Trap Houses vs. Safe Houses

Those of you familiar with the language of addiction will know that I am not comparing domiciles that fail building codes with those that do not.

A trap house refers to a drug den. An abandoned property where addicts go to buy and use drugs for days on end. Think squalor. Think bug infested mattresses. Think quiet desperation. Think death.

“There is one way into a trap house, and one way out.”

A safe house is also a place for drug use. However you can not buy or visibly take drugs within. But you are expected to be actively high when you visit. Inside you are given the opportunity to swap out dirty needles for clean. And you may ride out your high in an upright chair instead of slumped on a dirty street curb. But most importantly: in a safe house you will not die. Nurses are present to monitor breathing, administer narcan, and call ambulances.

A Boston safe house opened in April after receiving support from the medical community, those who care for the homeless, Mayor Walsh and Governor Baker. Safe houses, or “safe injection facilities,” already operate in Australia, Canada, Germany, the Netherlands, Switzerland and Spain.

Still the idea of ‘state sanctioned drug use’ sounds shocking. The medical community refers to this approach as “harm reduction.” (Certainly a less charged descriptor!)

The immediate goal is to curb the alarming uptick in deaths; especially among the young.   On a recent trip to a town office building I found the bathrooms locked. The secretary explained it was to “keep the addicts out.” My daughter’s former boyfriend overdosed in a Dunkin Donuts bathroom. Afterwards he chose Burger King stalls. The reason? He had just scored in the parking lot. The newspapers are full of stories of addicts being apprehended inside their own cars in public parking lots, under trees in local parks or tucked down public city alleyways. It is hard to understand an addicts sense of urgency. It can not be compared to the Friday night joy of buying a bottle of wine, bringing it home, opening it up to breathe, and then swirling it in the glass. There is a sense of immediacy that most of us will never know.

Therein lies the problem. What will prompt an addict to walk to a safe house to ride out their high when they score blocks or miles away? If curbing the number of deaths from opiates is the goal, then heroin users will have to be allowed to use their drugs in the safe house – or right outside. Death from heroin, or fentanyl-laced heroin, occurs almost immediately. The drug is potent enough to shut down breathing within the first few minutes.

Of course we can’t allow safe houses to become “shooting galleries.” Or can we? Sometimes it seems like the most humane option… especially when you witness first hand the places where addicts live. Even more so when you find your own child in them. I ultimately feared finding my daughter expired on a street corner, behind a dumpster, or in a motel. I didn’t want her last moments to be spent cold, unloved, hungry, or abused. It wasn’t an irrational fear… it was only a matter of time. I considered bringing her home, knowing she was not ready for change, but wanting her to have the warmth of her bed and food in her belly. I was ready to wave the white flag even if she was not.

Could a safe house have been that sort of place for my daughter?

But safe houses do not allow you to sleep in them. And they do not feed you. They are not shelters without rules, or over indulgent mommys. In the end they could not have allayed my fears.

The only other North American safe house (a true safe injection facility) exists in Quebec. A medical study by The Lancet showed that thousands of lives have been saved: overdoses stopped, the spread of HIV/Aids minimized, counseling and detox services accepted. It is working, despite the usual NIMBY complaints.

Hopefully lives will be saved here in Boston. There is nothing more upsetting than stepping over an addict on the wintery streets of Albany and Mass Ave and “continuing on your way.” Now at least you can lead them to a warm, comfortable room where a counselor can ask them if they want help. Can offer them water. Can look them in the eye and take their blood pressure. A small amount of decency can be provided.

Time will tell. My only hope is that we have some hard science around the outcomes. No more moralizing on the one hand, or fear based preventive measures on the other. Since 1980 addiction has been classified as a disease. To a certain extent it angers me that we have come to this. Would we be considering safe houses if we had provided better, more efficient, longterm, quality care earlier to this population? I don’t know. But I guess we have to start where we are. And I can’t help but embrace a concept I would never have considered years ago.

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