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Supervised Opioid Injection Facility

The nonprofit Safehouse is currently in a legal battle to open an opioid injection facility in Philadelphia.

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They hope to provide people who use injectable opioids with a safe place and the proper tools to inject drugs, as well as resources to escape drug abuse and overcome related issues.

Though some evidence suggests these facilities tend to be safer for users without encouraging additional drug use or crime, there is much controversy surrounding their place in communities.

Supervised Opioid Injection Facility in Philadelphia

In the face of the opioid epidemic in the United States, rates of opioid overdose deaths are rising, and abuse rates are not yet under control. Many states are beginning to look at more radical solutions to at least stem the number of deaths caused by opioid abuse.

It is within this context that a controversial idea has been proposed by Safehouse. This nonprofit intends to set up a safe injection site in Philadelphia, PA, where a number of services will be offered to keep people who choose to abuse opioids, like heroin and fentanyl, significantly safer than if they used these drugs elsewhere.

Per Safehouse’s model:

  • They will provide a medically supervised consumption room. This room will provide safe, sterile equipment (notably needles), fentanyl test strips (which are often used to check if a drug is what a dealer claimed it is), safe disposal equipment, and (perhaps most notably) the on-site ability to reverse overdoses and provide emergency care.
  • There will then be a medically supervised observation room. Here, users can be monitored, offered a variety of services, and the chance to meet with specialists. Again, emergency care can be provided if it is needed.

It should be noted that this facility is not purely intended to be a place where people can safely use drugs. The intention is to offer medical services that can treat wounds, provide counseling, test for things like HIV, and offer referrals to primary care physicians.

The facility will also offer referrals to other services people with drug abuse may need, such as social services, legal services, and housing opportunities. The idea behind the model Safehouse offers is to provide a safe place for people who abuse drugs while also giving them easier access to resources to escape addiction and poverty.

Safehouse has no intention to provide any illegal drugs, nor could it justifiably do so under U.S. law. The organization says they want to provide a safer place for people who use drugs without actually encouraging or fully endorsing drug use.

Legal Opposition

The federal government is in opposition to this idea, and the Justice Department has sued Philadelphia in an attempt to block it.

William M. McSwain (R), the U.S. attorney for the Eastern District of Pennsylvania, is a key lawyer for the opposition. His primary argument is a supervised injection facility will violate laws aimed at crack houses, which make it illegal to knowingly run a place where a proprietor knows illegal drugs will be used.

McSwain has been highly critical of the idea in general, claiming relevant medical research into things like safe injection facilities will not necessarily apply in the case of Safehouse’s Philadelphia facility.

In a written statement released on February 6, McSwain referred to Safehouse’s proposed facility as a “deadly drug injection site.” While he acknowledges that he believes the organization has good intentions, he insists that what they are doing is categorically illegal. He is also critical of their seemingly open defiance of the law. He claims they have the support of almost no legal power in Philadelphia.

McSwain is notably correct in that many Philadelphia lawmakers and authorities are uncomfortable with or completely against the idea. Governor Tom Wolf (D) echoes similar concerns that the facility is against the same federal laws McSwain cited.

Despite these harsh criticisms, Safehouse recently won the initial lawsuit. U.S. District Judge Gerald A. McHugh was of the view that the proposed facility was not at all what the laws in question had in mind when aiming to ban crack houses, and that Safehouse does not have “the objective of facilitating drug use.”

The core of this argument is more or less that Safehouse intends only to keep people who use drugs safe and prevent them from dying of overdose, not to willfully encourage or facilitate drug use. This distinction is legally important due to the wording of the laws in question.

Winning this case does not completely pave the way to the facility being opened, however. Both Safehouse and the Justice Department are going to be in a legal back and forth for some time, with Safehouse acknowledging this and not immediately moving forward, out of caution and legal prudence.

General Criticisms of Safe Injection Facilities

Supervised injection sites have tended to lack the budget for comprehensive services and high-level evaluation in the past. One criticism is that this could lead to facilities not being able to fully provide in the way intended. Another is that the data may be more skewed than assumed. More expensive, comprehensive research would certainly be a benefit regardless.

NPR highlighted a review of studies on the subject of safe injection facilities that claimed evidence of their benefits was not as strong as thought, but also notes the review has since been retracted (with the author’s consent). It was notably criticized for methodological weaknesses, even before it was retracted.

At least some Philadelphians have echoed a concern many people have of safe injection facilities. Some people believe they may attract people who use illicit drugs to their communities. These facilities tend to be far nicer and safer than drug houses, private residences, or otherwise hidden away spots typical of illicit drug use.

This concern does not appear to have been thoroughly examined by any study, and it warrants more research. Some may argue that citizens should be able to see that data point first, while others argue the net positive these facilities provide warrants their development regardless of the final conclusion of such a study. All the same, it is information many have wondered about with no clear answer at this time.

One criticism of these facilities that does not seem to be valid (discussed more below) is that they encourage drug use and may be dangerous overall to the health of citizens. The idea is that by providing a safe space for people to do drugs, they may be more likely to then engage in drug use. However, the data does not seem to back this point up.

Arguments in Favor of Safehouse’s Facility

Dirty needles are one way in which HIV, which eventually develops into AIDS, is spread. Whether it be because of poverty, difficulty acquiring needles, or simply not being informed of the dangers, it is common for people who use injectable drugs to share and reuse needles.

It is also common for areas that are frequently used for drug abuse to be littered with used needles, which can present similar hazards. If a person is pricked by a needle used by someone with HIV or another transferable disease, they are at risk of getting that same disease. This includes people who use the needles intentionally and those who are accidentally pricked.

This is one of the strongest arguments in favor of allowing facilities like the one Safehouse proposes. Facilities like this are already legal and fairly widespread in Canada and Europe, and they have slowly been embraced by citizens and officials (just as those in the United States increasingly seem to warm to the idea). Exactly how much they help to reduce the spread of disease, however, is not yet immediately clear.

Another strong argument for these facilities is their ability to save lives. As already discussed, many of these facilities, including the one Safehouse proposes, have the trained staff and necessary medicine and equipment to reverse overdoses.

Compare this to the situation at a private residence or drug den, where those around a user may be reluctant to call any kind of emergency service out of fear of legal repercussions. While some illicit drug dens may offer emergency services, there is no oversight into their training and little guarantee they will be properly equipped because they already operate outside the law.

Safehouse fully intends to offer services to help people overcome addiction and the situations that may lead them to abuse drugs, such as poverty, homelessness, or mental illness. A review of 75 studies on the subject concluded these facilities make drug use safer and have no negative impact on crime or drug use.

That second part is one key argument in favor of safe injection facilities. They don’t seem to encourage drug use while simultaneously making those who choose to use drugs significantly safer. It is for this reason that a growing number of academics and medical researchers call for these types of facilities to be fully legalized and embraced in the United States.

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