The third season of the classic HBO show The Wire introduced an approach to drug crime that sparked people's imaginations. In response to the toll of homicide and crime the drug trade is taking on the community in Baltimore, rogue Police Maj. Howard "Bunny" Colvin decides to try something new. Inspired by the brown paper bag that effectively decriminalized drinking in public, Colvin decides to try the approach with drugs. "There has never been a brown paper bag for drugs," Colvin tells his officers, "until now."
Hamsterdam was born.
On Tuesday, Philadelphia city officials gave the green light to a Comprehensive User Engagement Site, commonly known as a safe injection site, in Philadelphia. This site will be the first formal one in the United States.
Almost immediately, Twitter buzzed with users who jokingly corrected the headlines on the announcement: Philadelphia isn't the first city in America to have a safe injection site! Baltimore had Hamsterdam.
In The Wire, Hamsterdam was a law-enforcement-free zone, located over a couple of vacant blocks, in which — aside from violence — everything goes. The goal was to move the drug trade away from the community and create a physical marketplace for all things illegal.
That's not what is happening in Philadelphia.
Philadelphia's safe injection site is going to be much duller than Hamsterdam. It is also going to save many lives.
A safe injection site is a harm-reduction measure to treat drug abuse. The premise is based on the evidence-backed notions that illicit drug use is a reality that is not going away anytime soon and that drug-use disorder is an acquired disease of the brain and should be treated as such. Given these two notions, it is worthwhile to pursue measures that reduce the harm associated with drug use, such as transmission of HIV/AIDS, wound infection, and overdose death.
The first harm-reduction efforts were the establishment of syringe-exchange programs for the injection drug user in the 1980s as HIV/AIDS was spreading to epidemic proportions. These attempts were considered niche and the research to evaluate them faced fierce opposition. By 2016, 17 states and the District of Columbia explicitly authorized syringe-exchange programs in their law.
The next big battle that the harm reductionists faced was over Naloxone, a low-risk lifesaving medication, also known as Narcan, that quickly reverses opioid overdose. Allowing bystanders to use Naloxone was also highly objected to in its early days of the 1990s and 2000s as some feared that access to the drug would encourage drug use (a claim that has been debunked multiple times). Currently there are Naloxone programs in over 200 communities throughout the U.S. and almost every state law provides bystanders with immunity from liability when administering Naloxone.
The current big frontier for harm reduction is safe injection sites: a site in which a drug user gets access to sterile needles and has a clean place to use, can get medical care for wounds, and if the user overdoses (which now with the extra-potent fentanyl happens more frequently than ever), he or she can be revived with Naloxone immediately, and hopefully at some point be referred to addiction treatment.
The alternative for using drugs in a site as described above? The best-case scenario is enrollment in a treatment program that provides medications such as methadone, but given the lack of treatment slots nationally and in the Philadelphia area, it is more than likely that a person will wind up using in one of the many unsafe injection sites that exist in Philadelphia organically.
While there are a few underground safe injection sites in the U.S., the Philadelphia site will be the first of its kind. Evaluation of similar sites in other countries can shed light on what Philadelphia can expect. Research mainly from Australia and Canada suggests that the Philadelphia site will be a facility that is utilized by high-risk users, change injection practices to less harmful ones, increase enrollment to treatment due to contact with consumers, and decrease overdose deaths with no increase in crime.
It is worth taking a look at pictures from Vancouver's sites to realize how different they are from Hamsterdam. These are the sites Police Commissioner Richard Ross visited and helped change his mind from "being adamantly against [the sites], to having an open mind."
Every city in America has a Hamsterdam, an area that is neglected by law enforcement and social services. Some called Kensington Avenue Philadelphia's Hamsterdam. But these are areas with more harm, not less.
It is our job to set the record straight about safe injection sites: This isn't Hamsterdam, it's harm reduction.