‘Safe-injection site’ more likely for Philly, but big hurdles to clear

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Thousands of used needles litter the ground at a heroin encampment in Kensington. (Emma Lee/WHYY)

Thousands of used needles litter the ground at a heroin encampment in Kensington. (Emma Lee/WHYY)

Top Philadelphia officials are advocating that the city become the first in the U.S. to open a supervised injection site, where people suffering from heroin or opioid addiction could use the drugs under medical supervision.

But according to multiple city insiders close to the talks, the controversial proposal aimed at addressing the city’s deadly opioid crisis must first overcome resistance from other key players, including top city police officials and Councilwoman Maria Quiñones-Sánchez, whose district includes Kensington, considered the heart of the opioid epidemic.

“The first and most important condition for a successful safe-injection facility in Philadelphia is the political buy-in within Philadelphia,” said Scott Burris, who leads Temple University’s Center for Public Health and Law Research. “All the law enforcement, health, and community stakeholders have to agree that this is an important thing worth trying.”

In a plan described under the condition of anonymity since officials were not authorized to publicly discuss it, a new nonprofit would be established to host the site, which would be financed through private donors. One possible financial backer is philanthropist Max Tuttleman, who has indicated he wants to invest in strategies to combat the opioid epidemic. Tuttleman told WHYY that safe-injection sites are an “innovative approach” in preventing overdose deaths.

At the injection site, drug users would have access to clean needles while medical professionals stand by with the overdose-reversing drug Narcan, the brand name for the medication naloxone.

Cities like Seattle, San Francisco, and Ithaca, New York have taken steps to set up supervised injection sites, but none currently operates in the United States, although there are more than 100 such facilities around the world. Harm reduction advocates say the facilities reduce overdose deaths, as well as the likelihood of infections from HIV/AIDS and hepatitis C.

Importantly, advocates say, social service workers at the safe-injection sites could help those addicted to opioids receive detox or drug treatment services.

But if the experience in other American cities is any guide, the public backlash to the idea will be swift and mighty. Critics of safe-injection sites, including federal law enforcement officials, say they enable, and even “normalize,” illegal drug use.

Advocates of the sites have a different stance.

“Heroin use is already happening and taking place,” said Jen Bowles, who researched the opioid epidemic in Kensington as part of her doctoral dissertation at Drexel University. “If these interventions were failures, would they have spread around the world the way that they have and continued to persist?”

Opioid-related overdose deaths claimed 900 lives in Philadelphia in 2016. And officials expect the 2017 death total to be around 1,200, which is quadruple the number of people who were murdered in Philadelphia last year. Officials expect the synthetic drug fentanyl, which can be 50 times stronger than heroin, to be linked to many of those fatal overdoses.

“Supervised injection sites are a form of harm reduction,” said Philadelphia District Attorney Larry Krasner, who was sworn in this week. “They’ve been proven to be very important. The only way to get people to turn their lives around is to keep them alive long enough so they can do that, and we’re going to do that.”

City sources say if other stakeholders can get on board, Krasner would take a hands-off approach to Philadelphia’s safe-injection site, vowing to not launch criminal prosecutions of anyone associated with the site.

The Philadelphia Police Department declined an interview request for this story, but last year, Commissioner Richard Ross told Fox29 that having city police officers “present during the administration of an illegal narcotic would be problematic.”

Two city sources said Ross is still not fully convinced otherwise, even though others in the Mayor Jim Kenney and Krasner administrations are pushing ahead.

“A supervised injection site is now not a matter of if, but when,” one source said. “But we still need to figure out how not to have the police bum rush the place.”

A local police response may not be the most serious of the challenges facing a supervised injection site in Philadelphia.

President Trump has nominated local conservative attorney Bill McSwain to be the next U.S. Attorney for the Eastern District of Pennsylvania. McSwain is widely expected to be confirmed by the U.S. Senate, but the process may take another two months.

McSwain declined comment, but advocates of the safe-injection site say fears of a federal crackdown are real. Once confirmed, McSwain’s boss would be Attorney General Jeff Sessions, who on Thursday made moves to start enforcing federal marijuana laws in states that have legalized pot, reversing Obama-era guidance to step back from such actions. Previously, Sessions instructed federal prosecutors to pursue the harshest possible penalties against defendants convicted of drug crimes.

In Vermont, where state officials are exploring the idea of safe-injection sites, the new U.S. Attorney appointed by Trump recently issued a stern warning: if a safe-injection site opens, expect federal officials to prosecute those involved and for the facility’s assets to be seized.

“The proposed government-sanctioned sites would encourage and normalize heroin use, thereby increasing demand for opiates,” wrote Vermont U.S. Attorney Christina Nolan. “It is a crime, not only to use illicit narcotics, but to manage and maintain sites on which such drugs are used and distributed. Thus, exposure to criminal charges would arise for users and safe-injection facility (SIF) workers and overseers. The properties that host SIFs would also be subject to federal forfeiture.”

Though he would not elaborate, Pat Trainor, the Drug Enforcement Administration’s Philadelphia Field Division spokesman, said of Vermont’s position: “After reading the statement, the DEA concurs.”

Temple’s Burris served on the mayor’s opioid task force, which in May recommended that the city explore the idea of setting up a place where people can inject heroin under the watch of medical professionals.

He said the city should not reject the idea of a supervised injection site just because there are threats of a federal crackdown.

“Force the feds to take a position,” Burris said. “If they really want to arrest doctors and nurses and confiscate a building or equipment from a not-for-profit trying to save lives, let them say that, and let’s look at that in the clear light of day.”

Krasner, the city’s new maverick district attorney, is taking a similar position.

“If they’re opposed to it, then they can in their realm do whatever they want,” Krasner said of federal law enforcement. “But within my realm, we intend to work with capable harm-reduction folks who are trying to save lives and make the city better.”

Another major sticking point is what community would welcome the divisive facility.

Councilwoman Quiñones-Sánchez has publicly said before that she does not support a supervised injection site in her district, which includes Kensington, where officials and advocates hope to launch the program.

It is the same section of the city where city officials last summer began clearing out a decades-old notorious heroin encampment along the Conrail tracks known as “El Campamento,” where hundreds of thousands of used syringes piled high, becoming the visual scourge of the epidemic’s grip on Philadelphia.

Sources say absent support from Quiñones-Sánchez, a plan for a safe-injection site could be scuttled.

“Do we want to now send a message that you can come here and buy the cheapest drugs available and then actually have a place to use them?” she told the BBC last year.

Bowles, who also served on the mayor’s task force on opioids and is now completing post-doctoral research at the University of California in San Diego, said the not-in-my-backyard, or NIMBY, blowback is likely to be fierce, as it has been in a number of other American cities.

She said that comes despite studies that have shown that safe-injection sites help reduce fatal overdoses.

“What this boils down to at this point is a sociological debate regarding the most appropriate way to address drug use,” Bowles said.

“And it’s really difficult in the United States because we have a culture that’s so engrained with the war on drugs, that just says, ‘Drug use needs to stop,’” she said. “And there’s a tremendous fear that says, ‘If we create a space in which drug users can more safely consume drugs, that that may somehow be encouraging drug use,’ but that conflicts with the science that found that not to be true.”

When WHYY reached out to Quiñones-Sánchez about whether her position on a safe-injection site has changed, she did not respond to that specific question. But her statement did seem to indicate she was warming to the idea.

“I anxiously await any plans from the city for how it will comprehensively deal with the opioid crisis,” Quiñones-Sánchez wrote. “I welcome a process for engagement with stakeholders to consider how an injection site will work within a reformed continuum of care for folks dealing with their disease.”

Mayor Kenney said top city officials recently returned from visiting a supervised injection site in Vancouver, Canada. They also met with city officials in Seattle, who have committed $2 million to setting up a supervised injection site dubbed a “community health engagement location.” However, the Seattle proposal is still working through strong opposition from some parts of the community.

“I expect to make a decision soon about whether or not this is something that would help the problem we’re seeing here,” Kenney said.

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