For the first time since 2013, the annual number of overdose deaths in Philadelphia has declined — 1,116 people died of an overdose in 2018 — 101 fewer deaths than in 2017. It is too early to know what to make of the 8 percent reduction. One year of data doesn’t give us much information about what’s to come. The decline in overdose deaths between 2012 and 2013 -- a 15 percent reduction — was nothing more than the calm before the storm.
Over the past few years, Philadelphia has become known as the face of the urban opioid crisis — both because of the images of the public manifestation of the crisis that came out of Kensington and one of the highest overdose death rates in the nation. The city has already spent millions of dollars on doses of naloxone to hand out, public awareness campaigns for treatment and overdose reversal trainings, clean ups in Kensington, shelter beds, and policing. The crisis is still raging.
Public Health Commissioner Thomas Farley credits these efforts — naloxone specifically — for the reduction. The real news, he argues, is not the size of the reduction but the fact that the years-long increase in overdose death has stopped.
Public-health advocates and experts have hung their hopes on a supervised injection site to further reduce overdose deaths. The proposal by nonprofit Safehouse to open one has been beset by legal and community pushback.
The main point of contention is the location and permanence of the site. While it may make sense to have the site in the Kensington area where there is a concentration of potential clients, residents worry that a site will further entrench the crisis in their neighborhoods.
We as a city seem to be at an impasse on this issue. But there is a compromise that could serve in the interim opening a mobile site.
Cities in Germany, Spain, Canada, and other countries have converted vans to a two- or three-seat clinic — similar to a small version of a Red Cross van for blood donation — in which clients inject drugs under medical supervision. Supervised injection vans are usually a way to expand the reach of a brick-and-mortar site, but that is not a required condition. Seattle, for example, is considering opening a mobile site. Sites around the world do more than supervise injection — they hand out syringes and naloxone, provide wound care, and refer clients to services.
Mobile sites are cheaper to operate than a fixed site, can provide services to multiple areas, and adapt to the needs of both potential clients and the neighborhoods in which they operate.
As the opioid crisis continues to change and evolve, our responses and solutions must follow suit. And since this is a deadly problem that gets deadlier — especially as the more dangerous synthetic opioids like fentanyl edges out heroin — the window for responding isn’t large.
If a brick and mortar site is what’s standing in the way of allowing a supervised injection site to save lives, we should instead put it on wheels.