. To have a drink was to invite evil into one’s body.
But this belief isn’t consistent with scripture or much of Christian history. Genesis 1 affirms that all of creation was made good, and 1 Timothy 4:4-5 states, “For everything created by God is good, and nothing is to be rejected, provided it is received with thanksgiving; for it is sanctified by God’s word and by prayer.”
We have examples of alcohol used in celebrations (Deuteronomy 14:6), to make the heart glad (Psalm 104:15), for medicinal purposes (Proverbs 31:6, 1 Timothy 5:23), and in the sacrament of the Lord’s Supper (Matthew 26:27-28).
The Bible articulates a purpose for alcohol and is encouraging of its use in responsible ways toward those ends. At the same time, scripture warns against disordered relationships with alcohol and the many ways that alcohol can harm ourselves and others (Proverbs 20:1, Ephesians 5:18). Warnings are given to leaders (Titus 1:7, Proverbs 31:4-7) and a special condemnation for those who drink and oppress the poor (Isaiah 5:11-13).
Fentanyl, a powerful synthetic opioid, is used safely as a part of general anesthesia and is a common pain reliever during childbirth. At the same time, illicit fentanyl is driving overdose deaths. People are dying because of impurities, inconsistency in dosing, absence of monitoring, and lack of education about potential side-effects and interactions with other drugs. Fentanyl is not “evil” but a powerful drug that is best used with extreme caution and in limited circumstances.
From this moral perspective, the goal is not to eliminate all drug use. Instead, the goal is to create systems where the potential negative consequences of drug use are minimized and while the potential benefits are preserved. SCS don’t reflect an ideal situation but they do respond to real world needs and can effectively reduce harm that would otherwise occur.
Myth 2: Bad People Use Drugs for Bad Reasons
It’s a common assumption that those who use drugs just want to “get high.” And the use of drugs represents the rejection of a meaningful life of purpose in the pursuit of hedonistic pleasure. The use of drugs, with the exception of caffeine (to the chagrin of John Wesley, I’m sure), is seen as diametrically opposed to the Protestant work ethic.
While drugs, from alcohol to opioids, are popular because most people enjoy their effects, reducing drug use to pleasure seeking is overly reductionistic. Drug use is often motivated for much deeper reasons — and many people only find a path to recovery once they identify those underlying motivations.
People might use drugs to address pain, both physical and mental. Or they might be self-medicating for anxiety or depression. Others might be in search for transcendence, connection, a sense of safety or feelings of love.
In this framework we can understand that people who use drugs often want to attain good moral ends. Drugs, however, can be a deceptive path to those ends. A few glasses of wine might relieve some anxiety today, but a bottle of wine every night might soon become the source of anxiety.
When we switch from thinking that people who use drugs are “bad people who want bad things” to “imperfect people (like all of us) who want good things” then it makes sense to switch our stance from one of condemnation and punishment to that of empathy and support.
This also helps explain the counterintuitive reasons why SCS are effective. Typically, in public policy, you get more of something when you subsidize it and less of something when you increase the costs. But these programs decrease “costs” in the form of decreased health risk, free syringes, and fewer overdose deaths.
While a core tenet of Christianity is the celebration of a free gift of grace that none of us are able to earn, Jesus warned about the reaction of the “older brother” in the story of the prodigal son. Far too often we desire that those on a different path receive the punishment we think they deserve and resent anything given that we believe another has not earned.
SCS provide a place where lives are saved, relationships are built, and services are offered. The only requirement is to show up with the desire to take a step to take care of one’s own health and wellbeing. These sites demonstrate it is more powerful to support people in their choices to live healthier and more stable lives than it is to punish people for using drugs.
Myth 3: Addiction Is Just a Moral Failing
While it has become commonplace for political leaders to acknowledge that substance use disorders (SUD) should be treated as a public health issue and not a moral failing, responses to SCS show that we have a long way to go to make sure our policies match.
One of the defining characteristics of an SUD is persistence of drug use despite negative consequences. Approaches that simply increase negative consequences fail to understand the underlying condition. This again underscores why empathy and support are more effective change agents than punitive measures.
Using the framework of public health also helps us clarify what “success” looks like and answer questions about potential moral hazards.
Would we say that we should restrict or eliminate access to bypass surgery because it could encourage some people not to change their diet and exercise? Would we withhold cholesterol-reducing medication until a person can prove that they haven’t eaten fried foods for a year or more?
Drugs are not the enemy. People who use drugs are not the enemy. What is worth fighting is a system that acts as if people who use drugs are people whose lives are not worth saving and health isn’t worth caring for.
SCS aren’t going to end the overdose crisis, but they can and will save lives, prevent the spread of infectious diseases, and provide hubs of support that are desperately needed.
The Biden administration took an important step forward by explicitly endorsing harm reduction measures in their plan to address the overdose crisis. Now it’s time for them to make good on that promise and allow cities and states across the country to take the next step in saving lives.