Understanding Morals Is Key to Accepting Safe Injection Sites

Understanding Morals Is Key to Accepting Safe Injection Sites

The United States is in the midst of a long-running opioid epidemic that has killed nearly one million people since 1999 and cost over $1trillion in health care, law enforcement and social services since 2001. ,Safe injection sites, also known as supervised injecting sites or opioid prevention centers, are places where anyone who uses illegal opioids, such as heroin, without fear of prosecution or spreading disease. These sites don’t provide drugs, they don’t degrade neighborhoods, and they don’t promote crime. However, there has been strong opposition to their opening across the country.

The first program in the U.S. opened in New York in November 2021, inside existing medical facilities offering multiple services. By August 2022, Onsite NY’s centers had intervened in over 390 overdoses, preventing injury and death.

Internationally, safe injection sites have reduced the risk of overdose, death and the spread of infectious diseases, increased public safety and decreased public drug injection or nuisance. Sites connect people to medical care and expedite social services that help them quit smoking. They also aim to reduce stigma that can often prevent people from seeking treatment.

Despite the efforts of advocates to promote “opioid prevention centres”, it’s been difficult to get widespread support for these programs. In one national study in 2018, only 29 percent of Americans supported legalization of safe injection sites.

How can we get support?

Proponents of safe injection sites can employ common techniques of persuasion, which require some form of understanding and acknowledgement why people oppose them. Speakers can build credibility by acknowledging and understanding the other side of the issue. Although this may seem like an easy task, it can often be difficult to identify people’s true fears and the true nature of their opposition. This is where the little-known theory of moral foundations theory comes in.

Moral foundations theory–which says several universal values underlie how humans determine what they believe is right and wrong–helps to explain, and even predict, the strong opposition to safe injection sites, despite robust evidence for their success. The theory has five lenses: care for others; fairness; authority; purity; liberty. The opposition to safe injections sites is more about the first four lenses than liberty. To better understand how the overall theory applies, consider this basic statement, which rests on the moral value of harm versus care: people harm themselves through substance use, but safe injection sites allow others to care for them.

The theory attempts to explain how people weigh fundamental value against each other, which ultimately determines whether they support or disagree. There is precedent for using moral foundations theory in understanding a social dilemma. In a recent paper in the journal American Psychologist, researchers found that moral values accurately predicted COVID-19 vaccination rates in counties across the U.S. Individuals who value fairness and loyalty to their group were more likely than others to be vaccinated. However, those who are concerned about purity and morality were less likely to be vaccinated.

As in the case with vaccination status, we can use the moral values to pinpoint the main objections to safe injection sites. To increase support for sites we must be able speak to and refute the counterarguments that are associated with prioritizing other moral values than care for others. These include fairness, authority, and purity.

When federal funding is at stake, the moral value and fairness of fairness often rises up to the top. Safe injection sites opponents argue that people who use substances are unfairly receiving free services such as clean needles, drug testing, and medical supervision. They claim that taxpayers would be subsidizing illegal drug use. Safe injection sites are more affordable for American taxpayers than allowing injectable drug use to continue untreated and addressed. Sites are estimated to save millions over time, with New York City estimating $7 million in annual savings across four proposed sites.

There is also the question of authority. There is not consensus as to who is the primary authority on substance use: the criminal justice system or the health care system. The war on drugs has historically made the criminal justice system the dominant authority on illicit drug usage. This is changing. We are learning more about the biological and psychological basis of addiction, the rising costs of incarceration and the disproportionate damage draconian drug laws cause to minority populations. Health care is emerging as the most well-equipped system and central authority to manage the many mental and physical conditions that people who use injection drugs. It is important to note that safe injection sites don’t allow drug use to be obfuscated by the criminal justice system. Instead, they seek to designate a new authority: medical professionals.

Opponents place great importance on purity and drug use is a moral failing and self-contamination of the body and spirit. But research shows that substance use disorder is a chronically relapsing brain disease connected to inherited genetic factors.

There are other ways that purity can be viewed as a moral value. Even though objective data on safe injection sites disproves these fears, there are still concerns about increased crime, strangers, and litter. These sites, especially those that are built into existing medical facilities, give local residents private and secure places to manage their diseases, instead public places like parks.

By understanding the moral lens through that safe injection sites are viewed, we can identify reservations as well as opportunities for cooperation to provide this vital form of healthcare. Onsite NYC is funded by private philanthropy despite its successes. These programs have been denied funding by federal, state, and city officials across the nation. In August, California Governor Gavin Newsom vetoed legislation that would have allowed opioid prevention centers in some cities.

Although safe injection sites might seem counterintuitive at first, they provide safe spaces for people with substance abuse challenges to access treatment and recovery resources in an environment that is compassionate, nonjudgmental and effective. Understanding moral values can help prevent us from ignoring or denying the reservations of the other side. This is a crucial component in gaining support. We can bridge political divides by opening up dialogue about safe injection sites and the values that make them acceptable. This will allow us to make these sites more widely available to save lives.

This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.


    Alexandra Plante is a Director at the National Council for Mental Wellbeing, specializing in substance use disorder initiatives, and works alongside the United Nations Office of Drug Control and Crime (UNODC) on unethical practices in substance use disorder treatment and recovery. She has previously worked as a consultant for U.S. federal agencies, state policymakers, international agencies, as well as private entities like Google. Her writing has been featured by outlets such as Psychology Today, Harvard Health Publications, and The Fix. She holds a Master’s degree in Quantitative Research in Communications. in Quantitative Research in Communications, and previously served as a Director at the Massachusetts General Hospital and Harvard Medical School – Recovery Resear

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