What we know, as of now, about injection sites.
By Gregg Snook, M.A., NCC, LPC
I am sure you have heard in the news about the controversy regarding the possible Safe Injection Site that is being planned in the Kensington section of Philadelphia. Depending on who you speak with, it may be a hot topic. I assume there is a lot of opinion associated with a safe injection site and not a lot of policy or approaches. It makes sense. The idea of having a place where drug use is encouraged seems completely counterproductive to the mission of a safe injection site. I think the emotion behind these positions and arguments made for them comes down to the difference between abstinence and harm reduction. It is my hope in this editorial that I can provide information rather than address the merits of either position.
The safe or “supervised” injection site that is currently being discussed to open in Philadelphia, called Safehouse, aims to provide an environment that allows for safe oversight of substance use in order to prevent overdose deaths and possibly connect users to treatments. According to the Safehouse website, the facility hopes to: encourage treatment, reduce harm, provide a sterile means of consumption, reverse overdoses, provide wound care and basic medical services, provide onsite education, provide referrals to mental health/substance abuse services, offer safe disposal of supplies, and offer medication assisted treatment.
The site explains how interested individuals would use the safe injection site. First, users are registered at the site, almost as though it was a gym membership. Then, members are able to be provided with sterile equipment, test strips to examine if there is fentanyl (a strong analgesic that often contributes to overdose) in their substances, and they are given a space to use their substances with supervision. Members are NOT provided with any drugs at the site. Employees of the site will NOT aid in the administration of any substances. The substance user is observed by staff in order to identify and prevent overdose in the user. Then, substances and equipment used during the process are disposed of. Users are offered wraparound services and basic medical support. This last part can seemingly include things ranging from a bandage or referral to supports or treatment.
The site stresses that it does not provide, sell, or supply any substances to users (users presumably, provide them on their own). Nor do they assist with the administration of any substances (they’re not helping any one shoot up or consume other substances).
Philadelphia is not the first place to consider having a safe injection site to address the issue of opioid use in the community.
The idea of a safe injection site is not necessarily new. It is reported that there are approximately 120 safe injection sites in Europe. It is also reported that there has been a safe injection site in Vancouver, Canada for about 10 years now. It is reported that no deaths have occurred at any of these sites, and overdose fatalities decreased by 35% in Vancouver after the site opened.
These numbers can be seen as a success regarding mortality rate. It is not unreasonable to discuss how people using these sites would recover or stop using drugs. It was reported that participation in detox services increased by 30% after the site opened in Vancouver. Approximately 52% of IV drug users (injecting drugs) sought treatment. These numbers seem to provide information regarding those who may seek out treatment to work towards possibly not using drugs further.
According to a recent report on National Public Radio (NPR; heard by me on WHYY), an article titled Researchers Released New Data on Secret, Illegally Operating Supervised Injection Site in the U.S. discusses part of the plans and factors for the site. This article discusses how the Philadelphia Inquirer ran a poll and found that 67% of those whom responded were opposed to the site and 22% supported it. Another poll referenced in the article, conducted by the Pew Foundation, reported that 50% were in support and 44% were opposed. The article also reported that more than 1,100 individuals died of drug overdoses last year in Philadelphia.
The community is also important to consider when thinking about the Safehouse injection site. Another NPR article, entitled Kensington Neighbors Angered by Potential Location of Supervised Injection Site, discusses information gathered from residents of the Kensington section of Philadelphia, as well as legal challenges to the site. Brian Abernathy, the director of city management, is reported to not be in support of the location. He is reported in this article and others to be interested in the legality of the site and the benefits to the city. Former Governor of Pennsylvania, Ed Rendell, is a backer of the site and supporter. Another city organizer was reported to have visited an injection site in Toronto, Canada and voiced concerns about the difference between the settings in Canada and the presumed site in residential Kensington. The concerns were regarding how well concerns about use could be contained in a residential area. It was also reported in the article that Pennsylvania State Attorney General, Josh Shapiro, favored another strategy to remove drug dealers from the area via legal involvement.
There is a legal contest to the site by the Attorney General’s office to the site. The legal contest seems to be a result of a war-on-drugs legislation from the 1980’s that extends penalties to any place of business that may be used in or housing the sale of drugs. In some of the reading, the law was summarized as saying that law enforcement can target things like raves or business that engage in the sale of drugs “out the back door” or in addition to another business in a place that was established under legal pretenses. The position of Managing Director Abernathy (seems to be investigating if this law, or laws like it, can apply to the safe injection site (WHYY article Federal Prosecutors Sue to Stop Nation’s First Planned ‘Supervised Injection Site’ in Philly). On a larger scale, the community organizers and the Attorney General seem to feel that the site would increase risks to the residents in the Kensington section of Philadelphia already living in what is often referred to as “the largest open-air drug market in the United States.”
The concerns of those who oppose the site seem to focus on a purported impact. It is reasonable to consider the difficulty in instituting something that may not be new in other countries, but is new in the United States. Below is a pie chart from the Philly.com website for crime in the time between April 12, 2019 and May 12, 2019. The section for “narcotic/drug law violations” was reported to number 140 offenses, accounting for 21.24% of crime in 30 days.
The proposed safe house site is reported to want to work in tandem with the community and local law enforcement, with the goal of decreasing drug-related crimes in the area. According to projections, the site is expected to save the city of Philadelphia approximately two million dollars, mostly in response costs to drug-related issues such as overdose and ambulance rides. Considering that reported crimes in Kensington also includes public intoxication, drug possession, drug paraphernalia charges, and the like, it would make sense that those crimes may decrease if they were contained in a safe house site (assuming the legal contest does not prevent it on the grounds of all use being illegal under federal law). Benefits could also manifest in other ways, such as lowering costs of responders to drug-related health issues (as Narcan is administered in the site), as well as preventing the sharing of needles with the safe observation and disposal that could occur at the site. When the needle exchanged opened in Philadelphia in the 1990’s, it was reported that the HIV rate of transmission via sharing of needles decreased by 95%.
It is also reported that there are conversations occurring in the state of New Jersey and the city of Pittsburgh regarding safe houses. It seem as though the discussion of safe injection sites may be occurring in different areas to address the problem of opiate use and resulting health issues.
As I stated above, I did not want to write this article with the goal of supporting either side of the safe injection site debate. Instead, I wanted to collect information from sources in order to more fully understand the intention of the site and understand the views of the opposition. It is reasonable to consider that the idea of an organized place that helped people get drugs and use them would be absurd. It is also understandable that individuals may feel differently regarding the intentions of the site based on their expectations of the problems it hopes to assess. This again brings us to the difference between abstinence and harm reduction. The position of abstinence based solutions attests to individuals ceasing their drug use entirely. The position of harm reduction asserts that addiction can be a complex issue that often results in relapse. Harm reduction asserts that having options for safety to be considered in someone’s addiction in order to prevent death. This in the hopes that their recovery (ceasing of using drugs in maladaptive and disruptive ways) can eventually be addressed through some kind of treatment. Some of the data from sites in other countries indicate that these sites can lead to individuals connecting with resources and support that would be easier to access due to them being at the site, being registered, and, therefore, available to those who can point them toward treatment options.
The issue seems to be in the planning stage for at least the past year. The legal contest occurred in February of 2019. There will be more to come as the community, site, and authorities consider the site moving forward. The desire of wanting to provide help for those who are using, as well as the concerns of those who are considering the ramifications of having a site in their community will also need to be addressed as time moves on.
To the readers, I would suggest, should you be interested, to continue to read about things that may come out regarding the Safehouse Injection site. This seems to be a complex issue with a lot of people concerned about the well-being of people in the community, as well as those who are struggling with the use of addictive substances. I hope this article was informative.
