Philadelphia, the city with the highest opiate death rate in the country, wants to become the first U.S. city to allow supervised drug injection sites for opiate addicts, city officials announced last week. Safe injection sites are locations where people can inject drugs under the supervision of a doctor or nurse who can administer an overdose antidote if necessary.
The city hopes to interest private-sector organizations in developing Comprehensive User Engagement Sites (CUES), which will not only provide safe injection sites, but also provide treatment and social services, wound care and access to sterile injection equipment and naloxone, in a walk-in setting.
Public Health Commissioner Thomas Farley, M.D. said the sites could be “a life-saving strategy and a pathway to treatment,” as one component of an overall strategy to fight the epidemic. “No one here condones or supports illegal drug use in any way,” Farley said. “We want people saddled with drug addiction to get help,” he said in a statement. More than 1,200 people fatally overdosed in Philadelphia in 2017, one-third more than 2016.
There are many unanswered questions about how the facilities might function, and how the city might overcome the legal hurdles that would prevent them. “We know from other centers that they save lives,” Farley said in a statement. “But it is complicated from a community perspective and it is complicated from a legal perspective.”
Mayor Jim Kenney said CUES will be part of a comprehensive strategy to address the opiate crisis. The Mayor’s Task Force to Combat the Opioid Epidemic is advising the city’s efforts to reduce opioid abuse, dependence and overdose in Philadelphia. Ajeenah Amir, a spokeswoman for the mayor, said the city plans to seek input from community members and groups to hear their concerns.
As part of their due diligence, last November city officials visited a supervised injection site in Vancouver, B.C., and Seattle, which has allocated $1.3 million to develop a facility. Since the Insite facility opened in 2003 in downtown Vancouver, more than 3.6 million people have injected drugs under supervision by nurses. More than 6,000 users have overdosed there but none have died.
“Our visits to Vancouver and Seattle really hit home that establishing CUES is just one piece of the puzzle to address the opioid crisis,” said Eva Gladstein, the city’s deputy managing director of health and human services. Our efforts to prevent addiction, help people access treatment, prevent overdoses in other ways, increase housing resources and address public safety concerns are already underway and must continue to grow and strengthen.”
City officials released a scientific review of studies of supervised injection facilities, which showed that the facilities reduce deaths from drug overdose; prevent HIV, hepatitis C, and other infections; and help get drug users into treatment.
The review also estimates that one site in Philadelphia could prevent up to 76 deaths from drug overdose each year, according to Main Line Health Center for Population Health Research at Lankenau Institute for Medical Research in Wynnewood, Pa., which conducted the review.
The task force’s other recommendations include:
- Increasing outreach and access to medication-assisted treatment;
- Developing “warm hand-offs” from emergency departments and the EMS system so that someone who has recently overdosed is connected as quickly as possible to treatment;
- Distributing the opioid overdose antidote naloxone to first responders, people who use drugs and community members;
- Providing “low-barrier” housing options that do not require sobriety;
- Working with residents to mitigate the quality of life issues that have arisen in neighborhoods close to the epicenter of the opioid epidemic.