Harm Reduction

Philadelphia Poised To Open America's First Public Safe Injection Site in Just a Week

Federal judge confirms ruling that it doesn’t violate federal “crack house” law.

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An indoor space where users of illicit drugs may inject under medical supervision and without fear of arrest may be opening in just a week in South Philadelphia, making it the first of its kind to operate openly in the United States.

On Tuesday, a federal judge confirmed and finalized a ruling from October after Philadelphia and the nonprofit group Safehouse in January requested explicit permission from the judge to open a safe injection facility (SIF).

Safehouse says its SIF model provides a range of social service options in addition to medically supervised drug use:

Participants will be presented with rehabilitation options at multiple points during a visit to Safehouse, beginning with when they arrive and go through a registration process.  A physical and behavioral health assessment will be conducted, and a range of overdose prevention services offered.

From the consumption area, participants will be directed to the medically supervised observation room and offered on-site initiation of Medication Assisted Treatment (MAT), wound care, and referrals to primary care, social services, and housing opportunities. Upon arrival, participants may choose to go directly to the observation room to access MAT and other services.

Today, Safehouse formally announced that it will open the first of these facilities in South Philadelphia, perhaps as early as next week. The South Philadelphia intersection where Safehouse will first open is about six miles from the Kensington neighborhood, which is where the city sees the most public use of opioids, and where the city and Safehouse hoped to open the first SIF. The Philadelphia Inquirer reports that Safehouse will be announcing a second SIF location in the near future, so it's still possible that Kensington or a nearby North Philadelphia neighborhood will still get a location.

While Safehouse is moving forward, the fight is not over. U.S. Attorney William McSwain of the Eastern District of Pennsylvania asked a federal judge to rule that a SIF would violate the "crack house" provision of the federal Controlled Substance Act, which makes it a federal crime to operate a facility for the purpose of "manufacturing, distributing, or using any controlled substance."

Instead, U.S. District Judge Gerald Austin McHugh of the Eastern District of Pennsylvania read through the law and determined that a SIF doesn't qualify as a drug den under the text and precedents of the law's application. On Tuesday, he affirmed this ruling, so Philadelphia and Safehouse are moving forward.

McSwain is appealing and is warning the city not to open a facility. But it's not entirely clear what he's going to do. Via the Inquirer:

"We believe that Safehouse's proposed activity threatens to institutionalize the scourge of illegal drug use—and all the problems that come with it—in Philadelphia neighborhoods. In light of these concerns, Safehouse should act prudently and not rush to open while the appeal is pending. But if it does rush forward, my office will evaluate all options available under the law."

McSwain has threatened everything from arrests to drug seizures to asset forfeiture in order to stop Safehouse. He insists—and this is the official position of the Department of Justice—that SIFs are illegal, encourage drug use, and shouldn't be permitted by cities or states. Proponents see SIFs as an important harm reduction tool to respond to America's opioid overdose crisis, fed in part by people buying black market drugs of unknown history, some laced with incredibly potent illicit fentanyl.

McSwain's essentially arguing here that the prospect of dying serves as a disincentive to use illegal drugs. But as Reason's Jacob Sullum has noted, attempts by the government to overly restrict legal access to opioids and painkillers actually exacerbated the consumption of illicit drugs and contributed to the overdose crisis. It's the spread of harm-reduction methods (like the availability of naloxone, which reverses overdoses) that have led to a recent decline in overdose deaths.

SIFs are another form of harm reduction. And studies in countries that have allowed SIFs have shown that they do assist in reducing deaths and the spread of disease, and cost-benefit analyses show that they save money in the long-run when compared to the public health expenses of sending emergency responders out to overdose calls.

But some neighbors only see a SIF as a lure for drug users. This morning some South Philadelphia residents who were not expecting the facility to be in their neighborhood protested the deal. One nearby business owner told the Inquirer, "You know the old saying, 'not in my backyard?' That's exactly how I feel."

But the public drug use, addiction, and overdose crisis is already in his backyard. A SIF will make it less deadly.

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  1. Be pretty funny if the Feds started seizing city assets …. cop cars, city hall …. turnabout like that wouldn’t bother me in the slightest.

    1. Why would that bother a marginalized, bigoted, anti-social authoritarian?

      1. Well … ya got me there. I admit I did not ask you. So: why would that bother you?

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  2. The South Philadelphia intersection where Safehouse will first open is about six miles from the Kensington neighborhood

    Because there aren’t enough jokes about Kensington.

    1. A six-mile trail of fears, with turds and needles for bread crumbs.

  3. Welcome to San Francisco on the Delaware.

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  4. If you thought I was not going to take this opportunity to remind everyone that Filthadelphia is the third worst place in the universe, you were wrong. And it has nothing to do with needle exchanges.

    1. The safe injection site will probably improve the joint.

    2. Can you tell me what the other 2 are? I can’t avoid Philly, but I’d rather not pass through the others.

      1. Search your feelings. You already know them.

        1. Seattle and San Francisco?

  5. Why do Reason authors and editors continue to provide links that are behind paywalls?

    1. Because they’re shitlessly terrified that they might have to learn to code if we don’t all fork over money for shitty propaganda.

    2. FYI, I find that some news sites that grant you “limited free reads per month” (semi-behind-paywalls) can be bypassed by using VPNs (I use Tunnelbear VPN for free; limited use of it is free) and-or Google “incognito” mode… I typically turn both on (VPN plus incognito; easy enough done). Then I have “unlimited access” to some of these news sites.

  6. federal “crack house” law

    Nice band name.

  7. But some neighbors only see a SIF as a lure for drug users.

    They are. That’s their designed purpose.

    1. But the public drug use, addiction, and overdose crisis is already in his backyard. A SIF will make it less deadly.

      It might be, and the SIF guarantees it will stay in his backyard.

      I don’t know what the answer is here on this particular subject. Sans the SIF, the police could crack down, other factors could come into play and either scatter or remove the drugs from the affected neighborhoods. Once a SIF is in place, that won’t happen.

      I still do believe that SIFs do save the lives of the people who are in the facility. I’m just not yet convinced that harm reduction alone is a good long-term strategy.

      1. Fuck the people who own property and pay taxes. They should go fuck themselves and pay more money to have their property infested by crackheads. And when their kids are killed and raped by drug addled psychopaths, they should thank the government for relieving them of some of their privilege. Free minds and free markets baby! Whoooooo!!!!!!!!!

        1. Since it wasn’t illegal to take their money to pay for schools, it can’t be illegal to take their money to pay for social service clini… er… SIFs. If the schools and SIFs attract drug addicts and illegal immigrants that perpetuate the need for the taking, the property-owning racists should either get used to living in a free society or leave.

        2. That’s kind of my issue with the whole thing, but perhaps with less hyperbole.

          We know for a fact that using Vancouver’s Insite as a guide, the neighborhood is a very, very ugly place. Do the people who live(d) and work(ed) in that neighborhood have any right to a safe, clean space? I would say that their concerns are important. The Insite neighborhood has been locked into hellhole status for years now. Yes, it was already a hellhole which is why they chose that location. But would it still be a hellhole? Possibly, but now that Insite is the designated magnetic hub for serious drug users, it’s unlikely to change anytime soon, without other policy changes.

          1. Do the people who live(d) and work(ed) in that neighborhood have any right to a safe, clean space?

            Since when do Libertarians acknowledge any “right” to “safety”?

            What I’ve always heard ’round here is that “safety” is a paid-for privilege, not a right.

            1. I used the word “right” because it was handy, but even as I was typing it, it’s not an enumerated or natural right. However, in this particular context, I’m using it interchangeably with the fact that they are in fact “paying” for that privilege, and not getting the benefits in return. Outside of natural rights, if I’m the victim of a crime or my house is on fire, I have a right to call the police or the fire department and expect some kind of reasonable response. I pay for garbage pickup, therefore I expect when I drag my can to the curb on Tuesdays, it will be picked up.

              I’m not trying to claim that it’s a ‘natural right’ the way some people claim free healthcare is a ‘natural right’.

              It’s not unreasonable to say that people living and owning property in a given area can expect certain minimal standards in the condition of the common areas controlled by existing state structures.

              It also has implications for things like majority rule and Democracy. If all your neighbors vote that something awful should be put in your neighborhood, do we just ignore your pleas?

      2. I’m just not yet convinced that harm reduction alone is a good long-term strategy.

        The co-opting by social services is no longer a hypothetical to be discovered after the fact.

        Personally, I can’t wait for 2 things: 1) The next Jeffery Epstein, Harvey Weinstein, or Bill Cosby figures out to dope up his victims and drop them off at a place like this so that his scumbaggery becomes even more nebulous and 2) Some evil populist discovers that his predecessor was busing people from an SIF clinic to the polls and then principled reporters and libertarians decide it’s a bad practice (the busing, not people shooting themselves up with drugs to the point that they can’t be held responsible for their own actions and must rely on others).

        The place sounds, from a moral/political perspective, creepy AF. Like a BYO soma clinic.

      3. Sometimes the solution to a problem is the problem itself. It is otherwise known as moral hazard. You want to make life easy for drug addicts, you will get more drug addicts.

        These places will do nothing but attract drug addicts who will then beg and commit crimes in the surrounding neighborhood to support their habit. And fucking reason thinks it is great. They need to open up one of these places nextdoor to the Reason headquarters.

        1. That of course is the unspeakable, yet True point. Former drug addicts talk about this themselves. One critic of the needle exchanges and safe injection site was himself a former drug addict. He was circumspect about their effectiveness because he said that he and 100% of his drug addicted friends and associates had to hit rock bottom before they got cleaned up. He felt that those systems carried people along just above rock bottom, allowing them to remain in misery in perpetuity.

          Yes, when some conservative cranky-pants implies that people have to be allowed to die, otherwise the problem will never get better, while that statement is obviously bad on optics, there is a kernel of truth to it.

          My personal objection isn’t about wanting people to die, it’s the… forgive me, Jordan Peterson-esque view on the cultural implications of “doing something”. It’s FAR easier to screw things up than it is to make them better, so I think we should be very careful about Safe Injection Sites. We may extend the life of a chronic drug addict, but we might be making things worse in the meta.

          1. Anyone who thinks treatment is effective at curing addicts need only look at professional athletes. Guys who are millionaires and whose careers depend on kicking their habit and are sent to the most expensive and best clinics and get the best care possible almost never kick the habit.

            The don’t stop until they hit rock bottom and realize they have no other options. As long as an addict thinks he has an option, he will go back to using figuring that he will be forgiven for it later. Its only when his choices are stop or die or go to prison that most of them will stop. If they were capable of stopping otherwise, they would have never became addicts or remained addicts long enough for it to be a problem in the first place.

            So really all these places are doing is allowing these addicts to avoid rock bottom and avoid making the choice or quit or die. They are just enabling them. They are not helping them.

            1. I don’t want to ignore the downstream implications and second-order effects of the drug war. It is an uncontroversial truth that our system and prosecution of the War on Drugs has contributed to the problem. However, the key word here is ‘contributed’. The libertarian notion that everyone could choose to be a free, high functioning heroin user if we could just end the war on drugs is bunk. Otherwise debilitating alcohol addiction wouldn’t exist.

              Yes, the drug war has made it worse, yes, I believe most (if not all) of these drugs should be decriminalized/legalized. I also understand that in the frustrating absence of that, people who mean well want to try to fix the problems. But given Insite’s experience, I don’t see light at the end of this tunnel, only tunnel.

          2. “He felt that those systems carried people along just above rock bottom, allowing them to remain in misery in perpetuity.”

            Which is, of course, the point

          3. “Yes, when some conservative cranky-pants implies that people have to be allowed to die, otherwise the problem will never get better, while that statement is obviously bad on optics, there is a kernel of truth to it.”

            Not a medical person I take it.

            Be very cautious about that. Best to let the medicos do what they do and stay out of it.

  8. Watching right-wing cranks belittle modern, successful cities illuminates the predictable course of the culture war. Resentful losers who reside in Kentucky, Wyoming, Oklahoma, or Mississippi — or see the left-behind backwaters as admirable rather than desolate and hopeless pools of street pills, faith healers, tobacco, indolence, and intolerance — muttering about society’s educated, accomplished, modern, skilled, diverse communities.

    1. Haven’t heard of any sewage-borne disease outbreaks in Bowling Green. OTOH, nothing says “modern” and “successful” like street bleaching to mitigate Hepatitis A. Or being the child of a syphilitic crack whore single mother, like you.

      1. I really believe that you are on a subject with this one

      2. Good luck with preferring Wheaton and Liberty to Harvard and Yale; Lubbock and Amarillo to San Francisco and Los Angeles; West Virginia and Alabama to California and New York; Fox and Breitbart to NBC and the New York Times; NASCAR, country warbling, Greg Gutfeld, and the Left Behind series to mainstream entertainments; and superstition, bigotry, and backwardness to reason, inclusivity, and progress.

        Open wider, clinger. You’ll be swallowing plenty more of what your betters prefer. Until your suffering is eased by replacement.

        1. Beyond the absurdity of all this, you have never been to any of those places. Just shut the fuck up. Seriously, there are people on here who have actual lives, educations and knowledge. You are not one of them. No one cares what you think about anything.

      3. nah. Last outbreaks in Ohio were in Cuyuhoga, Summit, Franklin, Scioto, Claremont, Butler, Hamilton, other counties. Statewide emergency declared recently.

        You are cool in Bowling Green.

    2. modern, successful cities

      We’re talking about Philadelphia. Try to stay on the same page, gecko.

    3. Haha. You heard it here, folks:

      Tobacco: bad

      Heroin: educated, accomplished, modern, skilled, (and most importantly), diverse.

      Haha. This is the best parody account ever.

    4. Watching right-wing cranks belittle modern, successful cities

      *standing ovation*

      Well done. A+

  9. From the consumption area, participants will be directed to the medically supervised observation room and offered on-site initiation of Medication Assisted Treatment (MAT), wound care, and referrals to primary care, social services, and housing opportunities. Upon arrival, participants may choose to go directly to the observation room to access MAT and other services.

    OK, so we successfully predicted that these SIF clinics were going to be co-opted by socialized medicine and social services… now how long before they become the 21st Century version of cooping?

    1. The Welfare Industrial Complex is totes libertarian

  10. I remember a medical talk on the opioid crisis. The speaker said something I took to heart. Opioids have a long track record of being used safely in hospitals and overdoses are very rare in an observed environment despite very frequent use. The speaker correctly said that Opioids aren’t deadly, the stigma attached to them is. Tainted meds, Shooting up in a bathroom, friends not calling the police because they’re afraid of being arrested: These things are deadly. Narcan is relatively cheap, easy to use, and simply reverses an overdose. Early on it saves lives. Too late, it’s no help. So, I’m going to say I’m in support of SIF clinics.

    1. People OD on opioids for two reasons, assuming they are not trying to kill themselves. First, they buy heroin off the street that is more pure than they thought and accidentally overdose themselves. Second, they kick their habit only to fall off the wagon and go back using thinking they have the same tolerance they had when they were hooked. They don’t and what is a good high to an addict kills someone who isn’t a user.

      They are also physically addictive as hell. But, if used correctly people have been addicts for decades without killing themselves. It is a shitty life even if doing it is legal. But, if the alternative is chronic pain, it is sometimes the best option available.

    2. e. The speaker correctly said that Opioids aren’t deadly, the stigma attached to them is.

      “The problem isn’t the drug or the drug users, the problem is other people. We need to re-engineer other people’s thinking.”

      Fuck that noise.

      1. You need to enable people’s vices. It is the only way to solve them. Didn’t you know that?

        1. In this case, it’s sufficient to not criminalize other people’s vices.

      2. “…Opioids aren’t deadly, the stigma attached to them is.”

        Libertarian toxicology.

    3. Opioids have a long track record of being used safely in hospitals and overdoses are very rare in an observed environment despite very frequent use. The speaker correctly said that Opioids aren’t deadly, the stigma attached to them is. Tainted meds, Shooting up in a bathroom, friends not calling the police because they’re afraid of being arrested:

      When Insite failed to reduce overall drug overdoses (in the long run- blamed on fentanyl), the suggestion eventually came around to what was predicted: That we start supplying the drug users with controlled opiods.

  11. “OK, so we successfully predicted that these SIF clinics were going to be co-opted by socialized medicine and social services…”

    Surprise, surprise, surprise!

  12. Not really sure the authority of the federal government to control in-state drug use facilities. This guy might not want to push his luck.

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  14. If they are going to do this, place the house next door to the governor’s home.

  15. How is addiction to anything good? Addiction is addiction. Treat those that are addicted with forced treatment. How is it my problem when a junky OD’s? We have tweekers and junkies stealing us blind and breaking into our homes. It is absolutely insane to support these SIF’s. They want it so bad, put it next to the governor’s home.

  16. Constitution Health Plaza announced late Thursday that the plaza was canceling plans to allow the nonprofit Safehouse to operate a supervised injection site on its premises in South Philadelphia.

    It remains unclear if Safehouse will continue to pursue a safe injection site in Philadelphia. The group did not immediately respond to a request for comment about the canceled plans to open at Constitution Health Plaza.

    Safehouse argues that allowing illegal drug use on its property will help prevent overdoses. Mayor Kenney, Philadelphia District Attorney Larry Krasner and former Pennsylvania Gov. Ed Rendell, who sits on Safehouse’s board, all support an injection site in the city.

    https://www.nbcphiladelphia.com/news/local/kenney-warns-of-deaths-as-safe-injection-site-plans-get-scrapped/2310106/

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