The city of Philadelphia has become the latest U.S. municipality moving closer to establishing a supervised injection site where intravenous drug users can inject under the supervision of medical personnel who can revive them in case they overdose.
Some of the city’s top leaders, including the mayor, health commissioner and a recently-elected district attorney, are supporting the idea, which would not require city council approval to proceed. Like many other cities, Philadelphia has experienced an alarming spike in deaths due to opiate overdoses. The city had about 1,200 overdose deaths in 2017.
“There are many people who are hesitant to go into treatment, despite their addiction, and we don’t want them to die,” said Thomas Farley, M.D., Philadelphia’s health commissioner and co-chair of the city’s opioid task force. Supervised safe injection sites, he said, save lives by preventing overdose deaths and connecting people with treatment.
Brian Abernathy, Philadelphia’s first deputy managing director, said officials still have a lot of work ahead figuring out the details, such as how it will be funded, who will operate it and at what location. Rather than operating it as a city facility, officials want to contract with a provider of addiction treatment services who would manage the facility.
Connecting with potential operators or investors was the primary purpose of the city’s announcement in January, said Jose Benitez, executive director of Prevention Point Philadelphia, a large nonprofit needle exchange. “It’s early to talk about our involvement at this particular point,” he told NPR. “As the city officials said, there’s a lot to consider.”
Officials also stressed that, along with preventing fatalities, providing related health services, prevention information and a way to get willing users into treatment will also be essential.
At least one council member, Councilwoman Maria D. Quiñones-Sánchez, has expressed opposition to putting a safe injection site in her district, an inner city area which has been hit hard by the addiction epidemic. “This notion of letting a private developer or a private person come tell us how this could be done, we’re not paying for it, we’ll do wrap-around services, so much of that is just up in the air,” Quiñones-Sánchez said. “So why make an announcement with no answers?
There are also legal issues to consider such as, whether the city would face prosecution for violating federal law, or whether immunity could be provided. That is not likely, Abernathy said, although there are attorneys studying the issue to find a solution.
The city’s police commissioner, Richard Ross, told NPR he is uncertain how his department would approach enforcement of the relevant city ordinances and state statutes. “I don’t have a lot of answers,” he said. But District Attorney Larry Krasner said he doesn’t expect that his office will be prosecuting those responsible for operating the injection facility.
“What will we do? We will allow God’s work to go on,” Krasner said, citing state laws of justification that allow the committing of minor violations in the interest of preventing greater harms. “We will make sure that idealistic medical students don’t get busted for saving lives and that other people who are trying to stop the spread of disease don’t get busted.”
Krasner is a strong supporter of the supervised injection facility concept, and says it is badly needed to help reduce the toll of opiate overdoses in the city. “My biggest concern moving forward with harm reduction is that government takes forever,” he said. “When we have three or four people dying every day, nobody can afford to wait.”
Farley told NPR that city officials have been seeking guidance from the city of Vancouver, B.C., which has had supervised injection sites since 2003.
Mark Lysyshyn, M.D., a health officer at Vancouver’s Insite injection facility, told NPR that Insite has not had a fatal overdose in its 15 years of operation. Over the years, the facility has prevented as many as 120 fatal overdoses in a single week, he said.
“We hope that users will come to the site for all of their injections. And so people who are using heroin on a regular basis typically inject two to three times a day. And so they will often come to the facility for all those injections.”
Contrary to what some critics say, the supervised injection facilities are not enabling drug use, Lysyshyn said; they are “enabling people to stay alive.”