(Photo via twitter.com/HorsePowerEv)
The opioid addiction epidemic has been declared a state of emergency both in the state and the nation, and locally, the City of Philadelphia has been ramping up its response to the crisis in the past year, recently suing opioid drugmakers.
The city took another step forward Tuesday to quell the epidemic by announcing its plans to support the development of privately operated safe injection sites, or Comprehensive User Engagement Sites, where users could inject opioids under medical supervision.
Philadelphia’s addiction crisis was estimated to kill 1,200 people last year, up from 907 in 2016. Eighty percent of those deaths were caused by opioids. Especially menacing was the surge of fentanyl-related deaths.
The Mayor’s Task Force to Combat the Opioid Epidemic in Philadelphia, which included health professionals, government officials and other experts, recommended the city consider backing safe injection sites in its May 2017 report. Other suggestions included encouraging public awareness of the overdose-reversal drug naloxone (a media campaign, Don’t Take the Risk, is live) and hiring a harm reduction coordinator (the city’s first started her job in November).
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Details of the future sites are still vague, but officials shared at an announcement event on Tuesday that the sites would be operated by a private company and include other health services, such as access to addiction treatment.
The announcement comes on the heels of a November visit to a Vancouver injection site by Philadelphia health officials, including Dr. Thomas Farley, commissioner of the Department of Public Health; Eva Gladstein, deputy managing director of the Health and Human Services Cabinet; and David Jones, commissioner of the Department of Behavioral Health and Intellectual disAbility Services.
“We cannot just watch as our children, our parents, our brothers, and our sisters die of drug overdose,” Farley said in a statement. “We have to use every proven tool we can to save their lives until they recover from the grip of addiction.”
A review of studies on existing safe injection sites estimated that one site in Philadelphia could prevent as many as 76 deaths caused by drug overdoses per year.
But some harm reduction activists are saying the city needs to take one further step for the plan to truly help the population it’s targeting: Invite active drug users to the table.
Commissioner @PPDCommish says he was completely against this idea at the beginning. When he spoke with colleagues in Vancouver, he began to open his mind to the idea. #PHLOpioids pic.twitter.com/DEjNLUjcIr
— Philadelphia Public Health (@PHLPublicHealth) January 23, 2018
According to a Department of Public Health spokesperson, the task force included one person in recovery, a member of the Pennsylvania Harm Reduction Coalition, who was a “vocal advocate during the discussions for CUES.” There were also several people in task force subcommittees in recovery.
Paul Cherashore, a co-organizer of Philadelphia Overdose Prevention Initiative who frequently speaks out in support of harm reduction strategies for reducing overdose deaths, said that’s not enough.
“This is a very top-down process, and that doesn’t always reflect what’s best for drug users,” said Cherashore, who also calls himself a drug user rights activist. “This reflects what’s best for service providers and city officials.”
It’s a refrain we’ve heard often in the social services sector: Leadership must reflect those it’s serving. Otherwise, the professionals providing services risk not understanding their community’s needs.
“It’s for these people, so to not have their input in the process doesn’t make any sense,” Cherashore said.
Dr. Evan Anderson, a professor in University of Pennsylvania’s nursing and medical schools, explored the idea of drug users as individuals within a larger geographical community when conducting a recent study about infections related to injection drug use.
The study’s interviewees, all active drug users in Philadelphia, responded overwhelmingly in support of safe injection sites — not only for their own benefit, but for that of people who live or work in neighborhoods such as Kensington where public drug use and intoxication is rampant.
“Our participants said, ‘We really are concerned about the effect of our public injecting and public intoxication on the community. We don’t like that we’re exposing children in the community to it,'” Anderson recalled.
That fear of disrupting the local residents “motivated our participants to inject in secluded spaces” more than fear of arrest. (But in turn, that seclusion increases risk of death, Anderson said: No one is around to help if they overdose.)
There is “absolutely” a case for active drug users to be a part of finding the solution, Anderson said.
“Where these facilities have worked well, their development and implementation has really relied on active participation from people who have used the facility, and also people who live and work around the facility,” he said. Service providers need to understand, for instance, what makes such sites attractive to users — how to make them accessible, comfortable, non-alienating.
Of course, safe injection sites have their detractors, including those who see them as condoning drug use.
Councilwoman Maria Quiñones Sánchez, who represents several North Philadelphia neighborhoods that bear the brunt of the crisis, published a statement yesterday against the plan.
“Those suffering from the disease of addiction need help and a warm place to come in to safely. But they cannot be allowed to control our neighborhoods and negatively impact the lives of the families who have lived here for generations,” Quiñones Sánchez said.
“Now we rush to make headlines as the first American city to open a safe injection site, but we are abdicating our responsibility to address both the health crisis of addiction and the community crisis that these encampments have created in the Barrio,” she said. “Opening an injection site without a real plan in place will further entrench the crisis in Kensington.”
And there are the legal issues: While new District Attorney Larry Krasner has vocalized his support and said he would not prosecute those working in such sites, Pennsylvania Attorney General Josh Shapiro has expressed his apprehension, and the ultra-conservative U.S. AG Jeff Sessions’ Department of Justice has warned such sites could “violate several federal criminal laws.”
To that, Scott Burris, a professor at Temple University’s law school who also oversees the Center for Public Health Law Research, says: Let the feds come arrest the medical professionals trying to save lives, and then let the legal process work.
“We’ll take it up with Congress,” he said.
According to Burris, who published an academic paper studying the effects of safe injection sites a decade ago with then-Ph.D student Anderson, there’s nothing in Pennsylvania state law explicitly prohibiting them.
“For many people, there’s a reflective, instinctual reaction that somehow, if you’re doing anything to help drug users, you are encouraging drug use and preventing them from hitting the rock bottom so they can recover,” he said. “The problem is, it’s factually wrong.”
If you want people to recover from drug addiction, Burris said, you have to keep them alive, reduce the harm they’re causing themselves and make treatment easy to get — something safe injection sites have been proven to do.
“We need to check our first reactions at the door and give this a chance, because this can work,” he said.-30-
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