ABSTRACT
[...]the number of annual overdose deaths increased by 37% to more than 96,000 from 2020 to 2021.1,2 Overdose deaths are so high that the U.S. Department of Health and Human Services has introduced harm reduction initiatives that have historically been controversial: needle exchange programs to slow the spread of bloodborne diseases and provision of fentanyl test strips to help people who inject drugs identify contaminated street drugs.3 However, the U.S. Department of Health and Human Services stopped short of supporting supervised injection sites, a harm reduction strategy that has been proven to save lives in other countries.4 Supervised injection sites have been legally operating in Europe, Canada, and Australia since 1986.4 With the 2021 opening of the nation's first supervised injection sites in New York City and a growing movement advocating for expanding them to other U.S. cities, family physicians should be knowledgeable about the potential impacts of these sites.5,6 These facilities are over-seen by health care personnel who provide sterile injection supplies, counseling on safe injection techniques, emergency care in the event of an overdose, primary medical care, and referrals to appropriate social and addiction services.7 The personnel in the facilities are able to offer services to people who would otherwise inject drugs in public spaces.8 Unfortunately, because of legal considerations, the U.S. Justice Department has fought to prevent the opening of supervised injection sites despite evidence that they lower death rates and decrease disease transmission.3 Supervised injection sites improve health outcomes. The American Academy of Family Physicians issued a policy statement supporting these facilities.15 Although federal support is lacking, individual cities and states are leading the efforts to increase harm reduction strategies to prevent overdose deaths. In 2021, Rhode Island became the first state to legalize supervised injection sites, with locations to be decided in 2022.16 Family physicians have several opportunities to promote this needed change, including speaking in support of the sites at town halls, working with local advocacy groups to promote efforts to create the sites, and working with physician organizations such as the American Academy of Family Physicians to develop supportive policies.