It all seemed so sure. Until, suddenly, it was DOA.
In late February, after a U.S. court finally cleared its way, the Philadelphia nonprofit Safehouse announced that it was on the brink of opening the nation’s first-ever legal safe-injection site—a place where drug users can inject in a supervised setting, where staffers can reverse overdose if it happens with the drug Narcan—in a health plaza in South Philly. The announcement came after years of efforts to open such a site—and with the support of the mayor and the health commissioner, who both cited the fact that the city has had roughly 3,500 overdose deaths the past three years.
But then, thousands of members of the surrounding community, claiming that they were being blindsided, rose up in a furious rally against the site outside the health plaza on a Sunday—and no sooner had the site been announced than the plaza said it was declining Safehouse’s lease ... and Safehouse said it was folding up its plans, for the time being.
Then, no sooner had that happened than the City Council swiftly started advancing a bill that would all but ban a safe-injection site anywhere in the city.
According to local public radio station WHYY, Safehouse vice president Ronda Goldfein said, “We’re going to take a pause, even though we are legally entitled to open.” She said that they had heard the community loud and clear and wanted to allow time for “meaningful conversations” about what a site in the neighborhood might mean.
On one hand, the news that a neighborhood shut down plans for a place for people to shoot heroin legally might not be so surprising. After all, it’s taken decades to amass even a baseline level of public acceptance for needle-exchange programs, those places—dating back to the start of the AIDS crisis—where drug users can go to access (but not use) clean needles to avoid getting HIV and hepatitis C. Despite mountains of research showing their efficacy, as recently as five years ago, during Indiana’s rural HIV outbreak, then-governor Mike Pence virtually had to have his arm twisted to start a limited needle-exchange program to keep the crisis from worsening.
On the other hand, two years ago, when TheBody last reported on efforts around the country to open safe-injection sites (sometimes called safe consumption sites, SCS, or even overdose prevention sites, OPS) to counter a national wave of overdose deaths, it appeared then that San Francisco was on the brink of opening the first one—and would soon likely be followed by Philadelphia and Seattle, then perhaps New York City and Baltimore.
Two years later, there is not one such legal, above-ground site in an American city, even as the latest Centers for Disease Control and Prevention statistics show that overdose deaths continue to be a major problem, especially in the West.
In San Francisco, where annual overdose deaths surpassed 300 in 2019, safe-injection site efforts have been stalled due to legal impositions. Such sites are illegal at the federal level, and Trump’s Department of Justice has said that it would prosecute safe-injection site operators, which is why the U.S. court clearance in Philly was such a big deal.
In late February, San Francisco mayor London Breed and supervisor Matt Haney announced legislation to permit nonprofits to open safe-injection sites, providing equivalent legal cover to the Philly court ruling. Meantime, the California legislature is once again trying to pass a bill that would also provide legal cover. But all this means that the first site in San Francisco would likely not open until next year.
In Seattle, no site is imminent, despite the support of the mayor, Jenny Durkan; a Washington state court ruling against efforts to block funding of such sites; and a city council that allocated $1.4 million for safe-injection sites two years ago. Jesse Rawlins, who heads the group Yes to Safe Consumption Sites, said that his coalition “remains super-energetic and really focused on implementing an SCS as soon as possible to address the overdose crisis”—O.D. deaths in Seattle surpassed 400 in 2018—”and increase access to drug users’ health care.”
But he added that the backlash that just happened in Philly has put the movement momentarily back on its heels. “One of the things we can do better in our community-engagement strategies is to treat [opponents] as humans with valid concerns. Then you’re able to have a meaningful dialogue and ask, ‘What are you really concerned and fearful about?’”
To those who answer that they don’t want active drug users in their neighborhood, “I would tell them that there already are drug users in their neighborhood, and we’re hoping to combat problematic drug use by bringing it inside.”
In New York State, a new entity called Research for a Safer New York has been incorporated by a group of agencies (New York City’s Housing Works, VOCAL-NY, St. Ann’s Corner of Harm Reduction, and Washington Heights CORNER Project, and Ithaca’s Southern Tier AIDS Program), not only to convince Gov. Andrew Cuomo and the state health commissioner to let them open a research pilot of safe-injection sites, but to insulate their individual agencies from financial damage should the federal government come after them if they do so.
In Ithaca, the liberal home of Cornell University and Ithaca College, the mayor, Svante Myrick, has been a longtime safe-injection site supporter, talking openly about addiction’s harm to his own family. “We’ve been able to do interesting things here, like start state-funded drug-user health hubs connected to our needle exchanges, where doctors and nurses treat people for hep C and do wound care and medical triage,” said John Barry, the executive director of Southern Tier AIDS Program.
“Unlike Safehouse in Philly, we own our own buildings, so we could potentially open up an SCS,” he continued, “even though, yes, given current local and federal New York State law, the local police would be in a position to arrest us if we opened it.” He said that their slog of getting buy-in from state lawmakers continued. “I think at one point [the support] is suddenly going to snap [into place],” he added.
He said that safe-injection site advocates had to continue trying to convince community members that sites are not only compassionate, but practical. “You need to show them how successful existing harm-reduction programs like needle exchanges have been at stopping disease, ER visits, and hospitalizations. Taxpayers need to hear that that can save them money. And also that it’s better having people inject in a clean and supervised space than overdosing in the bathroom of the local donut shop.”
And in Baltimore, with more than 1,700 overdose deaths in the first nine months of 2019 alone, the safe-injection site movement grinds along, with a new mayor (Jack Young) who at least is not vocally opposed to the idea of safe-injection sites the way the last mayor was, and a new city council president, Brandon Scott, who supports the idea as well as an informational public hearing (yet to be scheduled), after which the council would vote on an ordinance to allow such sites in the city.
On the state level in Maryland, bills authorizing safe-injection sites have come up for action in both chambers and expired year after year (one expired in the senate in March), according to Rajani Gudlavalleti, community organizing manager for the Baltimore Harm Reduction Coalition, which has been working to advance safe-injection sites in the city for a few years now.
“Over the years, we’ve increased the number of supporters and legislative cosponsors,” said Gudlavalleti, including Marilyn Mosby, the state’s attorney for Baltimore, “but many are scared of the political risk.” She said that at the latest senate hearing on the bill, “It was extremely rough, filled with so much vitriol and stigma against drug users.”
But she said that the bitter pushback has also inspired people in the movement, many of them current or former drug users themselves, some of whom have been incarcerated, to stick together and support one another. At the hearing, she said, state Sen. Delores Kelley, an opponent, said at one point, “Let’s be honest—there isn’t a person in this room who would allow an OPS to run on their block.”
After which, said Gudlavalleti, the 30-some overdose-prevention site supporters present—including Rev. Jim Muratore, a popular pastor from Hampden, the part of Baltimore made famous by filmmaker John Waters—all made a point of saying that they would be fine with an overdose-prevention site on their block.
Gudlavalleti said she thinks that, soon enough, safe-injection site proponents in the U.S. should do what their counterparts in Toronto and Vancouver did, which is simply to go ahead and set up safe-injection sites in tents in parks, defying the police. In those localities, police essentially looked the other way, and local and provincial lawmakers even threw financial support behind the sites, despite the fact that they were technically illegal under Canadian federal law.
It’s not clear that such a move would play out the same way in U.S. cities, but Gudlavalleti said that, at this point, with overdose deaths continuing, it’s worth the risk.
“It’s a form of civil disobedience,” she said. “Legislators are so afraid of public backlash, but the terror is all in their imagination. At this point, we just need to show them what this is.”
The past two summers, she said, safe-injection site activists have set up “mock” tent sites in public parks in areas with high overdose rates, as a way of educating the public about the sites. She said passersby have been receptive. “We tell them that an OPS is just what they’re looking at, and ask if they have suggestions to make it better.”
Data on Their Side
Much like the decade-long story with needle exchange, the safe-injection site battle seems to be one with phobias about drug users and drug use on one side and solid data showing effectiveness (without socially disruptive consequences) on the other. Safe-injection site advocates point to data from longstanding sites in Europe and Canada, particularly a 2011 Lancet study finding that a Vancouver site resulted in a 35% drop in overdose deaths in the vicinity of the site, compared to a roughly 9% drop elsewhere in the city.
Studies have also shown that the sites can lead people into drug treatment, don’t increase drug-related crime in the area, and actually bring drug users and their paraphernalia in off the surrounding streets.
According to Kassandra Frederique, who was recently made executive director of the Drug Policy Alliance, which advocates for decriminalization of drug use and harm-reduction approaches (such as needle exchange and safe-injection sites) to drug use–driven health crises, the safe-injection site movement in the U.S. is now in a sophomore phase, where nothing lies ahead but the slow, hard process of mobilizing buy-in, neighborhood by neighborhood—or even neighbor by neighbor.
“The initial novelty of the issue has worn off, and different movements are doing the hard work of building community infrastructure,” she said. “How do we have conversations in this moment? I think everyone is working to be clear that SISs are not a silver bullet but part of a comprehensive response” that also includes widespread training in how to administer overdose-prevention medication (Narcan) and access to drug treatment for those who want it.
And as for the deep fear that drives resistance in many communities, Frederique acknowledges that part of supporting safe-injection sites, for community leaders and lawmakers, requires having “the same political courage you need to stand up for a homeless shelter, a methadone clinic, or a syringe exchange. You can’t let fear dictate community health.”
She adds: “We never said this was going to be easy.”