If the Philadelphia nonprofit Safehouse successfully opens a sanctioned space where people can bring their own illegal drugs to inject under medical supervision, the site would be the first of its kind in the country. Sort of.
That’s because, for almost five years now, such a site has been operating illegally somewhere in the United States. The site’s operators won’t disclose its location, but a select group of researchers has been given access to data collected there since its opening in September 2014. One of those researchers released new data from the site at an international harm-reduction conference last week in Portugal.
According to epidemiologist Barrot Lambdin at RIT International, the site has six booths set up with needles and other equipment for people to inject drugs, along with a table where assisted injection is available. One staff person is always present. Lambdin said the site has hosted more than 9,000 injections among an estimated 540 individuals since it opened, preventing more than 8,400 public injections that would have otherwise occurred on the sidewalk, in parks, or in restaurant bathrooms. He said more than 85% of people using the site reported having to rush their shots when they were in public places.
“That has big implications for overdose risk, especially in the era of fentanyl and the changing drug supply,” said Lambdin. “People aren’t able to control how slowly or quickly they’re able to use as much when they’re in public spaces.”
The site’s staff and researchers also observed a five-fold increase in overdoses at the site from 2015 to 2019. In 2015, there was one overdose for every 1,000 injections. Now, there are six. That means that there is an overdose for every 167 injections at the site. During the same period, the rate of overdoses in which the powerful synthetic opioid fentanyl or other synthetic opioids were present increased by an average of 70% each year.
Despite the growing rate, Lambdin said, all the overdoses were prevented using naloxone, the opioid-overdose reversal drug, resulting in no overdose deaths on the site.
Lambdin’s research was presented at last week’s Harm Reduction International conference in Porto, but it has not been accepted in manuscript format yet by any research journals. Previous research on the injection site was published in 2017 in the American Journal of Preventive Medicine.
The unsanctioned nature of the injection site places limits on the full range of services it would otherwise offer, as well as its capacity to be evaluated by researchers. Its hours of operation are limited, and anyone coming into the space has to have been invited, presumably limiting the number of individuals who would otherwise know about and use the site.
Many proponents of supervised injection facilities tout their ability to connect those in active addiction to treatment. Lambdin said this site does not formally offer that linkage to care because doing so would risk exposing its location.
Lambdin acknowledged that many more comprehensive studies offer evidence to support the benefits of sanctioned injection facilities. Insite, the first such facility in North America, has been operating in Vancouver’s Downtown Eastside since 2003. This data, he said, is simply evidence that even in a limited, unsanctioned capacity, such a site could prevent overdose deaths in the United States.
“If you can take those injections that are occurring in those unsafe locations and move them into a safer environment, then that suggests strongly that we’re going to be able to reduce overdose death rates in the community,” he said. More than 70,000 people died of drug overdoses in the United States in 2017.
Lambdin is not collecting data on the difference the site has made in reducing infectious disease, or on the difference in neighborhood cleanliness, crime, or potential cost savings for the area surrounding it. Supporters point to those indicators as evidence that an intervention could not only decrease overdose deaths, but also improve overall public health and quality of life for nearby residents — a concern expressed repeatedly by residents of Kensington, where Philadelphia’s site has been proposed.
In Philadelphia, where more than 1,100 people died of drug overdoses last year, Safehouse board members have said they plan to open a site in 2019. The nonprofit has the support of the city, but Mayor Jim Kenney urged Safehouse to slow down in response to pushback against the group’s proposed site from its neighbors.
Though support and opposition have been expressed repeatedly from vocal stakeholders, overall public opinion on the matter is difficult to gauge. Two recent polls attempted to measure Philadelphia voters’ support for supervised injection facilities.
In one poll, conducted by the Philadelphia Inquirer, 67 percent of respondents opposed a designated space for safe injection, while 22 percent said they supported it. The other poll, conducted by Pew, found a more even response to its question: 50 percent supported the site and 44 percent did not. The margin for error was great enough that the difference was not statistically significant. Pew found that support was highest among those who have lived in Philadelphia 10 years or less and among 18- to 29-year-olds Those ages 50 to 64 and African Americans were least likely to support the idea.
Even if public opinion swung in the direction of supporting a site, Safehouse would still have to win in court. In February, federal prosecutors filed a lawsuit designed to block the site from opening.