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California Bill Would Allow Supervised Drug Consumption Centers

California Bill Would Allow Supervised Drug Consumption Centers
California Bill Would Allow Supervised Drug Centers To Prevent Drug Overdose GUEST: Dr. Carla Marienfeld, addiction psychiatrist, UC San Diego Health

California Senate is weighing the risks versus the benefits of a controversial plan involving injection drugs. AB 186 would set up injection centers where people can use opioids and heroin in a safe and clean supervised environment. Under the centers would be located in San Diego but in the counties that have been the hardest hit by the opioid epidemic, including LA County. Joining me is Dr. Marienfeld . She is an associate clinical professor in the UC San Diego school of medicine. Welcome to the program. Thank you for having me. These supervised injection centers may be new to the U.S. but they are used in other countries like Canada. Can you give us a sense of how they work. I know they do not supply drugs. That is correct. They do not supply drugs. They are a safe facility where people who would use drugs in less safe environments would be able to come in, bring drugs with them and use in such a way that there is staff on site who can observe so if somebody was to use too much or have a combination that is dangerous, there are people who could help provide overdose assistance or help them access medical services. In addition to being a place to get people out of using in public facilities and public restrooms and cars and other spaces, it is an opportunity for people to come in and have access to the healthcare system in a way they may not otherwise. There is no known infectious diseases and other risks associated with drug use. This helps provide access so they can be dealt with earlier and potentially in a more cost-effective way. Counseling services for addiction treatment would also be available for people using the centers. As an addiction psychologist, would you say that most opioid addicts want to quit? It depends on where they are in their drug use history and their recovery. For many patients who are just starting out, they do not recognize the risk and they have not experienced the harms. Once they get past a certain point, they describe how they do not used to get high. They are using to prevent withdrawal and to maintain a sense of feeling normal. For many, they reach the point where it is not fun. The money is going to opiates and it has ruined relationships with friends and family and they may have had health consequences. That is typically when somebody would be seeking help. Trying to decrease the barriers to asking for help to finding out what help is available and to understanding the options, that is when that is an important aspect of the services provided. Supporters of this idea says it treats addiction as a public health problem rather than a crime. Is that the approach we should take ? In general, anything that involves health that affects large population should be considered as a public health problem. It does affect our society in many ways. It can affect in terms of cost of healthcare, trying to address issues earlier than later and trying to boy hospital based care and it affects society how they get drugs, the crime and other things that are occurring in the lifestyle of somebody who is using drugs and it affects the larger society. It affects in terms of this red of disease and HI -- HIV, if they do not have access to clean needles, it might spread amongst each other and through heterosexual contact and other ways, it can go into the larger population. The California state sheriffs Association and another of other groups say injection centers run by the state it would send the wrong message about how society deals about drug abuse. If Heroin and opioid abuse is not seen as a crime, do you think it opens the door to more experimentation ? This is the most common objection that we are sending a mixed message about condoning drug use. It is an important consideration in terms of how you set these things up. This is considered a harm reduction approach. If we think about alcohol, for example, ideally, nobody would become so intoxicated that they would not be able to drive. If people do become intoxicated that they cannot drive, the message is that this is not good and safe and healthy. We want to have a designated driver. We are reducing the harm but you can still do it in a way that talks about the risks and wanting to prevent people from using in the first place. When you have it as a medical model where you can provide this kind of messaging to people, you can send that message that this is not a safe thing and it is not a long-term healthy strategy to be using these kinds of drugs. I think that is an important message that can be sent when you have these kinds of facilities. Opioid desks and emergency room visits have been increasing since the year 2000. There is close to 3500 opioid -related deaths since that time. Even though San Diego is not seen as one of the hardest hit counties, is it your sense we are in the midst of a serious problem? Yes. We see that parallel increase in San Diego as you see throughout other parts of the country that are being hit harder. What is interesting about this bill at in this context is that there is data from other safe injection facilities in Australia and Canada. None of those are in the context of the environment that we have right now with this opioid overdose epidemic. And disorders that are also increasing. In this context, it is a unique situation where potentially, we have more lives that could be saved. I had a patient in my office last week who had a family member who had gotten a Narcan kit. Those are the kits that are used to reduce opioid overdoses. She had known how to use this because when my patient had an overdose in front of her, she could administer it and get her to the hospital. Anything we can do to increase the prevalence among people who are using drugs can help save lives. Safe injection facilities are a safe place for people to learn more about overdose prevention, how to use the kits and how to save people's lives. I have been speaking with Dr. Carla Marienfeld, and addiction specialist and an associate professor of psychiatry at the UC San Diego school of medicine. Thank you so much for your time. Thank you very much.

California is considering opening drug consumption centers, where drug users could get high under the supervision of health care professionals.

The centers would offer clean needles, a safe environment, access to life-saving medication and referrals to substance abuse treatment.

Under AB 186, eight counties would be allowed to roll out pilot programs. San Diego is not one of those counties.


The bill was introduced in response to the nation’s opioid epidemic. Since 2000, about 3,500 people died from opioid-related deaths in San Diego County.

But law enforcement groups worry the centers will attract crime.

And efforts to block the opening of similar sites in Washington are underway.

Dr. Carla Marienfeld, an addiction psychiatrist at UC San Diego Health, discussed Monday on Midday Edition how similar programs in other countries work and what they've done to reduce overdose deaths.

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