Philadelphia to Make History with Nation’s First Supervised Injection Facility

For decades, Philadelphia held the dubious honor of hosting America’s largest open-air heroin market in a tangle of pockmarked streets on the city’s north side, known as the “Badlands.”

On Tuesday, less than two weeks after Pennsylvania Governor Tom Wolf declared the overdose crisis a public health emergency, city officials, including District Attorney Larry Krasner and Police Commissioner Richard Ross, announced they’re ready to put Philadelphia on the map as the first municipality in America to open a supervised injection facility (commonly referred to as a SIF), where IV drug users can shoot up using sterile equipment under the watchful eye of trained medical personnel. The goal, they say, is to save lives and improve communities impacted by public drug use through a concept known as harm reduction.

At an afternoon press conference packed with media, community stakeholders, and representatives of Philadelphia’s harm reduction community, policy advisors to Democratic Mayor Jim Kenney explained the administration’s rationale.

“These are unprecedented times and we are taking unprecedented steps,” said Philadelphia Managing Director Michael DiBerardinis, explaining that the city will encourage the private sector to launch “one or more Comprehensive User Engagement Sites,” or CUES — a term the city chose over SIF to emphasize the additional mission of offering clients recovery options like rehab and social services.

“We don’t see these sites as solely for supervised injection,” said DiBerardinis’s first deputy, Brian Abernathy. “They will serve as pathways to get people into treatment.”

In its push to be first, Philadelphia joins a growing list of cities and states — including Seattle, New York and Vermont — where policymakers have proposed supervised drug use as a means of tackling runaway overdose fatalities.

Some municipalities, like Ithaca, NY, are looking to their state legislatures to pass SIF-friendly bills. Others, like King County, WA, have chosen to act alone, even in the face of staunch opposition. But even in cities where supervised injection has been approved by local governments, like San Francisco, the process of siting and funding a working SIF has been slow.

Philadelphia is taking a different approach by leaving it up to private organizations to make the first move on supervised injection. This not only skirts bureaucratic hurdles associated with approving city funding, but avoids the risk of contentious public hearings, such as those held in Boston last June.

Without direct city involvement, a dedicated team of activists could raise its own money and conceivably set up shop tomorrow, with the imprimatur of both the mayor and District Attorney, who has vowed not to prosecute SIF workers. A local harm reduction group, SOL Collective, has already announced its intention to engage the city in talks about opening a site.

This represents a shift for the city, which last summer shut down a secluded camp situated beside a stretch of railroad tracks in North Philadelphia known as “El Campamento.” Hundreds of IV drug users found temporary sanctuary at the camp, which was supplied with a steady stream of clean syringes and doses of the overdose-reversal drug naloxone by harm reduction groups from as far away as New York. The camp, which had evolved organically and was being maintained exclusively by drug users, experienced just 17 overdosesover a 12-month period, according to the medical examiner’s office, compared to more than 900 citywide.

But that is not the story Dr. Oz chose to tell when he visited El Campamento in April 2017. Instead, his bleak portrait became a source of embarrassment for the Kenney administration, which then forced the property’s owner, Conrail, to fence it off. The displacement of El Campamento angered some Philadelphia residents, as drug users began moving into more populated areas. As of Tuesday’s announcement, several hundred users remained camped out along three major thoroughfares on the edge of the Badlands, encroaching on newly gentrified neighborhoods to the south and east.

When told of the city’s decision, most drug users approached by The Appeal said they would gladly use a CUES facility, as long as it was close to where they buy their drugs. This issue is lost on some critics of CUES, such as Councilwoman Maria Quiñones Sánchez, who supports supervised injection in principle but objects to CUES because it would allow facilities to be located in her district, which includes the Badlands.

But users say that’s exactly where they should be. “Some people won’t even walk two blocks before they drop down for a shot, especially if they’re sick,” explains Mike, a homeless heroin user.

City officials evolved on the SIF issue after a November trip to North America’s first supervised injection facility, InSite, in Vancouver, Canada. Research shows that the introduction of supervised injection there in 2003 led to a 35% decrease in overdose fatalities in the city. It also improved overall health outcomes for IV drug users, and led to an increase in addicts entering treatment.

A Philadelphia study commissioned by the Kenney administration released this week found that CUES could save the city up to $100 million a year in healthcare costs and fatalities.

But opponents wasted little time attacking the idea.

On Wednesday, Pennsylvania Speaker of the House Mike Turzai (R-Allegheny) — who is challenging Wolf for the governorship in November — issued a statement condemning the plan. “Philadelphia’s supervised drug addiction-enabling plan is misguided and a violation of state and federal law,” he said. “I urge Gov. Tom Wolf and federal authorities to enforce the law.”

Pennsylvania’s Attorney General, Josh Shapiro, had already gone on record against SIFs in November, saying, “There is no safe way to inject heroin, fentanyl or carfentanil into your system.”

In fact, fentanyl is one of the three most common opioid analgesics used to treat postoperative pain and is employed safely every day in hospitals across the U.S. And studies show that medically prescribed heroin is not only a safe alternative to other opioid maintenance drugs, it is also more cost-effective and leads to better treatment outcomes.

Meanwhile, the city’s paper of record, the Philadelphia Inquirer, provided cover for officials like Turzai and Shapiro opposed to CUES by suggesting that CUES could be seen as “a dangerous liberal experiment that threatens law and order, in a similar way that so-called sanctuary cities have fueled the immigration debate.”

One official who was conspicuously absent from Tuesday’s announcement was Mayor Kenney himself, who, rather than join his administration in making harm reduction history, was across the street at City Hall, flanked by life-sized replicas of WWE wrestlers for a photo op declaring “Royal Rumble Week 2018.” The Mayor said he wasn’t aware of the press conference, while an aide blamed a scheduling conflict. While he may have intentionally avoided the spotlight, the mayor did issue a statement of support.

“Philadelphia’s fatal overdose rate is the worst in the nation among large cities, and incidents of overdose have steadily increased to an alarming degree,” the mayor said. “I applaud the work of the Task Force and city leadership in taking this bold action to help save lives.”