The push to open the nation’s first supervised injection site in Philadelphia got its day in federal court Monday, pitting the region’s top law enforcement official against the president of a nonprofit founded to help stem one of the country’s deadliest opioid crises.
U.S. v. Safehouse is being watched by site supporters and opponents across the nation, as it is expected to set a precedent on the legality of sites intended to give drug users a safe place to use, be revived if they overdose, and access treatment.
U.S. Attorney William M. McSwain grilled Jose Benitez, Safehouse’s president, for more than an hour, challenging how he planned to open a facility for people to use illegal drugs without breaking federal law.
Benitez replied that the primary goals of the operation weren’t to encourage drug use but to prevent and treat overdoses so drug users could live to access addiction treatment. “The only thing this is designed to do is to save a life — immediately,” Benitez said.
Monday’s long-awaited court hearing — focused on the practical details of how Safehouse would operate should it be allowed to open — was the first that U.S. District Judge Gerald A. McHugh has scheduled as he considers the case.
The Justice Department sued Safehouse in February, asking the judge to declare the idea of a supervised injection site illegal. Safehouse countered that the law in question was never intended to prevent what its officials say is a legitimate public health measure aimed at saving lives.
Benitez told McSwain — who in an unusual move came to court to argue the case himself — under cross-examination that the sites are just one part of efforts to prevent drug-related deaths.
But, he said, it’s an essential part: “You can’t go into treatment if you’re dead.”
McSwain probed Benitez on that point, asking whether a person who overdosed at a site and was revived, but later died of another overdose, should be counted as someone whose life had been saved.
Benitez responded swiftly that someone could just as easily overdose at a site, be revived, and enter treatment.
“Well, sure, that could happen. That would be a bit of a happy story.... The one that we all want,” McSwain said.
McSwain also asked Benitez why the organization did not attempt to get federal drug laws changed before opening the site.
“Because this is an emergency,” Benitez replied. “We have 1,100 people who died last year, 1,200 the year before that, 900 the year before that, and 600 the year before that. We are up to four times the homicide rate.”
He added: “We’re entitled to get our case heard. We didn’t choose this route, you chose this route.”
Monday’s hearing was the first day in court for an effort that’s been in the works in Philadelphia since 2017, when 1,217 people died of overdoses and city officials began to seriously consider the kind of facility that has operated in Canada and Europe for decades. In January 2018, Mayor Jim Kenney announced that he would do just that, with support from the city’s health department and District Attorney’s office. That summer, advocates incorporated Safehouse as a nonprofit.
Benitez, who is also the executive director of Prevention Point, a public health organization that hosts the city’s only needle exchange, on Monday explained in detail how the site would operate. Prevention Point serves 15,000 people in addiction, a sixfold increase over the last four years. Its staffers have reversed 500 overdoses around their Kensington headquarters in the last year, he said.
But, he said, drug use is not allowed inside Prevention Point’s building. That means staff are running outside to reverse overdoses every day.
“Our main challenge is getting to someone on time.… Minutes are everything in overdose reversals. The sooner we can get to a person the more likely they are to live," he said.
At a supervised site, participants would answer a brief series of intake questions, and could remain anonymous if they choose, Benitez explained. Then they would be directed to a “consumption room,” where medically trained staff would watch as they injected. No drugs would be distributed or shared on the premises, he said. In response to a question from McSwain, he said that minors and pregnant clients would be pulled aside and directed to appropriate services.
McHugh offered few indications of which way he might be leaning. At one point, he interjected as McSwain posed a question about whether people using drugs at an injection site would be committing a crime.
“I think it’s self-evident that they’ll be violating the law,” the judge said. Benitez added: “I don’t think the supervision of someone using drugs is an illegal practice."
Later, McHugh quizzed Benitez on a series of specific hypothetical situations ranging from how Safehouse would advertise and whether medical staff would step in to instruct users if they had trouble finding their veins.
“There may be an educational opportunity there [to] educate folks … in hopes of reducing wound care,” Benitez replied. “But there would be no physical contact or instruction.”
Supporters of Safehouse organized a demonstration outside the courthouse before the hearing began, propping up photos of people lost to overdoses, and handing out fliers. Advocates and parents whose children died wore badges reading, “Ask me why I support Safehouse.”
“I think it’s needed to save a life,” said Michael Worthy, who’s lived for 10 years in Kensington, the most likely location for the first site. Worthy was addicted to crack cocaine for 30 years and has been in recovery for a decade. He now works in addiction treatment.
“In our community, we have a lot of people talking about the effect that it’s having on the children’s ability to move around safely — with needles laying around, people who are in their addiction, using,” he said. A site "will help deter their concerns.”
Nan Goldin, a New York City-based artist who struggled with opioid addiction and now advocates against opioid pain pill manufacturers, said the sites are “essential." Since Philadelphia has one of the highest rates of overdoses in the country, she said, “they should be the first to open a safe consumption site and set the precedent. The activism here is really impressive.”
Jeanmarie Perrone, an emergency physician at the University of Pennsylvania who has helped lead the city’s response to the opioid crisis, testified on behalf of Safehouse earlier Monday morning. She spoke of reviving overdose victims in the emergency department, and even saving a man’s life on the Market-Frankford El.
“I think access to harm reduction — meaning clean needles and a supervised place where they can use, that isn’t the Amtrak bathroom, the Starbucks bathroom, the subway — is what we need to provide people, to elevate our respect and dignity for the plight of Philadelphia’s citizens,” she said.