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Medically Supervised Injecting Facilities: An Acceptable Tool to Reduce Drug Related Deaths?

In 2023, there were 1,197 suspected drug deaths in Scotland. This is  by far the highest rate of drug related deaths in Europe. Around the turn of the millennium, I was living in the Franciscan friary in Craigmillar in Edinburgh. This is an area when drug abuse was prevalent and at that time abandoned tenement flats were being used as shooting galleries by people injecting drugs, mostly heroin. I remember at that time checking the drugs death figures for Scotland. It was not long after the Good Friday agreement had been signed and I realised that the number of drugs deaths in Scotland that year was slightly higher than the average number of violent deaths per year in Northern Ireland during the troubles. It occurred to me that if we put the same level of resources into dealing with drug problems in Scotland as the government had put into dealing with paramilitary violence in Ireland, then maybe we could reduce the number of people dying from drug overdoses in Scotland.

Regrettably, that level of resources was never allocated to addressing drug problems in Scotland. Now, almost twenty-five years later, drugs deaths are ten times what they were at the turn of the millennium. One suggestion to help reduce drugs deaths is the introduction of medically supervised injecting facilities (MSIFs) in Scotland. These are facilities in which people can inject illicit drugs that they have acquired elsewhere, in a clean environment that is relatively safe. There are specialist healthcare professionals on site to deal with medical emergencies and to ensure that injecting is done in the least dangerous manner. Their aim is to reduce the incidence and prevalence of disease and death among people who inject drugs (PWID) and improve the public health and reduce the public order problems associated with injecting illegal drugs in public places.

In 2024, after years of legal impasse, the UK’s first MSIF – described as a Safer Drug Consumption Facility – will open in Glasgow. The Scottish bishops have not made any statement on the proposed MSIF. However, several Church of Scotland ministers, including a former moderator and the national police chaplain, have expressed support along with at least one senior Scottish policer. Should Catholic healthcare professionals be working in this type of facility, and should the Scottish Catholic Bishops encourage the provision of this service?

The provision of MSIFs is a morally contentious issue that divides opinion in the Roman Catholic Church principally because of the inherent moral ambiguity involved in cooperation with the morally illicit practice of injecting drugs such as heroin. While some harm reduction services such as needle exchanges have been provided by Catholic healthcare organisations, the provision of MSIFs continues to be controversial. Indeed, members of the hierarchy such as Archbishop of Sydney, Anthony Fisher OP and former Archbishop of Philadelphia Charles Chaput OFMCap, and Catholic commentators such as Steven Bozza and Jeffrey Berger MD, reject MSIFs as misguided and immoral.

In 1999 the Sisters of Charity Health Service announced a plan to set up an MSIF in St. Vincent’s Hospital in Sydney, in response to a request from the New South Wales Health Minister. The proposal was seen by the sisters as a continuation of the work that they had been doing since they first arrived in Australia. The sisters’ first task in Australia was to look after the women incarcerated in Parramatta Female Factory, most of whom were convicts who had been transported to the colony of New South Wales. According to Dr Tina Clifton, Chief Executive of the Sisters of Charity Health Service,  the situation faced by the women in the Female Factory and those using illicit drugs at the end of the twentieth century were similar. Both groups were lawbreakers and outcasts and both groups were being denied their dignity. The sisters took up the challenge to treat the convict women with compassion in the nineteenth century and at the end of the twentieth century, they were aiming to take up the challenge of treating society’s outcasts with compassion by providing an MSIF. The experience of the sisters in working with marginalised groups in this neighbourhood and their expertise in HIV and addiction treatment, were the main reasons that the sisters became involved. The proposal provoked a mix of reactions. The Conference of Leaders of Religious Institutes and Catholic Health Australia were among  many that  voiced support. Others believed Catholics, especially nuns, should not have anything to do with something morally wrong, such as drug abuse. Having provoked both praise and criticism, the proposal was referred to the CDF by the then Archbishop of Sydney. The CDF determined that it was not acceptable for a Catholic healthcare institution to operate an MSIF. The response was based almost entirely on the principle of cooperation in evil. In my opinion, the decision was flawed.

In April 2017, the Canadian Conference of Catholic Bishops published a statement on Canada’s Opiate Crisis and Drug Addiction (CCCB, 2017), which recognised the complexity of addiction and that there are no simple solutions to this problem. The Canadian bishops cautiously accepted the benefits of MSIFs but warned that on their own, MSIFs do not address the deeper problems of addiction and so should not become the centrepiece of any drug strategy. The Canadian bishops’ statement contrasts significantly with the views of Archbishop Chaput. In October 2019, when a federal court  ruled that a safe injection facility could be established in Philadelphia, Archbishop Chaput described the decision as saddening and as offering a dose of despair.

The Franciscan friars at Merchants Quay in Dublin have been tending to the needs of the poor on the south bank of the Liffey for over fifty years. Since the 1980s they have been looking after people with HIV and people with addictions. In the early 1990s, they became the first NGO to run a needle exchange in Ireland. Although this attracted some controversy and the friar running the needle exchange was reported to the Papal Nuncio to Ireland, it was never publicly condemned as morally unacceptable by the Roman Catholic Church authorities. In February 2018, the Irish Health Service Executive announced Merchants Quay Ireland as the preferred bidder to operate the first MSIF in Ireland on an eighteen-month trial basis. Despite government support, the establishment of the MSIF has encountered multiple legal and planning objections so, six years later, the Franciscan facility is still not operational. However, I have not been able to find any objections from the Church authorities or any objections made for theological or moral reasons.

Should Catholic healthcare professionals be involved in setting up and running the Safer Drug Consumption Facility in Glasgow? I believe they should, for several reasons. Despite the decision of the CDF in 1999, there is ample evidence that MSIFs are morally acceptable within certain conditions. They are not just morally permissible but morally desirable, partly because they are in harmony with the preferential option for the poor. There is no doubt that the provision of an MSIF involves cooperation in evil. However, this cooperation is justified. The use of an MSIF by a person who injects drugs may show some assumption of responsibility and could indicate that they are working to reduce the harm caused by their illicit drug injecting. This can be seen as a step in the right direction and an opportunity for growth. The provision of an MSIF can be understood not just as a matter of moral compromise but as a positive opportunity for both the clinician and the patient to develop the moral virtues of patience and hope.

The provision of MSIFs is not a solution to the current drug problem in Scotland, but it is one tool that can help to reduce the deaths and diseases linked to illicit drug injecting. I submit that any Catholic healthcare professional who feels called to work in an MSIF should do so and I call on the Bishops of Scotland to support this initiative.

References

Bozza, S. Berger, J. 2020. “Safe Injection Sites: A Moral Reflection” The Linacre Quarterly 87 (1): 85-93 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016435/

Canadian Conference of Catholic Bishops 2017. Statement on Canada’s Opioid Crisis and Drug Addiction Ottawa: Canadian Conference of Catholic Bishops https://www.cccb.ca/letter/statement-canadas-opioid-crisis-drug-addiction/

Chaput, C. J. 2019. “Safe injection sites: A dose of despair” Catholic Philly.com https://archphila.org/archbishop-chaputs-weekly-column-safe-injection-sites-a-dose-of-despair/

Clifton, T. 1999. “Why we accepted this challenge” Bioethics Outlook 10(3): 2-3 https://www.acu.edu.au/-/media/feature/pagecontent/richtext/about-acu/institutes-academies-and-centres/plunkett-centre-for-ethics/_docs/bioethics-outlook/vol10no3september1999.pdf?la=en&hash=6B2B0D814AF0F99C4A76AD60F2FF2503&hash=6B2B0D814AF0F99C4A76AD60F2FF2503

Fisher, A. 1999. “Why some people are uneasy about injecting rooms” Bioethics Outlook10(3):11-16. https://www.acu.edu.au/-/media/feature/pagecontent/richtext/about-acu/institutes-academies-and-centres/plunkett-centre-for-ethics/_docs/bioethics-outlook/vol10no3september1999.pdf?la=en&hash=6B2B0D814AF0F99C4A76AD60F2FF2503&hash=6B2B0D814AF0F99C4A76AD60F2FF2503