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Safe Injection Sites as Harm Reduction

Harm reduction is a set of practical strategies to minimize the negative consequences that are associated with illicit drug use. Safe Injection Sites (SIS) are considered overdose prevention facilities and are deemed as harm reduction. The purposes of SIS are to facilitate an environment for a safer use of illicit drugs by providing medical staff, clean facilities, and education. The medical staff are there to answer questions, provide sterile injection equipment, clean up after individuals, and refer individuals to drug treatment/rehabilitation centers. They never handle, provide, sell, or administer any drugs. SIS offer overdose prevention medication such as Naloxone (also known as Narcan), can quickly get an individual to the hospital in case of an overdose, and provide on-site emergency medical care when necessary.

There are plenty of pros, as well as cons, to Safe Injection Sites and many believe that they are promoting the use of illicit drugs. However, SIS reduce the spread of diseases such as HIV and Hep-C in drug using communities because they provide sterile consumption equipment and prohibit sharing needles. They reduce public injection, therefore reducing the public danger of using. Studies show that there is an overall decrease in drug use by frequent SIS clients and a higher rate of these individuals seek rehabilitation and recovery. There are 88% fewer overdose deaths per 100,000 users as reported in a literature review of over 100 Safe Injection Sites. The list of the positives of SIS goes on, but many are still weary.

SIS may encourage even more drug use. Individuals may be more likely to continue using illicit drugs without seeking help because they are not facing fears of disease from needle sharing and they will never be short of sterile consumption equipment. Many believe that this would be a safety net for people who refuse to seek treatment. However, the argument against this is that these individuals are going to use illicit drugs anyway. So, why not give them a safe place to use them and reduce chances of infection or disease, reduce the risks of overdose, and reduce the overdose mortality rate? Others believe that SIS will bring crime to the area that they are located. They could encourage drug dealers to start selling closer to the SIS location, but studies have shown that this is not the case. Lastly, they cost a ton of money to operate and keep open every day. Most people don’t want to be funding someone else’s drug use, especially if there are treatment centers close by where they could be sent instead. However, the costs of a Safe Injection Site can operate at a net positive. Reduced medical costs associated with ambulance rides and hospital costs, save the cities money.

The first government authorized supervised consumption room opened more than thirty years ago in Switzerland. There are now 120 sites operating in Europe, Australia, and Canada. As of two weeks ago, none operated in the United States.

Safehouse is a Safe Injection Site that recently opened in Philadelphia, Pennsylvania. They had to jump through tremendous hoops to get where they are now. In February of last year, the U.S. Attorney for the Eastern District of Pennsylvania filed a civil lawsuit against Safehouse. The lawsuit declared that supervised injection sites are illegal under the federal statute codified in 21 USC § 856, also known as the “Crack House” statute. This statute “…makes it a felony to knowingly open, lease, rent, use, or maintain any place for the purpose of manufacturing, distributing, or using any controlled substance.” This permitted the Justice department to prosecute property owners who knowingly and intentionally allowed others to use their property for the purpose of selling, distributing, or using illicit drugs. The lawsuit was not seeking money or seeking to seize any property or criminally prosecute any party, they just wanted to stop the production of the Safehouse.

On October 2nd, 2019, a US District Judge ruled that “the ultimate goal of Safehouse’s proposed operation is to reduce drug use, not facilitate it, and the 21 USC § 856 statute does not prohibit Safehouse’s proposed conduct.” This enabled Safehouse to move on with production. Finally, on February 25th, 2020, the Memorandum and Order for final Declaratory Judgment was out. Safehouse proposed early March 2020 as the date of operation.

Unfortunately, Safehouse had to cancel their lease due to complaints from local businesses and citizens. Originally, Safehouse said that they would open their first facility in Kensington, a neighborhood rife with drug deaths and homelessness. Kensington was ready for Safehouse, but Safehouse was worried that they wouldn’t be able to meet the demand of that neighborhood and therefore, went to find a lease in South Philadelphia. South Philly residents were outraged and feared that the opening of a Safe Injection Site would bring users from Kensington to the area, causing a surge to outdoor use of drugs. The organizer of Safehouse had to make a tough decision to pull back and decide the next course of action.

Safehouse’s mission is to save lives by providing a range of overdose prevention services, most of which are mentioned above. It would have been the first Safe Injection Site in the United States. Studies have shown they work well in reducing overdose deaths in other countries, however the United States and South Philly aren’t ready for the consequences, if there are any. SIS are extremely important for harm reduction and the recovery process. They do everything they can to make it safe for everyone involved and everyone who lives in the area. More people need to understand how valuable these facilities are and how much of a difference they make in the cities that they’re located. There needs to be a push for Safe Injection Sites to be implemented in every city and every town. Harm reduction goes a long way to combat the opioid/heroin epidemic.

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