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As U.S. overdose deaths soar, Rhode Island legalizes supervised injection sites. Philly’s effort remains in limbo.

In the wake of the highest overdose death toll the country has ever seen, advocates say that the need for supervised injection is more urgent than ever.

Insite, the first supervised safe injection site in North America, shown in 2016 in Vancouver.
Insite, the first supervised safe injection site in North America, shown in 2016 in Vancouver.Read moreLindsey Wasson / Seattle Times

Rhode Island’s decision to allow sites where people in addiction can use drugs safely has sparked new optimism that momentum for the movement may be building despite Philadelphia’s own stalled bid to open a supervised injection site.

The facilities, where medical workers can revive those who overdose and connect people to treatment, already exist in dozens of countries.

But Rhode Island is the first state whose legislature approved a two-year pilot to open sites around the state. The governor recently signed the bill into law.

In the wake of the highest overdose death toll the country has ever seen — 93,000 in 2020, a 30% rise from the year before — advocates say that the need for sites that studies have shown decrease fatal overdoses is more urgent than ever.

“This is a health crisis that’s going to take everything we can do to get back on track,” said Anton Bizzell, a former medical officer for the federal Substances and Mental Health Services Administration, who now leads a consulting group dealing with health equity and substance use treatment.

He recalled his alarm in 2015, when 52,000 Americans died of drug overdoses, setting a record. He hoped the latest numbers would inspire action. “There’s a momentum that we’ll be gaining,” he said. “And it’s a momentum that we need.”

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In 2018, Philadelphia looked like the country’s test case on supervised injection sites when city officials announced that they would allow one, and the nonprofit Safehouse formed and signaled its intention to open a site. But then-U.S. Attorney Bill McSwain sued to block it.

“There was a bit of a stall as the country waited and watched on the Safehouse litigation, which of course has been a roller coaster,” said Lindsay LaSalle, the managing director of the Drug Policy Alliance, a national group that advocates for harm reduction and an end to the “war on drugs” blamed for imprisoning mostly people of color while doing nothing to stop addiction.

Initially, a District Court judge ruled that the site could open, but a proposed location in South Philadelphia was scuppered after an intense community outcry. The court put a stay on that ruling, and the COVID-19 pandemic overtook any other efforts to find another site, said Ronda Goldfein, Safehouse’s vice president.

McSwain, who now is running for governor, appealed to the federal Third Circuit Court, which reversed the lower court’s decision early this year, ruling that such a site would violate federal law.

That most recent ruling was limited to the Third Circuit Court and doesn’t apply to Rhode Island. But it had a chilling effect nonetheless, LaSalle said.

“It’s great to have this victory coming out of Rhode Island as a signal to the jurisdictions that have been considering this for a long time,” LaSalle said. “They’re going to look to Rhode Island and say, ‘OK, they got it done. We need to get our head back in the game here and move this forward.’”

Goldfein called the news from Rhode Island “exciting,” although it will have little immediate practical effect on Philadelphia.

“We have not abandoned our legal claims, and we intend to continue to pursue them,” she said. “We are proud of our colleagues in Rhode Island. Social justice happens in a lot of ways — maybe it will happen in a groundswell across the nation. But we’re all moving forward.”

Goldfein added that national advocacy for supervised injection sites may force the Biden administration to take a stance on the issue.

“Either it violates the law, or it doesn’t. All this momentum gets to the point where the federal government has to say or do something. They cannot continue to say, ‘We care deeply,’ and then not address this question that so many people are asking.”

(The U.S. Attorney’s Office in Philadelphia said its position on the issue has not changed; representatives from the federal Department of Justice did not respond to a request for comment.)

Bills to open supervised injection sites have been introduced in the New Jersey, New Mexico, and Illinois legislatures. California lawmakers passed a bill legalizing the sites in 2018, but then-Gov. Jerry Brown vetoed it; legislators there are trying again. Activists in other states are also encouraged.

“We’re hoping, given the fact of the staggering [overdose] numbers just published this week, we’ll get some momentum and get things rolling here in Massachusetts,” said Jim Stewart, a member of the steering committee for SIFMA-NOW, the organization advocating for supervised injection sites in Rhode Island’s neighbor to the north. “We’re hoping this will create a sense of urgency on the part of elected officials.”

Rhode Island State Rep. John G. Edwards, who sponsored the supervised injection site bill in the state House, and lost two cousins to overdose, said the decision was easy for him. The state has championed several innovative approaches to the opioid crisis, including a program to ensure people in state prisons receive adequate medication for opioid use disorder, credited with bringing down overdoses in the state as a whole.

Supervised injection sites are a continuation of those efforts but became more urgent when the COVID-19 pandemic hit, he said.

“This has affected everyone,” he said. “I come from a small town — we’ve had multiple deaths in that small town over the course of the pandemic. I think the pandemic really drove it home for us in Rhode Island. Our numbers were going down every year, and then people didn’t get out, they weren’t able to go and get their services, and it drove depression, all the mental health issues that had pushed people into their addiction.”

In 2020, 384 people died of overdoses in Rhode Island, a state of about 1.1 million people. In Philadelphia, population 1.5 million, 1,214 people died of overdoses last year.

“This bill will keep people alive,” he said. “That’s it.”

The state will regulate but not operate the sites. Local governments will have authority to approve the facilities in their own jurisdictions. Edwards said that he knows of at least three or four organizations that have expressed interest in operating a site, and acknowledged that community buy-in will be key. “This isn’t going to be a bunch of legislators sitting down figuring out stuff,” he said.

But, he added: “This is not novel law. It’s really new for Rhode Island. But it’s something tried and true everywhere else.”

Staff writer Jeremy Roebuck contributed to this article.