'Life over abstinence': Colorado legislators again pursue supervised drug use centers
Published by Colorado Politics on Sept. 30, 2023.
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When Maggie Seldeen’s mother died from a heroin overdose, no one called 911.
At only 15 years old, overdoses were almost commonplace in Seldeen’s world, surrounded by addiction, drug dealing and domestic violence in the Roaring Fork Valley. Seldeen, an injection drug user herself at the time, did not know about naloxone, or Narcan, which reverses an opioid overdose. She did not know there was anything that could be done to save her mother’s life.
For the last three years, Seldeen has dedicated her life to informing others about overdose prevention. With her organization, High Rockies Harm Reduction, Seldeen travels around rural Colorado distributing Narcan, fentanyl test strips and clean syringes. She teaches everyone from drug users to high school students to jail staff about overdoses, disease prevention and how to care for people who use drugs.
“This work I do, I've been touched by it in every way,” Seldeen said. “We're so often volunteering and serving our friends and our family and our neighbors because we want to keep them alive. … People just need to know that this exists.”
These kinds of “harm reduction” organizations operate throughout Colorado, and now, they’re hoping to add another tool to their toolbox: "overdose prevention centers."
The centers, also known as "safe injection sites," are facilities where people can use illegal drugs under the supervision of medical professionals. They offer medical care, sterile drug equipment and connections to counseling and other treatment.
Colorado legislators are once again considering a bill to allow these centers in the state after a previous effort to do so failed in April.
The legislature's interim opioid committee released the first draft of the new bill on Monday. Members of the committee will vote on Oct. 30 whether to advance the bill to the Legislative Council Committee, where it will be introduced to the full state legislature for consideration in 2024.
“There are people who are not quite ready to start treatment, but they still need help,” said Rep. Chris deGruy Kennedy, D-Lakewood, committee chair and one of the legislators behind the bill draft. “If you keep them alive and keep them healthy, then you increase the chances that they finally stop using drugs and start treatment. And that's really the goal.”
The centers
Colorado legislators have debated overdose prevention centers since 2017, when an interim committee introduced a measure to allow a pilot site in Denver. That measure was quickly rejected in 2018 by a committee in the Republican-majority Senate. With Democrats now in control, a renewed effort passed the House earlier this year but died in a Senate committee when three Democrats voted against it.
The Denver City Council passed an ordinance authorizing a center way back in 2018, but they can’t establish the center unless a state law change allows municipalities to do so.
These centers have existed since 1986, with nearly 200 operating in 14 countries, according to the American Psychological Association. There are currently only two operating within the United States, both in New York City, though other cities, such as San Francisco, have previously had centers.
The centers have overseen millions of drug injections and thousands of overdoses, but there have been no overdose deaths reported in any of them around the world, according to the National Institutes of Health.
Despite this, the centers have met significant resistance from governments and public opinion, accounting for their slow spread over the last three decades. They are still federally illegal in the United States and critics view them as hurting surrounding communities and enabling drug abuse.
“My primary concern is what happens immediately outside the four walls,” said Greg Sadar, deputy chief of the Commerce City Police Department, while testifying on the subject in August. “I’m concerned that it might be a bit of a drain on resources because, while (officers) may not be responding to drug crimes in that immediate area, there’d be general disorder, quality of life issues."
Dr. Keith Humphreys, a Stanford University professor and leading drug policy researcher, said there is no evidence that the centers cause crime in surrounding areas.
“Certainly, some of them are in crime-ridden areas, but they were crime-ridden areas before the site opened up,” Humphreys said while testifying to legislators in August. “One study said the neighborhood reported an increase in crime. There’s one study that reports a decrease in crime. And a whole bunch of studies that report no effect. … The best bet is that there’s not actually a relationship there.”
Humphreys also dispelled a popular argument among proponents of the centers: that they increase the likelihood that drug users will seek treatment. Humphreys said studies that show users entering treatment at some point after using the centers show no “convincing evidence” that the former is caused by the latter.
"People who are seeking help and looking for a change in their life are going to use multiple services,” Humphreys said. “That tells you something about the people, but it doesn’t necessarily prove anything about the effect of the site, per se.”
Because of this, some opponents argue that the funding for overdose prevention centers would be better spent on funding treatment and other programs intended to stop drug use.
"My concern about safe injection sites is that they will be used as a place where folks will come and safely inject or smoke but won’t go into treatment and won’t get help,” said 17th Judicial District Attorney Brian Mason while testifying in August. “I think investing in treatment is more important than investing in safe injection sites.”
Mason said his district dismisses “a significant number” of drug possession cases for offenders who are willing to receive counseling, treatment and other services. Of those who complete the multi-month diversion program, 85% don’t return to the criminal justice system within three years. Mason said other district attorneys have told him they don’t have enough funding for such diversion programs.
Seldeen argued that relying solely on traditional treatment isn’t realistic.
Even when drug users want to enter treatment programs, in Seldeen’s experience, they have to pay thousands of dollars and wait weeks or months to get in, on top of missing work and having to find arrangements for family and pets. Then, if they successfully get clean while in that isolated environment, they return home to the same environment that caused them to turn to drugs in the first place, and more often than not, they relapse.
While some issues of treatment programs could be helped by additional funding, Seldeen said "harm reduction" methods, such these centers, provide a more “community focused solution.” They meet people dealing with substance abuse where they are and build a network of support around them, she said.
“We build supportive relationships with people to really try to have a holistic focus of recovery from mental health,” Seldeen said. “The goal being quality of life over abstinence.”
The bill
This latest legislative effort to allow overdose prevention centers is different than the one legislators rejected in April.
The new bill takes inspiration from Rhode Island, which passed a law to create a two-year pilot program allowing the centers in 2021, though the first site isn’t set to open until 2024. The Rhode Island policy includes more state oversight than Colorado’s bill last session, and was endorsed by the American Medical Association.
In addition to requiring local government approval to establish the centers, the new bill asks the state health department to set rules and regulations for the operations of the centers. These guidelines would be developed by the department’s executive director in collaboration with a nine-member committee, consisting of:
A person with a substance use disorder
A person working in overdose prevention
A person who has experienced a drug overdose or whose family member died from an overdose
A current or former law enforcement official
A representative of the Colorado Municipal League
A representative for the attorney general
A representative for a statewide medical society
A representative for a statewide hospital association
And a representative for the state chapter of a national society of addiction medicine
“We believe that by providing more state oversight, more robust state regulations where law enforcement voices are prominently featured, we're going to be able to find the right balance,” deGruy Kennedy said. “We’re going to be able to find a policy that can achieve what we know these facilities can do, which is save lives.”
Under the drafted bill, the centers would be permitted to operate in Colorado cities through Jan. 1, 2028.
To pass out of the interim opioid committee, the bill will have to gain the support of one of the deciding “no” votes against allowing overdose prevention centers last session: Sen. Kyle Mullica.
Mullica, D-Thornton, voted in support of drafting the bill in August, and is part of the group of legislators developing the draft. But while voting to allow the drafting, Mullica said there’s a “strong chance” he still won’t support the bill come October. If Mullica joins the committee’s four Republicans in voting against the bill, the vote will end in a 5-5 tie, which counts as a loss.
Mullica said he has many concerns about the bill, including how police would enforce drug possession laws surrounding the centers, what the state health regulations would look like, and why the pilot program would be four years instead of two like Rhode Island’s. But his primary concern is about the centers' efficacy in general.
“Will these be an effective way of helping people?” Mullica asked. “How many individuals would be impacted? ... Are we putting the resources in the best place where we can do the most good?”
Professor Humphreys said research shows the centers serve a very geographically limited group of clients, tending to only benefit people who hang out or live around the center: “It would be a pretty rare addicted person who would commute even 30 minutes with their drugs to go use them at a government-sponsored facility.”
This is especially a concern as Denver’s population is less dense than cities like New York, which utilize these centers, Mullica said.
An emergency room nurse himself, Mullica said he knows proponents of the centers want to save lives, but he doesn’t know if he agrees that the centers would save the most lives possible with the resources they'd require.
“I just want to make sure that what we're doing will have the best impacts,” Mullica said. “How are we going to help these people who truly need a lot of help? I want to continue having those conversations, even if they're tough, even if I'm skeptical. I'm trying to see if there is a way I could potentially get to a place of support.”
Mullica said he has not yet decided how he will vote on the bill and is keeping an open mind as the committee continues to listen to public testimony and adjust the bill draft.
If the bill fails in the interim committee, individual legislators can still introduce the bill themselves when the 2024 legislative session begins in January. But deGruy Kennedy said securing support from Mullica and the interim opioid committee would “help clear the path through the legislature next year.”
This effort comes as 1,799 people died from an overdose in Colorado last year, more than half of whom overdosed on fentanyl, according to state data. Colorado had 1,881 fatal overdoses in 2021 — a record high for the state and nearly double the number of overdose deaths just three years prior.
During a public hearing on the bill Wednesday, supporters urged legislators to do something to disrupt this trend.
“The alternative to safe use sites isn’t people not using,” said Jennifer Dillon with the Colorado Drug Policy Coalition, which is backing the bill. “If you oppose safe use, then you’re perpetuating unsafe use. And trauma and death are the result.”