Supervised Injection Facilities: It’s Time

Krasner at "Need a Little Help" event, June 22

Krasner at "Need a Little Help" event, June 22

The opioid crisis is ravaging our city. Every week, even every day, brings new stories about how this epidemic is destroying not only people who are addicted, but also their families and communities. Children in hard-hit Philadelphia neighborhoods have to step over dirty needles in parks and playgrounds. Last year, we saw 900 overdose deaths, and but for the heroic efforts of our first responders — as well as librarians, outreach workers, and other drug users — there would have been many more.

It’s a national problem that has catastrophic local consequences. The highly publicized Gurney Street “hot spot” drew addicted people from near and far to the Fairhill-Kensington section of our city. It was a health hazard and a public nuisance, until it was cleaned up a month ago. But something surprising was happening at Gurney. Of the approximately 900 overdose deaths in the city last year, only 17 occurred at that location — partly because drug users supervised one another and administered naloxone during overdoses.

The concentration of drug users at Gurney appears to have reduced overdose deaths, but it also blighted an entire neighborhood. Meanwhile a very different kind of hot spot for intravenous drug use has not experienced a single fatality since it opened, and has improved the neighborhood around it.

Insite, a supervised injection facility (SIF) in Vancouver, Canada, is a clean, modern clinic that looks like a local library branch. Since 2003 it has provided life-saving services to 3.6 million injecting clients in an organized, sanitary way, under the trained guidance of medical professionals and public health experts. Although 6,440 people have overdosed at Insite, none have died. Meanwhile, local opposition to it has all but disappeared.

The common thread here is harm reduction.

Harm reduction is what you do when the root cause of a problem is beyond your control. Helmets to reduce the risk of head injury, condoms to reduce the risk of sexually transmitted disease, a police force to reduce the risk of crime — those are all strategies to reduce harm.

In the case of the opioid crisis, SIFs like Insite are a harm reduction strategy that helps people struggling with addiction to stay alive and access treatment, and helps a city struggling with a national crisis to remain liveable for all who live and work there.

For people who are addicted, SIFs like Insite can offer access to addiction treatment and to basic medical services that reduce hospital admissions. They can reduce fatal drug overdoses and reduce HIV and Hep-C transmission by offering needle exchange and infectious disease testing. They can act as an early warning system by detecting surges in heroin laced with dangerous additives such as fentanyl.

SIFs can also cut down on neighborhood disorder and crime. Vancouver’s SIF has been demonstrating that since 2003. The American Journal of Preventative Medicine recently found that even “unsanctioned” facilities can deliver some of these benefits. In a two-year period at one unsanctioned site, there were about 2,300 fewer instances of public injections, about 1,700 fewer needles discarded on neighborhood streets, and no overdose deaths reported.

There are about 100 SIFs operating in 66 cities across nine countries, according to the Drug Policy Alliance, but in the United States there’s not a single one, not even in Philadelphia, one of the cities hardest hit by the national opioid crisis — although to its credit the Mayor's Opioid Task Force has expressed interest in the concept.

If I’m elected district attorney, I will use my powers as our city’s chief prosecutor to divert those suffering from addiction into treatment, not jail cells. I will use every tool at my disposal to go after large-scale drug distributors, including irresponsible pharmaceutical corporations. I’ll use our criminal justice system for what it’s intended to do: prevent criminal activity and make us safer.

But we need to do more. We cannot police and incarcerate our way out of this public health crisis. And sweeping it from one neighborhood to another is no solution either. Mayor Kenney said it in May: “We have seen the costs of inaction on epidemics in the past and cannot let that happen again.”

I agree. The opioid crisis is an urgent matter of public health that has direct impact on public safety. It is fundamentally immoral to stand by while needles are shared and lives are lost when that is preventable. As District Attorney, I will use discretion in charging, I will use the bully pulpit to reduce harm and save lives, and I will support properly run and appropriately located supervised injection facilities.

The opioid crisis is far bigger than Philadelphia, and nothing we do locally can get to the root of it. But we can reduce its corrosive effects on our city. No child should have to avoid dirty needles on the way to school. No mother should lose her son to a preventable overdose. No community should have to live with the problems of an entire society on its doorstep.

If there’s a chance that SIFs can reduce the harms that this national crisis is inflicting on our city, our communities and our loved ones, we have more than an opportunity. We have a moral obligation.

Philly DA hopeful Krasner wants addict injection clinics | Philadelphia Inquirer (AP)
DA Candidate Supports Safe Injection Clinics to Fight Opioid Epidemic in Philly | NBC10
Philly D.A. Frontrunner Backs Safe Injection Sites for Drug Users | Reason
Progressive Philadelphia DA Candidate Augments Platform | TechBook
Krasner: Safe Injection Sites Work | Philadelphia magazine
Protecting Heroin Clinics From Prosecution | The Atlantic