by Craig Klugman, Ph.D.
A hospital in Paris has opened that country’s first “shooting gallery,” a medically supervised facility where drug addicts can use their injection drugs in a safe, clean environment. The hospital provides clean needles and alcohol wipes, alternatives (such as methadone for a heroin addict in exchange for street drugs), and education. Patrons must bring their own drugs. France joins Australia, Canada, Denmark, Luxembourg, Netherlands, Germany, and Spain in hosting such programs. There are more than 92 facilities in 61 cities, over one-third in the Netherlands alone.
As I have written about previously, our current U.S. drug policies have been a disaster leading to incarcerating significant portions of young, minority men and a zero-tolerance mentality. Such approaches stigmatize users forcing them into secret where they share kits—increasing the risk for disease transmission—and decreasing the likelihood of receiving help when needed. Such galleries may represent a smart approach to helping those addicted to drugs.
Although no such galleries exist in the United States, that is not for lack of trying. For example, Ithaca, NY, Maryland and San Francisco have proposed such facilities, though none has created them, encountering strong community resistance, especially from law enforcement. A proposed Boston program does not allow visitors to bring or use drugs or needles on premises, but offers a medically supervised space for users to ride out their high. The U.S. has tried needle exchange programs where users can exchange used needles for clean ones plus cleaning supplies like bleach. There are over 200 such programs worldwide including in 35 U.S. states but they tend to be underfunded and have limited capacity. The Department of Health & Human Services requested increased funding for needle exchange programs in the 2016 consolidated federal budget. Jurisdictions are now permitted to request federal funds but whether the money will be released remains to be seen.
The Paris gallery is opening in response to the high rate of infectious diseases passed by sharing dirty needles in the drug using community. Proponents believe that it provides a safe environment that protects users from disease as well as from the police. In general, these sites have led to a decrease in drug deaths with no increase in drug use or trade. The galleries tend to attract male, homosexual/ bisexual, homeless, less educated people who began using injectable drugs in the recent past. These are vulnerable populations who have high rates of overdose deaths, depression and disease. The centers not only provide a safe environment and supervision, but an opportunity to tend to the medical needs of a population that avoids medical treatment out of fear of being arrested.
Opponents feel such facilities sanction drug use and could lead to an increase in drug use and drug trafficking. This perspective feels that these galleries are protecting criminals from prosecution: If one breaks the law then he/she should be punished. The facilities also have a seedy history. The first for profit centers the 1980s and 90s in New York and Sydney were not concerned with their patron’s health and operated in a semi-legal status.
These positions also represent two different theories on how to respond to drug use. On the one hand is the no-tolerance approach where drug use is illegal and thus needs to be rooted out at all levels—the individual users, the supply network, and the growers. Incarceration rather than treatment is the focus. This is the approach of the War on Drugs, which has not been effective in reducing drug use. The second approach is a risk-reduction method where rather than stigmatizing use, it is discouraged but the conditions for safe use are made available. Thus, there are needle exchange programs to reduce transmission of diseases like HIV and Hepatitis C as well as methadone programs and shooting galleries.
The term “shooting gallery” itself is meant to be controversial, to attract attention and to stir conversation. Such facilities are also known as supervised injection sites/facilities and medically supervised injection centers. Shooting galleries represent an innovative approach that helps people who are addicted to drugs rather than demonizing or criminalizing them. These facilities address the needs of a vulnerable population, acknowledging that risk reduction is a step toward risk elimination and far better than zero tolerance tactics.
*Thanks to my HLTH 229 Bioethics class for bringing the Paris article to my attention.