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Safe injection site advice for Philadelphia from Seattle: Don't wait to open

A year after Seattle's announcement, there still is no site for medically supervised drug use, a fact advocates blame on the city sitting back while the opposition mobilized. But Philadelphia health officials say waiting is exactly their plan.

A view inside the pop-up safe injection site in Moss Park in Toronto, Canada on October 3, 2017.
A view inside the pop-up safe injection site in Moss Park in Toronto, Canada on October 3, 2017.Read moreDAVID MAIALETTI / Staff Photographer

Just over a year ago, Seattle announced it would be the first American city to open a safe injection site in response to skyrocketing drug overdoses, and promised to stand fast against political fallout.

There still is no site for medically supervised illicit drug use in Seattle. But advocates say there is a lesson for Philadelphia, where officials said 10 days ago they would permit a site:

Don't do as Seattle did.

"Our biggest mistake was not implementing it really quickly," said Shilo Jama, the executive director of the People's Harm Reduction Coalition, which runs several needle exchanges in Seattle and elsewhere on the West Coast. "Once we passed it, we just kind of talked about it, and we didn't have a plan to implement it, and that gave the opposition time to mobilize. It became bogged down in bureaucratic hell."

But Philadelphia health officials' waiting is part of the plan.

"We appreciate the advice. However, we want to do this right," said Alicia Taylor, communications director for the city's Department of Human Services."We're not going to do any outreach until we have some interested parties, and we know what possible neighborhood area we're going to be doing this in."

Residents of the drug-plagued Kensington area, considered a logical location, complain of being ignored by the city. Much as they would like to get the entrenched camps of heroin users off their streets and away from their children, many fear anything that might make the community even more of a drug mecca.

In this climate, academic studies showing the sites save lives and decrease public disorder are getting drowned out. Activists who have mostly focused on reviving overdosing users, caring for their injection wounds, and finding them food and housing, are trying to sell the idea to the public. The Save Our Lives Collective, one such group, plans to host town halls and lobby City Council members, only a few of whom have said they support the sites.

Meanwhile, overdoses continue. In the Kensington area alone, as of Friday there were about a half-dozen suspected fatal opioid overdoses since the site was announced, according to law enforcement records.

"While people are discussing this and working this out, bodies are piling up," said Jose DeMarco, a member of the SOL Collective.

‘Very little backlash’

In Seattle, the plan was to open a site within city limits and one in surrounding King County. The city sat back while towns mobilized to keep sites out. Then came an anti-site ballot referendum that gathered steam for months until a federal judge struck it down.

Even in Canada, safe-site advocates have been frustrated over what they saw as similar foot-dragging. So activists in Toronto just opened one last summer, without city permission or alerting nearby residents, in a tent pitched in a park where drug users congregated.

"We didn't consult with the community, because that's not the community of people who would use it," said Zoe Dodd, an activist. "But we got very little backlash when we opened — people would say stuff to us like, 'You brought this here' — but drug use and open drug use had always been there." She thinks her group's action forced the city to open an official site more quickly.

All that came long after Vancouver in 2003 became the first North American city to open a site. Even there, though, the conversation took about a decade, said Travis Lupick, a journalist who's written a book about the fight. There, people in addiction joined with harm-reduction activists to get the city on board. A nonprofit helmed one of the first public-education campaigns.

"By the time [the site] actually opened, a majority of the city was on board," Lupick said. "There was a mayoral election eight months before it opened, and both of the leading parties competing against each other had an injection site in their platform."

Neighborhood opposition remained, but business owners who had protested came around after their doorways were no longer gathering spots for heroin users, who moved to the safe injection site, he said.

Back then, he pointed out, the opioid problem was nowhere near today's epidemic scale.

"The fight for the establishment of [the site] in Vancouver took a decade," Lupick said. "Philadelphia and any city struggling with the increase of overdose deaths does not have a decade to debate this."

It’s not Hamsterdam

When the conversation on WWDB-AM's Mark and Denise in the Morning turned to safe injection sites on Monday morning, Abraham Gutman turned the volume up. Gutman is fairly new to the city, a former medic from Tel Aviv who moved to New York to get a master's degree and now is an analyst at Temple University's Center for Public Health Law Research.

He listened in as the hosts, the Rev. Mark Kelly Tyler, the pastor of Mother Bethel A.M.E.  Church, and writer Denise Clay, discussed the sites. The plan sounded like Hamsterdam, the famous anything-goes zone in Season 3 of The Wire, they joked. On a more serious note, they said, it sounded like enabling drug use.

City officials would have scoffed at the idea during the crack epidemic, when people of color were sent to jail, not afforded places to safely use drugs, they agreed.

And so Gutman dashed off a comment on the show's Facebook page: Safe injection sites weren't like Hamsterdam — in fact, he'd just written an essay about it for the Inquirer — and there was significant evidence showing they decreased overdoses and the spread of HIV and hepatitis C, he wrote.  The hosts asked him to call.

That led to a few minutes of polite, on-air debate with City Councilman David Oh, who called in to express his doubts about the sites. The next day Gutman went to City Hall with a stack of studies for Oh.

"If you don't like safe injection sites because it rubs you the wrong way, it's your right to have that" as your opinion, Gutman said. "You don't have the right to make this an argument about evidence when there's evidence" supporting the sites.

Oh said later he is open-minded, but remains skeptical about the legal and political implications of sanctioning illegal drug use.  He leans toward programs that enjoy more public support, but allowed that he found Gutman's arguments compelling.

That, Gutman figured, was a start.

It will take more than a stack of reports to convince Kensington residents like Genevieve Geer, who is active in several community cleanup initiatives.

"No one has reached out to talk to us about it since" the announcement, Geer said, voicing the frustration many feel over the decades of neglect their community has endured, decay they believe could be reversed if the city really wanted to.

"If Amazon came in and said, 'We want to set up shop in Kensington, and you need to house the homeless and heal the addicted,' " she said, "it would happen in a week."