Will Philadelphia Be the First US City to Open a Supervised Injection Facility?

Last summer the New York Times reported that drug overdoses are the leading cause of death among Americans under fifty years old. According to the Centers for Disease Control and Prevention, there were around 64,000 drug deaths in 2016, and opioids were involved in just over 42,000 of those deaths, five times higher than in 1999. To put that in perspective, there are nearly 13,000 gun homicides and over 34,000 fatal motor crashes a year in the United States.

Many experts believe that the increase in opioid related deaths is due in part to the emergence of fentanyl. Fentanyl is an opioid similar to heroin and is one of the most widely used synthetic opioids in the medical community because due to its strength and effectiveness in managing pain. But because it can be produced cheaply in labs, it’s also being used widely in the illicit drug trade as an alternative to heroin (which takes longer to produce and requires more resources). Fentanyl is actually often sold as heroin to users, which greatly increases their risks because they’re using a more potent drug with very different dosages.

Philadelphia recently made the news for an unusual proposal to address its opioid crisis. Top city officials are proposing to open a supervised injection facility (SIF) where people suffering from opioid addiction can go to use drugs in the presence of medical professionals. There are currently ninety supervised injection facilities around the world, and although cities like Seattle, Washington; San Francisco, California; and Ithaca, New York are working toward establishing sites of their own, there are currently none in the United States.

At safe injection facilities, nurses offer sterilized equipment, tests, and supervision to individuals suffering from addiction. They provide test strips to indicate the presence of fentanyl, clean needles, overdose-reversing drugs, and vital sign monitoring. Safe injection sites are viewed as a bridge to treatment services. Not only do they prevent overdoses and limit contact with infectious diseases like hepatitis C or HIV, they also connect users to long-term addiction treatment.

Philadelphia Mayor Jim Kenney and District Attorney Larry Krasner are in favor of safe injection sites. Krasner has even pledged not to prosecute individuals who utilize them. However the city faces considerable barriers from its police force, the federal government, and even its own citizens.

Last year, Philadelphia Police Commissioner Richard Ross said he was “adamantly opposed” to the concept of safe injection sites and felt uncomfortable designating a legal place for using illegal substances. However after further research and exposure to the idea, he’s keeping an “open mind.”

Even if the police force can be convinced, the federal government will likely stand in the way. Vermont’s attempt to establish safe injection facilities was met with a warning: “SIFs are counterproductive and dangerous as a matter of policy, and they would violate federal law… It is a crime, not only to use illicit narcotics, but to manage and maintain sites on which such drugs are used and distributed.” In the statement issued by the US Attorney’s office, officials described fear that government-sanctioned sites would also encourage and normalize drug use: “Indeed, by encouraging and normalizing heroin injection, SIFs may even encourage individuals to use opiates for the first time, or to switch their method of ingestion from snorting to injection, the latter carrying greatly increased risk of fatality and overdose.” Federal officials instead promote “solving” the matter in federal courts with the help of “law enforcement intervention,” further perpetuating the corrupt criminal justice system. This despite the opinion of many addiction experts who argue that addiction is a disease requiring extended medical care, not isolating individuals in poorly equipped prisons.

But perhaps one of the biggest roadblocks for safe injection facilities is the local community. Due to the negative public perception of individuals suffering from addiction, no doubt influenced by federal government policy, communities have expressed adamant opposition to the establishment of safe injection facilities in their area (instead hoping to magically rid their streets of drugs with one fell swoop). Rather than solving the problem in the long term, communities want drugs off of their streets as soon as possible. This type of thinking lends itself to criminalization.

The problem here is that Americans largely stigmatize addiction because we don’t understand it. We perceive addiction as an individual moral shortcoming, not as a cultural one. Our empathy is so lacking, that we end up perpetuating the cycle of abuse associated with addiction. Because of our ignorance and fear we are not only unwilling, but vehemently opposed to providing addicts with the resources they need to get better.

Our stigmas stand in the way of progress. And as humanists, who value compassionate and rational thinking, we need to educate ourselves on addiction and provide opportunities for an open dialogue aimed at producing sorely needed solutions.