I live in Baltimore and I think that safe consumption spaces of course are an important part of comprehensive services provided to drug users. I've been involved with some exciting organizing around this in Baltimore city. So it's important to note that like many places there are a number of consumption spaces in Baltimore, McDonald's bathrooms. As one of my friends who's a peer outreach says the higher end bathrooms or all of garden bathrooms. Of course a number of boarded up vacant housing because unfortunately there are a number of vacant houses throughout the city of Baltimore. These are places where people consume drugs at the current time. We recently did a study of 270 people who inject drugs, who were connected to the needle exchange in Baltimore City and we studied where people inject. Forty two percent of users are reporting having injected in the street and 43 percent said that the place that they most often used to inject are public and semi-public places which include abandoned buildings, shooting galleries, those are places where someone charges people to come in and inject. The street, parks, and public transportation. Public and semi-public injecting locations in our study as well as others had been associated with increased risk of being arrested, of experiencing a non-favored overdose and having an abscess or an infection at the injection site. So, this study as well as others point to the importance of having a safe space for people to inject drugs. This graph shows the total drug and alcohol related intoxication deaths in Maryland from 2007-2015. Baltimore metropolitan area is the red line and you can see it just has such incredibly significantly higher rates of death in the population compared to the other areas of Maryland. Baltimore city which is a bit smaller than the Baltimore metropolitan area, had a 40 percent increase in opioid related overdose deaths from 2015 to '16. In 2015, 393 people died of an opioid death and that rose to 673 in 2016. Baltimore city has a very old heroin market, it's been documented since the 60s and since that time, it's had a large number of people who inject drugs within. As a result there's been a number of studies that have been conducted through Johns Hopkins with people who inject drugs particularly in the age of HIV over the last 30 years. We've conducted several studies recently including the one that I just mentioned on public injection to add to the evidence of why it's important to establish a safe injection facility here in Baltimore specifically. In 2017, we published an article that examined the cost effectiveness of establishing an insight style safe injection facility in Baltimore city. A single site with 13 stations. We estimated the cost would be about 1.8 million for the facility with all of its associated services and it would result in a savings of 7.8 million per year. The slide indicates where the cost savings would occur in HIV cases averted, hepatitis C infections averted, hospital days averted, overdose deaths, overdose related, ambulance calls et cetera. You may think averting six overdose deaths a year is small but given the number of injections that occur in Baltimore city and what could occur in a room with 13 boost we estimate that only two percent of all injections would occur in the facility, a single facility and that would result in six lives saved. Set in another way for every dollar that's spent there's a $4.35 savings. Of course all of these estimates are mathematically modeled but based on real data from Baltimore city, so we think that this presents a compelling case that even if you don't believe in the public health or the human rights aspects of why such a facility would be important, it's fiscally smart. Since the summer of 2016, there's been activity in Baltimore city to explore the feasibility of establishing these spaces. A group of us, I was one of the people that organized with a few clinicians and someone that works in the world of drug treatment and harm reduction started to convene with people, funders, the health department, people from the treatment community, politicians, to start to begin to talk about what this could look like in Baltimore. Began to meet with various representatives listed on the first bullet of the slide to talk about what a safe consumption space could look like in Baltimore city, and what it would take to get one established. We were lucky enough to receive funding from the Drug Policy Alliance and the Open Society Institute to hire a community organizer to start to organize around this issue. Something that was really important in our mind about her previous work and how Baltimore differs than some of the cities that we've mentioned where organizing is happening around safe consumption spaces, is that Baltimore really needs to frame this kind of facility in a racial justice framework. A big part of the work of this community organizer is to listen to community members bring various organizations and entities together who have concern about the effects of not only the overdose epidemic and the heroin epidemic. How safe consumption spaces are truly a response to the deleterious effects of the war on drugs to communities within Baltimore city. The war on drugs is so disproportionately affected in the city African-American males, families, children, we see this type of space as an important response to the negative impact from the war on drugs to the negative impact of racial profiling, arresting people off the corners just because they're standing on the corners, disproportionate sentencing for crack compared to powder cocaine et cetera. At the current time the Coalition which is called the Bridges Coalition began to engaged in community listening and educational programs so having educational programs in various parts of the city and also talking to the community to hear their concerns about the war on drugs and its effects, and is in the process of working with various constituents in order to gain multifaceted support to move this idea forward. So in conclusion, it's important to say that this problem of elevated rates of opioid related overdose is not going away. It's really important for us to embrace all of the tools in the toolbox we have to help people be safe in their active drug use and to get them to a point where they're ready to quit using drugs. The evidence for safe consumption spaces are clear it's been extremely well studied. There over 50 published studies from inside alone about the benefits and positive outcomes associated with the space. I would say that in the US it really is only a matter of time that one of these facilities will be happening. Hopefully, by the time some of you are listening to this lecture you will have already heard that one of these exists in the US. The framing is really, really important particularly in a city like Baltimore. This kind of facility needs to be talked about. So many communities have bad experiences of methadone clinics and private drug treatment programs moving into their neighborhoods not being good neighbors. People feel that they bring drug users into neighborhoods. We think it's really important to talk about the fact that safe injection, safe consumption facilities are actually meant to remove people from the streets so that people aren't sending their kids to school and they're worried about them coming into contact with a needle, or seeing people inject drugs, and that it really is an important aspect of humanely responding to drug epidemics. It's a positive solution compared to so many negative things that were done in the name of the war on drugs. Thank you for listening and I hope that this presentation opens your mind to the importance of both advocacy and evidence in furthering public health.
