Legit, Safe Places to Inject Heroin Are Closer Than Ever

A tool lots of other countries have tried is suddenly within reach in cities like Philadelphia.
Supervised injection sites are coming.
Collage by Cathryn Virginia | Images via Shutterstock

Last month, around the same time Bernie Sanders was heading to Canada to check out their affordable supply of insulin, Jim Kenney went north, too. The mayor of Philadelphia was determined to see "safe injection sites," where people are allowed to inject opioids like heroin—under supervision—up close. Kenney has been one of many powerful officials in his city mulling the creation of similar facilities. But plans have stalled both because of legal battles—the feds do not generally support people using so-called street drugs—and community concerns.


A hearing next week could start to change all that.

Lawyers for the Philadelphia-based nonprofit Safehouse, which is leading the charge in trying to establish the first above-ground safe injection site in the United States, are set to appear in court for an evidentiary hearing. It's the first step in a case that may set a national precedent for how to save lives at the local level amid an ongoing opioid crisis.

Safehouse's position centers on what many in the activist and medical communities call harm reduction. The idea is that people are going to use drugs, legally or otherwise, and the best approach is to figure out how to make them least likely to die in the process. At Safehouse, according to its website, this would amount to rooms observed by medical professionals—should somebody overdose, they can administer a reversal with drugs like naloxone—as well as a handful of services such as counseling, education, legal and housing referrals, and fentanyl and HIV testing.

This stance is bolstered by plenty of global precedent, even beyond America's northern neighbor: 60-plus cities around the world have built and operated safe injection sites, all without a single fatal overdose. And needle-exchange programs in the U.S. have long operated under the same framework.

Meanwhile, Philadelphia has been among the U.S. cities hit hardest by the opioid crisis: According to a Pew analysis, nearly a third of residents of the city—which reported 1,116 drug-related deaths in 2018, 84 percent of which were a consequence of opioids—said that they knew someone who died because of opioid use. Kensington, a neighborhood in North Philadelphia, is also home to what the New York Times Magazine described as the "largest open-air narcotics market for heroin on the East Coast."


Safehouse's fight became national news in February, when U.S. Attorney William McSwain launched a civil suit against it on the grounds that the plan would amount to illegal activity. But Ronda Goldfein, the vice president of Safehouse, as well as the executive director of the AIDS Law Project of Pennsylvania, was actually somewhat relieved by the move.

"It's the fear of the federal government that kept us on hold, and has kept all the other jurisdictions that are eager to move forward with this kind of initiative, that have a desperate need to move forward, as well," she said. Political squabbles in New York City and Denver have stopped them from advancing similar measures, and the mayor of Somerville, Massachusetts, recently suggested nothing in his town would happen until, perhaps, next year. (McSwain's office did not respond to a request for comment.)

If you ask the people advocating for it, this is a modern clash about federalism, pitting prosecutors and law-enforcement officials against the patients, lawyers, and doctors who want to combat a drug crisis on their own. Last August, then–Deputy Attorney General Rod Rosenstein wrote in the New York Times that the Justice Department would "meet the opening of any injection site with swift and aggressive action." Rosenstein has since stepped down, but there was no indication the Department of Justice had suddenly warmed up to the idea in the interim.


"We quickly realized that the criminal penalties are pretty extreme," Goldfein said.

The Controlled Substances Act (CSA), the law under which the federal case was brought, has colored national drug policy for decades, especially when it comes to the "schedules" of various narcotics—a cartoonish system that currently suggests cannabis is as dangerous as heroin. Goldfein insisted, however, that she and Safehouse "will be maintaining a premises for the purpose of saving lives," and cannot be targeted under the law's original intent.

The good news for her side is that this isn't just activists fighting the powers that be. Ed Rendell, the former Philadelphia mayor and Pennsylvania governor, has become something of a boisterous mascot for Safehouse, serving on its board. In fact, after Rosenstein published his op-ed, Rendell responded by saying the Justice Department should arrest him first, instead of the people building, employed by, or visiting a potential Safehouse.

In addition to arguing that CSA shouldn't apply to safe-injection sites, Goldfein said her legal defense would also lean on the Religious Freedom Restoration Act. That Bill Clinton–era law has been employed, unsuccessfully, by both Native American tribes to combat land upheaval and a Quaker who didn't want to pay federal income taxes. Here, the idea would be that harm-reduction advocates' "faith" is in saving lives, and they are obligated to do so because of their beliefs.


Leo Beletsky, a professor of law and health sciences at Northeastern University, cautioned that the increasingly strange battle's outcome was hard to predict, mainly because such a campaign has never really been waged.

"In the case of Safehouse, it's not an officially government-supported, government-authorized, or government-run facility. It's a nonprofit," he said, suggesting that a worst-case scenario might not invite local outrage the way it would if the project were actually run by an official agency.

"If you're hauling state employees in handcuffs, that looks quite different than if you're hauling off Philadelphia activists in handcuffs," he said.

Nonetheless, Goldfein remained optimistic about the outcome—even if a victory in court would still leave winning her neighbors' backing on the agenda.

"We're feeling pretty good about ourselves," she said, adding, "At the end of the day, Philadelphians should be able to take care of Philadelphians."

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