As Philadelphia continues to reel from last year's 910 fatal drug overdoses, local officials, medical professionals, and philanthropic organizations are considering a controversial idea: Opening special facilities where heroin users can inject drugs safely.
"Desperate times call for innovative measures," said Priya E. Mammen, director of public health programs in the Department of Emergency Medicine at Sidney Kimmel Medical College at Thomas Jefferson University. "We're in a position now where we have to rethink everything."
On Wednesday, the idea of "safer injection sites" was proposed during a meeting of the Mayor's Task Force to Combat the Opioid Epidemic, which Mammen and at least 50 others attended.
The proposal calls for a pilot program to reduce fatal overdoses by providing medical supervision. If users get too much heroin, or product that's boosted by a synthetic opioid like fentanyl, their breathing stops. Quick intervention with the rescue drug naloxone reverses the drug's effect, reviving the person. The sites, paid for through philanthropy, not public funds, would be staffed by a nurse or doctor, and would be in Philadelphia's worst-hit neighborhoods.
In addition, the facilities, called Comprehensive User Engagement Sites (CUES), would direct people who use IV drugs to treatment and social services, provide wound care for what can be severe injection-related infections, and supply sterile injection equipment.
Nearly 100 safe-injection facilities operate globally — primarily in Europe. They operate under the same principles as CUES, which omit the word injection as stigmatizing.
In the English-speaking world, however, legal facilities operate only in Vancouver, British Columbia, and Sydney, Australia.
Sarah Evans, who was one of the managers of North America's first safe-injection site in Vancouver, made a warmly received presentation Wednesday before the mayor's task force.
The Vancouver center, called Insite, opened as a pilot project in 2003 after the city's chief medical officer declared a public health emergency following the deaths of 200 people.
Insite has 12 stainless steel booths where users can inject their own drugs. It's open 18 hours a day.
"What they do is prevent overdose deaths very well," Evans said in her 10-minute presentation. Since Insite has been open, there have been more than 3.5 million injections there, but no fatal overdoses.
Initially, some people in the surrounding community had "a lot of questions" about the idea, but neighbors have warmed to it and 75 percent now support it, Evans said.
"The longer it is open, the more people approve of it," she said.
Evans said the Royal Canadian Mounted Police concluded that the site decreased crime in the neighborhood.
Several studies, Evans said, have showed the injection site has made the area a better place to live and conduct business than it was when people were using drugs on the streets.
"It did not negatively affect community drug-use patterns, it did not promote initiation into the drug, and did not increase petty crime," Evans said. "Things actually improved. It reduced public injection, and reduced littering of drug-related paraphernalia."
Task force members who heard her presentation included city Health Commissioner Thomas Farley, DEA agents, city police, community activists, and government officials. Mayor Kenney was not present. In addition to winning community approval, the plan also would have to pass muster with local and state law enforcement, since heroin use anywhere by anyone is illegal. Officials where these programs operate look the other way, recognizing that the alternative is worse, proponents say.
A task force subcommittee is likely to make a formal proposal to Kenney next month.
Paul Cherashore of the Philadelphia Overdose Prevention Initiative (POPI) said he was optimistic the city might come around to opening at least one center.
"The big problem is political capital and how much political capital it will take to make it happen," said Cherashore, whose group has collected 1,200 signatures on a petition supporting safe injection sites for the city. "There are many people who don't want an injection site in their backyards.
"We argue that we're taking it out of their front yards and putting it in a contained facility, in a private building," Cherashore said following the task force meeting. "This could be a very good thing for them."
Health advocates estimate that 55,000 people in Philadelphia use illicit intravenous drugs. Most are city residents. The East Coast's largest heroin market operates out of the city's Kensington and Fairhill neighborhoods, according to the U.S. Drug Enforcement Agency. Many customers are from the suburbs, as borne out by the more than 435 fatal drug overdoses last year in Bucks and Montgomery Counties. Other surrounding counties added hundreds more to the death toll.