Switzerland, for example, opened its first overdose prevention site in 1986. Recognizing that having people remain reliant on getting their drugs illegally was not optimal, it began piloting heroin prescriptions in 1992. Between the early 1990s and the mid- to late 2000s, overdose death rates were cut in half, and the number of people starting heroin use fell 80 percent, with public injections almost entirely eliminated. Overdose rates have stayed far below the 1990s peak since then.
Meanwhile, the more time patients spent receiving prescribed heroin, the more likely it was that they switched to abstinence or more traditional medication treatment, which means that rather than enabling longer periods of addiction, providing safer drugs and medically supervised places to use them both extends lives and encourages abstinence.
When skeptics imagine overdose prevention sites like OnPoint’s, they seem to picture the equivalent of keg parties or drug orgies, with people who inject drugs being egged on to “shoot, shoot, shoot” as if they were chugging alcohol.
In reality, the centers are calm and homey, welcoming people who are typically unwelcome elsewhere. And this environment is critical to fostering more effective recovery from addiction. “You are worthless unless you quit,” is the message people with addiction are given every day, nearly everywhere they go. Many are suspicious of treatment because of bad or even traumatic experiences with medical providers and prior attempts at rehab. They don’t trust that being told “you need treatment” means anything other than rejection and humiliating, potentially futile therapy.
In contrast, accepting people as they are builds connection and helps them to feel valued, which is a far more potent way to spur recovery. “Kindness is a very powerful reinforcer,” said Dr. Volkow, referring to a positive factor that can motivate learning and change. “You can get so much more by being kind with people than by being punitive,” she said, adding that the stress of isolation, incarceration and ostracism is more likely to drive bingeing, not quitting, because drug taking is often driven by a need to feel socially connected.