In the first two weeks of 2021, Philadelphians and Americans have seen conflicting messages from law and policy with huge implications for access to drug treatment and life saving resources.

On Jan. 12, U.S. 3rd Circuit Court of Appeals ruled that Safehouse — an overdose prevention site proposed to allow for safe drug practice and access to treatment services for those suffering from addiction, with the backing of city governmental agencies — violated federal law.

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Ignoring research and data, successful overdose prevention sites outside the U.S., and support from physicians to social workers, recovery specialists to parents and families, the decision came down to the Court’s interpretation of a 30+ year old law. In her dissenting opinion, Circuit Judge Jane Richards Roth wrote: “Safehouse is trying to save people’s lives.” Days after this decision, U.S. Attorney William M. McSwain, a Trump appointee who brought the civil suit against Safehouse, resigned knowing that he would be replaced by the incoming Biden Administration—and leaving Safehouse’s fate up in the air. This sets discouraging precedent for cities across the country, such as Seattle, San Francisco, and New York, who were following the Safehouse case closely with interest in opening their own overdose prevention sites.

While McSwain’s actions against Safehouse threaten public health, his colleagues in the Trump administration actually did something two days later to help it. On Jan. 14, the outgoing U.S. Department of Health and Human Services (HHS) of the Trump Administration reversed a 20 year regulation, known as the X Waiver, mandating that all physicians and health care providers take additional training and certifications to treat addiction with the medication buprenorphine, a life-saving addiction treatment. For years, doctors and treatment providers had advocated to “X the X-waiver” to decrease barriers and increase availability. It made no sense to those of us on the frontline of the devastation of addiction that nearly 100% of practicing physicians and prescribers could potentially cause the unintended consequence of opioid addiction by prescribing pain meds, but fewer than 7% could actually treat their own patients for the same.

Brett P. Giroir, M.D., Assistant Secretary for Health at HHS, cited the rise in drug overdoses in recent years, and the COVID-19 pandemic, as compelling the Administration to act. This is a game changer for the Philadelphia region — a city with not just a high concentration of health systems and medical providers, but also with the nation’s highest overdose mortality rate of any large city.

Yet meanwhile, Pennsylvania’s own state government might hold us back. On Jan. 8 — days after the Capitol insurrection and when PA representatives further delayed the Electoral College count by not accepting the results of its own constituent votes, and representatives in Harrisburg went so far as to not seat a newly elected member — State Sen. Michele Brooks announced she will reintroduce her plan to impose even more strict barriers to access to drug treatment, which previously failed to pass.

If voted in, her proposal would mandate office-based prescribers of buprenorphine to pay additional fees to the state in order to be able to treat their patients. This would remove treatment in the state even further from standard of care and evidence-based approaches. Just as some of our state representatives reflected their lack of interest the wellbeing of others by refusing to wearing a mask when held in close quarters while armed rioters entered the Capitol, they seem to sacrifice what is good for Pennsylvanians despite presiding over the state with the nation’s fourth-highest overdose mortality rate.

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These developments have left me confused - disappointed and trepidatiously hopeful at the same time. We have seen our own Pennsylvania representatives disregard the voice of the people they were elected to serve, both in Harrisburg and on the national stage. We have seen how the letter of the law seems to take different shape and form depending on who is on the other side. But we have also seen positive change.

Our work lies ahead of us. The 3rd Circuit judges who ruled against Safehouse call us to action: “Courts are not arbiters of policy. We must apply the laws as written. If the laws are unwise, Safehouse and its supporters can lobby Congress to carve out an exception.”

Amidst the chaotic activity of these first two weeks of 2021, the lessons are clear. Voters and civilians are the ones who choose elected officials. We are also the ones who must hold them accountable. This is true for our City Council members who don’t honor their word, state representatives who don’t honor the regulations of the land, and our federal officials who wield enormous power. That advocates and experts were able to “X the X-waiver” to make treatment more accessible to all is a testament to the power of raising these issues. We can’t stop using our voices now. It’s still a matter of life and death. But it’s also a new day.

Priya E. Mammen is an emergency physician, a fellow of the Lindy Institute of Urban Innovation at Drexel University, and an adjunct faculty at the University of Pennsylvania.