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With heroin camp sealed, city needs a place that's safe to shoot up

The question now is no longer if we should have a safe injection site, but how and when.

A used syringe rests on the bridge above the Conrail railroad tracks at B Street in Philadelphia on Aug. 3, 2017.
A used syringe rests on the bridge above the Conrail railroad tracks at B Street in Philadelphia on Aug. 3, 2017.Read moreDAVID MAIALETTI / Staff Photographer

On the street above the train tracks, a knot of television crews and news reporters gathered around a phalanx of city officials on hand for a day too long in the making: the closing of the heroin camp in a Fairhill gulch.

Now, the officials said, the real work was to begin — helping those trapped in addiction along the Conrail tracks and all through the surrounding neighborhood of Kensington. For the first time in more than a decade, the camp was quiet Monday, except for the strains of festive music from the news conference. Only one of the shacks was still occupied, its inhabitant trying to nap before "moving on," he said. The medical hut – where the camp "doctors" injected those who needed help finding a vein and administered the lifesaving spray Narcan to overdose victims – was deserted. And everywhere, still, the mountains of needles.

There, in the silence, the great shame of this place was somehow ever more stark: How did we let suffering people live like this for so long?

And how, in this shuttering of a place unfit for human habitation, can Philadelphia be losing the closest thing it had to a safe injection site?

As advocates point out, of the staggering 902 fatal overdoses in Philadelphia last year, only 17 occurred in the camp – despite the thousands of injections that took place there. It's likely the most concentrated site for heroin in the city. But outreach workers supplied the users here with Narcan. They kept one another alive.

Now, the bulldozers disperse the camp's occupants into the neighborhood. And the city is, rightfully, there to meet them and offer treatment. As of Friday, outreach workers at a trailer set up near the camp had screened 50 people, though it's not yet known how many eventually made it into treatment.

But as encouraging as that number is – and it is remarkable – there are tens of thousands more people in the grips of the opioid crisis in the city who are not yet ready for recovery, or unwilling to navigate a treatment system that still falls short.

The city estimates that it is on track to average three overdose deaths a day. Advocates believe that in the absence of even the most perilous of safe spaces, the toll will rise even higher. And as the Gurney Street camp closed last week, the city is barely past the early stages of a conversation about the option that could save those lives: safe injection sites.

This is a controversial proposal, but people are dying at devastating rates, higher even than the AIDS crisis. We have to embrace a solution that evidence tells us works. The city has to lead and advocate against the kind of backward thinking and fear-mongering that got us here in the first place and will stalk the debate for its entirety.

It takes guts to install a safe injection site. Seattle is close to approving the country's first. At the height of the AIDS crisis, Philly declared a public health emergency and funded another controversial initiative: a needle exchange that now saves lives in Kensington.  The city needs to show some of the same guts now.

Brian Abernathy, the first deputy managing director, is leading the city's exploration of safe injection sites. He told me Friday that he and his boss, Michael DiBerardinis, are not yet convinced a safe injection site could work here, but they "remain open to being convinced."

He said he's far warmer to the idea than he was in May when a city task force urged the city to consider a site. Abernathy said he doesn't question the health benefits of a site.  After all, there's overwhelming evidence from Europe and Canada showing how sites keep people alive and healthier – and usher far greater numbers into treatment.

It's the legal issues, he said. Liability challenges that would arise in a city-sanctioned space. Law enforcement questions of how to secure and police it. Neighborhood impact. Potential backlash from a presidential administration that has already targeted the city for its sanctuary policies.

"I don't think the decision around safe injection is one that I can just flip the page," Abernathy said.

Of course not. But that these questions exist shouldn't derail the conversation. The answers exist. The city needs to just look harder to find them. Officials plan on traveling soon to Vancouver – which opened the first safe injection site in 2003 – to investigate. Good. Book the tickets.

But they have already heard from Canada.

When she addressed the city task force earlier this year, Sarah Evans, a former coordinator of the Vancouver site, reported that crime and drug use rates did not rise. The neighborhoods grew cleaner. Life expectancy rates around the sites rose by 10 years. Quickly, community support grew. Now, amid the crisis, staff at the site rescue eight overdose victims a day on average, a site spokeswoman said. No one has ever died there.

"By now, safe injection sites are seen as just an essential part of dealing with drug use in the city," Evans said. And they are supported by the mainstream, she said. Even police.

Philadelphia will reach a decision by the fall, Abernathy said. On Aug. 31, advocates are planning a march through the heart of Kensington to raise awareness for the overdose crisis.

Even if you don't agree with safe injection sites, go and listen to the people there who do – the people who have dedicated their lives to this issue.

The conversation so far has been burdened by the stigma surrounding addiction. The Inquirer's editorial board, for instance, has wrongly argued against safe injection sites. This has to be a conversation that engages everyone, including people who are against it, including many in law enforcement, who advocate for well-needed reforms but still see safe injection sites as a step too far. Above all, city officials must be held accountable for any failure to act.

The question now is no longer should we have a safe injection site. It's where and when.