What is a safe injection site?

After a year in which an estimated 1,200 people died of drug overdoses in Philadelphia, city officials now are saying they would welcome safe injection sites as a harm-reduction measure aimed at keeping people in addiction alive long enough to get into drug treatment. Philadelphia could become the first American city to host these sites, which  may be the most politically contentious public-health measures around. Advocates see them as common sense tools to help people in addiction while also cleaning up neighborhoods plagued by public drug using. Opponents fear they will just encourage drug abuse, and invite outsiders into already stressed neighborhoods such as Kensington. And some people are conflicted between wishing to help people in need, and fearing the consequences of appearing to sanction illegal activity. Here are some frequently asked questions about safe injection sites; please add your questions in the comments area and we will try to answer them.

These are places where drug users can inject heroin under medical supervision to protect against overdose. The concept behind this "harm reduction" measure is similar to that of programs like Prevention Point, which operates a needle exchange, provides health care, and helps get users into treatment. If they are not ready to stop using, a safe place to inject can at least keep them alive.

None in the U.S., though others, such as Seattle, are seriously considering them. They exist in numerous European and Canadian cities, including Toronto, which has seen its overdose deaths decline significantly since opening a facility.

Social media has been having fun with this comparison, but in truth, there is no comparison. The HBO series' Hamsterdam was a couple of vacant — and very violent — Baltimore city blocks where there was no law enforcement, so the drug trade could operate without interference. Safe injection sites — where there is no drug trafficking, and which are supervised by medical staff, not violent criminals — are small, regulated facilities that would not make for such entertaining television viewing as The Wire offers.

People suffering from addiction cannot choose to just stop using. But if given a place to use safely, they can also be shown outreach efforts aimed at helping them recover and get their lives back on track.  In addition to lives saved, cities save money if they don't have to rush ambulances to the scenes of overdoses and provide hospital care.

Studies of existing safe injection sites indicate that they do not increase drug use or crime.

Providing drugs is not what these sites do. Users bring their own drugs, and inject them under supervision by medical staff, who administer the reversal drug naloxone if they overdose. This can be lifesaving for people who do not realize it if the heroin they have is especially pure, or has been adulterated with the powerful synthetic opioid, fentanyl. Also, if a person who has gotten off drugs relapses, their system cannot handle the same dose they used to use without incident.

The opioid epidemic is so enormous, law enforcement officials such as Gary Tuggle, the former head of the DEA in Philadelphia, agree that "you can't arrest your way out of it."  But the fact that this epidemic is predominantly affecting white people, unlike the 1990s crack epidemic, has led some to conclude that race is why the response is so much different to the opioid crisis.  And that concern is a factor in the debate over safe injection sites.

Philadelphia Police Commissioner Richard Ross recently said that his thinking on safe injection sites has evolved as the death toll has soared and as he has studied the issue, though he still has questions about policing an area with a safe injection site. Philadelphia District Attorney Larry Krasner pledged his office would not prosecute people operating sites, or using at them.

Some Pennsylvania officials, including Attorney General Josh Shapiro, are raising potential red flags. Gov. Wolf also has reservations, but said he wouldn't stand in Philadelphia's way. But how federal officials would receive such sites is not yet known.

Research indicates that the sites tend to be used by people who do not have stable housing. University of Pennsylvania researchers recently surveyed people with addiction, who told them they would use the sites not only because of the health benefits but also because they don't want to use out in the open, especially where children might see them.

Some people have objected on ethical and moral grounds. Others have suggested that if someone gets into a car accident after leaving a site impaired, liability could be an issue for the operator of the site. Others say it is an obvious violation of the law to be using illegal substances, and cannot be condoned.

City health officials emphasized Tuesday that they are inviting private entities to fund and operate the sites — not obligating tax dollars. They also noted that saving people from overdosing would actually save money in health care and emergency responses. For instance, one study estimated that Baltimore would save $6-million in city costs by opening a site.

Property values are affected by many factors. But safe injection sites in Canada have been shown to reduce public disorder associated with drug use, such as open heroin injection and discarded needles, which likely harm values. They also have not been shown to increase crime.

SOURCE: Inquirer files