Ed Rendell, a Democrat, is a former governor of Pennsylvania. Jose A. Benitez is executive director of Prevention Point, a nonprofit in Philadelphia. Ronda B. Goldfein is executive director of the AIDS Law Project of Pennsylvania. Together they founded Safehouse, which provides overdose prevention services.
In a well-reasoned 56-page opinion, U.S. District Judge Gerald A. McHugh ruled that a supervised injection site, designed to combat the staggering death toll of opioid overdoses by allowing people to inject drugs under medical supervision, does not violate the “crack-house” section of the Controlled Substances Act because the site would be operated not “‘for the purpose of’ unlawful drug use” but to "save lives.”
Philadelphia, like the rest of the nation, has been hit hard with opioid overdoses. In 2017, a staggering 1,217 people died in the city of such overdoses despite the fact that the overdose reversal drug naloxone was widely available and could quickly reverse the effects of the overdoses before they became fatal. The problem was, of course, that most people who overdose do so alone, and even if naloxone was on the table next to them, they couldn’t administer it because an overdose renders a person unconscious.
Cities across the country have been considering medically supervised injection sites to reverse potentially fatal and debilitating overdoses and offer drug treatment by the administration of naloxone by trained medical personnel. But before any city progressed too far down the road, the Justice Department notified U.S. attorneys across the country that the practice was illegal and would be the subject to criminal prosecutions.
We co-founded Safehouse in Philadelphia to operate two safe injection sites because we believed we could no longer wait as the death toll continued to rise almost unabated. Our facilities would function like they do in Canadian cities: Opioid users would be free to come to the sites and inject their products with clean needles, and health workers would be on hand to make sure no one overdoses. At no point would we distribute or even touch controlled substances; the user would bring them to our facility. This isn’t a substitution for treatment, but it is safer than having people use drugs alone or on the streets. And before the user would inject in front of our medical personnel, they would have to speak with treatment professionals to discuss treatment availability.
Our proposal quickly drew ire from the U.S. attorney in Philadelphia. And while we may have won that first legal battle, we still have hurdles to clear. The government is likely to appeal, and we need to raise at least $1 million to prepare the site and to cover their initial yearly operating budgets.
We have promised the city government and the public that we would not request any government money, so we have to raise the money among private donors. We are confident we can do so quickly given the number of people who have lost family members to opioid addiction and overdose.
More importantly, however, we hope our victory emboldens other cities to venture into setting up their own harm reduction sites. While our federal ruling is not binding on other jurisdictions, we believe its logic and reasoned interpretation will help proposed facilities in places such as New York, San Francisco, Boston, Seattle and Denver when and if they face court challenges.
It is important to understand that we, like other harm reduction advocates, do not believe supervised injection sites are the answer to the opioid crisis. That depends on sweeping reforms in Washington and state legislatures to, among other needed steps, significantly reform the way large drug companies market and distribute opioids; hold accountable the doctors who have deliberately or unintentionally overprescribed them; and revamp medical school curriculum, which does not teach about the danger of overprescribing.
But we do know that supervised injection sites will save lives. In the winter of 2016, one of us (Rendell) witnessed the heartbreak of college friends whose son, John Decker, died in his parents’ bed from an overdose of heroin while they were on vacation. Decker was a lacrosse player at Cornell University, where he suffered a serious leg injury, leading him to take painkillers and starting him down the tragic road to addiction. He had everything to live for. He was smart and personable, and had embarked on a successful career. His death shows why we should all be personally involved in this fight.
More than 70,000 Americans died of drug overdoses in 2017. This is more than the combined U.S. fatalities for the 20 years of the war in Vietnam and the 16 years of the Iraqi war. We can do better. We must do better. No more John Deckers. No more overdoses anywhere.