Oregon opioid panelists talk safe injection sites, overdose reduction strategies with former White House drug czar

A comprehensive approach to addressing the opioid crisis should encompass safe injection sites, former White House drug czar Michael Botticelli said during a discussion in Portland Friday at Central City Concern.

"If you wait until they have an overdose, it's too late," said Botticelli, who served in the Obama White House and is now the executive director of Boston Medical Center's Grayken Center for Addiction Medicine. "We need to think about things like expanding needle exchange programs."

The term "safe injection site" receives low public support, he said. Public support rises when these sites are referred to as "overdose prevention sites," he said.

Whatever they're called, the idea is gaining currency. An editorial in the New York Times on Sunday argued for supervised drug consumption sites, where trained staff would provide clean needles and administer the antidote naloxone for overdoses and offer long-term treatment options. Seattle and San Francisco are taking steps to open such sites.

The idea was one of many Botticelli raised during the discussion, hosted by the Oregon Coalition for the Responsible Use of Meds, a service of Lines for Life.

Botticelli served as former President Barack Obama's director of National Drug Control Policy. Other participants included Lines for Life CEO Dwight Holton; Sen. Ron Wyden, a Portland Democrat; U.S. Rep. Suzanne Bonamici, a Beaverton Democrat; Dr. Rachel Solotaroff, president and CEO of Central City Concern, which provides health care, addictions services and housing in Portland; and Dr. Andy Mendenhall, senior medical director at CCC.

The discussion focused on a variety of root causes and solutions to substance use disorders, which afflict one in 10 Oregonians.

"Many (people living with the disorder) are individuals whose basic needs aren't being met, and that includes housing," Solotaroff said. "When we talk about substance use disorders, we need to think about other factors. It's complex but not unsolvable."

Requiring doctors to register with and consult the Prescription Drug Monitoring Program database every time they write a prescription is also key, as is providing medication-assisted treatment, such as methadone and buprenorphine, Botticelli said.

"We can decrease the risk of overdose death if they get on a medication," he said. "I hear too much divisiveness about abstinence vs. medication-assisted treatment. It's not either-or. It's both."

Solotaroff cautioned against putting too much stock in the medication-assisted treatment approach.

"I want to make sure we don't prescribe ourselves into a corner and think we can medicalize our way out of it," she said. "I wouldn't want to narrow options and eliminate choice."

While much of the discussion focused on upstream services to prevent substance use disorders in the first place, harm reduction was a recurring theme.

Haven Wheelock, program coordinator for the Outside In needle exchange program in downtown Portland, said she lost 17 clients in recent months.

"People I knew and cared about are no longer with us," Wheelock told the panelists. "Yes, we need to look at prevention, but we need to keep people alive. We need supportive environments. We create those in harm reduction services. Upstream is great, but we are literally in a crisis where people are dying, and that's not okay."