After a year in which overdoses outstripped the murder rate by 4-1, librarians ran outside to save people from overdosing, and makeshift heroin camps sprawled under bridges and on street corners, Philadelphia city officials Tuesday took their most radical step yet against the opioid crisis.
It's time, they declared, to do what no other U.S. city has done: Establish medically supervised facilities where people can inject drugs, be revived if they overdose, and then be helped into treatment.
"We are facing an epidemic of historic proportions," Health Commissioner Thomas Farley said at an afternoon news conference at City Hall. "The people in the city of Philadelphia, our brothers, our sisters, our parents, our children, are dying. And they don't need to die. And we have an obligation to do everything we can to prevent those people from dying."
The city will not operate the sites — at locations yet to be determined — but will encourage private organizations to take on the task. Farley and others emphasized that the sites are just one aspect of what must be a major, coordinated response to a crisis that took an estimated 1,200 lives last year, the highest death rate of any major U.S. city.
The sites — the city is calling them Comprehensive User Engagement Sites — "meet [people in addiction] where they are, offer help getting treatment, and help them stay alive until they are ready to get treatment," Farley said.
"We are not naive," said city Managing Director Mike DiBerardinis. "Nothing you hear today is the solution, but small parts of a larger effort."
City officials have been researching and debating the idea for the better part of a year, visiting a site in Vancouver and commissioning a report on evidence collected in Canada and Europe. Its conclusion: A single site in Philadelphia would save 25 to 75 lives a year and millions of dollars in hospital costs and public funds, while reducing public injection of drugs and other neighborhood problems.
Police Commissioner Richard Ross said that the Vancouver trip changed him from "being adamantly against [the sites], to having an open mind" — albeit with serious questions about how police would interact with the sites.
Mayor Kenney, previously scheduled to appear at a news conference about World Wrestling Entertainment's "Royal Rumble," did not appear at the safe injection site news conference, but said he supports the plan.
"We don't want [people in addiction] dying on the street and we want to have a place to administer Narcan if necessary," Kenney said of the rescue medication. City officials handed out 21,700 doses of the drug last year, without which the death toll likely would have been higher.
"We also want an opportunity to speak to people about their future and getting their lives straight," the mayor said. "They can't do that under a train bridge or on a train track."
City spokesman Mike Dunn said Council approval is not required for the sites.
Councilwoman Helen Gym called the decision "bold, brave, and lifesaving."
Overdose Deaths in Philadelphia
Notably absent from the news conference was Councilwoman Maria Quiñones-Sánchez, whose district includes Kensington. She said in an interview later that the city needs to address the encampments where people in addiction have clustered, affecting the quality of life for her constituents.
"I'm not saying I'm opposed to the site, I'm saying I don't see how the site addresses the immediate issue," she said. "This is about being first. This about a media cycle because when you don't have a comprehensive plan, that's all it is."
Quiñones-Sánchez voiced a common complaint, that in previous drug epidemics, police tried to arrest their way out of the problem. Now, in a majority-white drug problem, the approach is different. Councilwoman Cindy Bass expressed similar concerns, saying, "We have to get serious about taking care of all drug use."
City officials stressed that international research indicates safe injection sites are effective — one in Toronto saved 139 lives in six months last year. They are not connected with increased crime or drug use, and help clean up unsightly neighborhood issues, their report indicates.
Still, within an hour after the city's announcement, Pennsylvania House Speaker Mike Turzai said Gov. Wolf should order a "cease-and-desist order" to the city.
"I think it's a stark violation of federal law," said Turzai, an Allegheny Republican who hopes to challenge Wolf in the fall election.
Wolf also expressed reservations but did not say he would stand in the city's way. "While we understand the desire of local governments to try to save lives, this concept presents a number of serious public health and legal concerns," he said.
The local U.S. Attorney's Office would not comment about the city's announcement, and the Justice Department had not responded to a request for comment.
Advocates, however, applauded the news.
"This is a huge step for us in the city," said Jose Benitez, the director of the Kensington needle-exchange and outreach site Prevention Point. "We're looking forward to what the next steps are."
Members of the harm-reduction group SOL Collective said they hoped to start talks about opening a site soon. "It's absolutely a question of, 'We need to do this right now to save lives,' " said Christina Garces, a medical student at Temple University.
A mayoral task force on the opioid crisis recommended that the city consider safe injection sites last May. In the summer, officials worked to close encampments around Kensington, closed a decades-old camp in a train gulch along Gurney Street, and bricked up an abandoned church that had become a shelter for young people using heroin among the ruined pews. Though the spaces were dangerous and decrepit, for many they offered the only safe places where they could inject heroin around friends who could administer Narcan if they overdosed.
And while the city offered outreach services, closing those spaces drove people to new refuges, such as under train bridges on Lehigh Avenue.
At Lehigh and Kensington Avenue, people in addiction said they supported the idea of a medically supervised site.
"There's nowhere safe," said Christopher Drescher, 40, of New Jersey. He's been using drugs since the age of 12, he said, and earlier this year overdosed behind a Wawa. It took three Narcan doses to revive him, he said, after someone happened to see him passed out behind the building.
Using heroin in a safe injection site would be more respectful to the neighborhood, especially children who often pass by the camps on Lehigh Avenue, he said, adding that people try to warn one another when kids are nearby so they don't inject drugs.
Julie S., a mother of five from Norristown who was camping on the opposite side of the bridge, said she thought often of what might happen if one of her own children were to pass by the camp, and takes pains to keep needles off the ground.
A safe injection site would mean "a safer environment for everyone," she said.
Seattle, the only other major U.S. city that is close to opening such facilities, set aside $1.3 million in its budget to open safe injection sites last year. Opponents tried and failed to float a ballot measure that would have banned the sites before they even opened.
An unauthorized safe injection site has been operating in an undisclosed location in the United States since 2014. Cities like San Francisco, New York, Ithaca, N.Y., and Denver have begun to seriously consider sites. A study in Baltimore found that the city would save $6 million on medical costs connected with overdoses by opening one site.