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Philadelphia Pushing Forward with Safe Injection Site Plans

Former Gov. Ed Rendell says he's willing to defy the feds and risk arrest to reduce overdose deaths.

Ed RendellSiavosh Hosseini/NurPhoto/Sipa U/NewscomDespite threats of federal prosecution, Philadelphia activists and public health experts are pushing forward with plans to build a safe injection facility (SIF)—a place where drug addicts can get their fix while being monitored for overdoses and can be directed to resources that can help them get clean.

San Francisco leaders had been hoping to build sites in the city by this summer. But fears of federal prosecution put the brakes on the effort, and then Gov. Jerry Brown vetoed a bill that would have shielded the workers from being prosecuted under state-level drug laws.

In Philadelphia, city leaders are getting a boost from former mayor (and former governor) Ed Rendell, who is throwing his support behind the effort. He even says he's willing to go to prison if the feds try to come for him. If he succeeds, the city will host the country's first SIF.

Philadelphia has some of the worst opioid overdose problems among all large American cities. It saw more than 1,200 fatal overdoses in 2017. Reason recently interviewed journalist Christopher Moraff for a street-level view. A SIF there would most almost certainly reduce the risk of overdose deaths.

Deputy Attorney General Rod Rosenstein has warned that anybody attempting to open an injection site risks getting busted under federal law. To that, Rendell says, essentially, Bring it on. He tells NPR: "I have a message for Mr. Rosenstein. I'm the incorporator of the safe injection site nonprofit, and they can come and arrest me first."

Rendell has experience risking arrest to push forward harm reduction policies. He supported the launch of needle exchange programs in Philadelphia in the 1990s to reduce the spread of HIV among drug users. When he signed the executive order authorizing needle exchange programs in 1992, he invited Pennsylvania's attorney general to come arrest him first. And it was one of the people running Philadelphia's current needle exchange program who approached Rendell to get him involved in starting an injection site. According to the Philadelphia Inquirer, Rendell agreed immediately.

That nonprofit is named Safehouse, and thus far it has raised $200,000. The Inquirer notes it will take $1.8 million to launch and operate a site for a single year and then $800,000 a year to run it thereafter. It doesn't even have a site location yet.

The city's leadership supports the facility, but it's leaving operations in private hands and says it will not use city money to help fund it. District Attorney Larry Krasner says he won't prosecute workers or volunteers there. CBS notes that the Philadelphia police commissioner is "not sold" on the SIF. But if Krasner refuses to prosecute them, there's not much he can do.

So that leaves Rosenstein and the Justice Department and his threats. We know through past studies that SIFs do reduce harms and overdose deaths and do not contribute to crime or encourage additional drug use. But there are many people like Rosenstein (and even old-guard Democrats like Brown) who can't accept the idea that reducing the harms caused by drug use is more beneficial than trying to force people to stop using drugs.

Photo Credit: Siavosh Hosseini/NurPhoto/Sipa U/Newscom

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  • MiloMinderbinder||

    It won't take federal criminal charges to shut this place down.

    Some junkie who gets a fix at the SIF is later going to OD and his grieving parents and estate are going to sue Rendell's non-profit out of existence

  • S.T. Greer||

    Any time you read that "we know" a number of social science facts as a consequence of "studies," the only thing you actually know is that you are being bullied by the writer.

    Social science cannot definitively establish that making it easier to use drugs does not increase drug use. The fact that the writer wants to pretend it can and already has only shows he can't be trusted, no matter how valid his position might otherwise be.

  • Hugh Akston||

    It's true. Unlike real science, social science can't prove a negative.

  • ThomasD||

    What we know is that such arguments are wholly unnecessary from a libertarian standpoint. I do not care if they do or do not save lives, such activities are not within the purview of the Federal government, so Rod needs to fuck off.

    Beyond that such arguments are counterproductive from a libertarian standpoint, as they imply that Utilitarian concerns might trump liberty (e.g. what if these 'studies' showed that SIFs made things worse?)

    Determinations of utility are best left to every individual.

  • ||

    The role prescription opioids have played in the overdose crisis has been misunderstood and exaggerated. As Jacob Sullum noted recently, the number of opioid users who ultimately become addicted any given year is relatively small (one to two percent) and the rate of fatal overdoses among users with prescriptions is even smaller. Scott Shackford, Associate Editor, Reason Magazine

    So, the problem isn't people and their choices to do drugs or OD, the problem is the Top Man and his solution.

  • BestUsedCarSales||

    It can be part of it, but if a Top Man is preventing access to safer form of a drug through governmental force, then it is absolutely reasonable to say they are a major part of the problem.

  • ||

    My point was rather that Scott wants it both ways. When the President says it's an epidemic and we need to commit funds, it's (rightfully) described as not a problem and being blown out of proportions in order to fuel the drug war. But when Seattle can't possibly shield and fund an SIF headed by an ex-Mayor, which is totally not crony capitalism*, the epidemic is something we should care about and really want communities to set up SIFs to combat.

    Here's an article from Sullum noting that the majority of overdose-related deaths are the result of multi-drug cocktails. Am I allowed to OD in an SIF if none of my drugs of choice are injectibles or will I be required to inject the ones that are and leave the rest with the coat check girl?

    *Non-profit, duh.

  • Cathy L||

    Dude, you're such a careful reader and follower of this story that you can't tell the difference between Seattle and Philadelphia.

    Please go fuck yourself and stop acting like Trump wants to spend money on something other than putting drug users in prison rather than making heroin available OTC as it should be.

  • ||

    Dude, you're such a careful reader and follower of this story that you can't tell the difference between Seattle and Philadelphia.

    Again the city, state, or leader matters not. The point is Scott isn't opposed to the nanny state, just the wrong kind of nanny state.

  • ThomasD||

    If do gooders want to (try to) do good who's to say it's any of my business?

    So long as they do not lift my wallet or otherwise seek to implicate me in their schemes I say have at it.

    But we all know that's the crux isn't it? These do gooders are not going to be happy doing this on their own, and the negative consequences that flow from them will never be placed at their feet.

  • ||

    They aren't do gooders. It's not like Rendell has been out personally handing out needles making sure that HIV+ drug users are getting all the clean ones. They're perceived do gooders.

    If there were really a profit in it, the needle program would be funding the SIFs but it's not. Especially considering that the overwhelming benefits ascribed to an SIF are from clean needles. It's an end run to implement healthcare under the guise of treating people who voluntarily consume their disease vector/intoxicant.

  • creech||

    Need a site NIMBY? How about City Hall courtyard where all the bus, trolley, subway, and rail lines cross right in the center of Philly? No residential area thereabouts, shielded from the view of those who are squeamish, and in the face of the bureaucrats who work in City Hall.

  • Diane Reynolds (Paul.)||

    and can be directed to resources that can help them get clean.

    I'm wondering if the strategy they're going to employ will be different than Vancouver's Insite. I'm trying to dig up the statistics but Insite's success with getting people through rehab successfully was depressingly low. So they end up with long time addicts on the street-- measured in years.

    Also, overdose deaths have gone up sharply in the years since Insite opened. There's debate as to where the blame lies, but it should be pointed out. People like to point out the study that appeared a year after insite opened which showed a 35% reduction of overdose deaths. But now that trend has reversed, and insite officials blame the arrival of Fentanyl.


    It doesn't even have a site location yet.

    That's always the tricky part.

    do not contribute to crime or encourage additional drug use.

    I'm not sure how that's calculated. Using Insite as the example, even supporters of the SIF conclude the neighborhood is an awful hellhole. Seattle officials have repeated said "Don't worry, we won't be like Insite". While it may not have increased crime, there's an argument to be made that they've condemned the neighborhood to permanent 'distressed' status.

  • albo||

    It doesn't even have a site location yet.

    That's always the tricky part.

    Take over an abandoned row home in Kensington. Cheap to buy, and that's where a lot of the addicts are.

  • BestUsedCarSales||

    There's a lot of fears here. And then again that they're targeting a very secondary issue with this particular wave of ODs. They're saying, let them OD, but let them do it under supervision and we can save them. Rather than more general questions about why ODing has gone up. I still think the solution is to just let people buy their drug of choice. They could get known quantities, quality, and purity and don't have to worry about being laced with more potent forms.

    Injection sites are a weird secondary solution. I don't mind them existing as a form of charity, but there's a lot of doubt on how much this will actually be charitably run in any case.

  • Cathy L||

    While legalizing drugs and ending black markets is the most important solution to these problems, safe injection sites are also significant and would be needed in the absence of black markets anyway.

  • Diane Reynolds (Paul.)||

    People are very concerned about "attracting" more of what you're trying to reduce or stop. Take this sentence:

    Because we now know that giving homeless people a free home is an effective tactic for eliminating homelessness, and is cheaper than caring for them on the street, the nonprofit also builds apartment complexes for the homeless , along with homes for low-income Seattleites.

    Come to Seattle, get a free house. Kayyyyyyyyy.

    By the way, the above link is a 2016 article. I believe their detailing the 'tiny house village' that Seattle just closed down. The reason they closed it down is crime in the neighborhood and calls to police shot up.

    The site was controversial from the beginning because residents are allowed to use alcohol and drugs, something not permitted at the other city-sanctioned encampments.

    [...]

    But it incensed residents of the surrounding north Seattle neighborhood; calls for police service on the block where Licton Springs sits spiked 62 percent in a year, according to a Seattle Times analysis.

    It's one of the trickiest political balancing acts. How do you give people real help, stop criminalizing them, but not draw the ire of your constituents if there's a serious negative side effect.

  • MatthewSlyfield||

    "Come to Seattle, get a free house. Kayyyyyyyyy."

    These are off grid tiny homes, on the order of 400 sqft or less, with a total build cost of around $2K a piece. With an median home value just under $800K in Seattle, these fishing shanties might as well be free.

    No one is going to be moving to Seattle to live in one of these things, but for the homeless already in Seattle, they are a big improvement over a cardboard box in an alley.

  • damikesc||

    ...but a bunch of free or heavily subsidized living in a city doesn't have a great track record of not turning into utter shitholes.

  • Diane Reynolds (Paul.)||

    No one is going to be moving to Seattle to live in one of these things, but for the homeless already in Seattle, they are a big improvement over a cardboard box in an alley.

    Not true. People at the lower end of the income spectrum have in fact been moving to Seattle from all over the country to "be homeless" here.

    ARE PEOPLE DRAWN TO OUR HOMELESS SERVICES?
    It would appear so. To take one local example, a man named Teman Crawford told KIRO in November that he came to Seattle from California because his friends called it the "land of opportunity."

    "There's a lot of angels up here. A lot of love. People buying people brand new tents, giving them blankets, putting food in their stomachs," he said.
  • Len Bias||

    "Teman Crawford told KIRO in November that he came to Seattle from California because his friends called it the "land of opportunity."

    Seattle may have surpassed the SF Bay Area in craziness. I always thought of Seattle as a sane alternative if things get too crazy here, but not anymore.

  • Cathy L||

    So...not to live in one of the tiny houses, but because people in the area are charitable.

    Let's hear about your campaign to ban people from donating money to panhandlers.

  • DesigNate||

    Set them up in the parts of town that are already run down? Like old abandoned warehouse/industrial districts.

  • Mickey Rat||

    There is also the problem that all you are doing is facilitating self destructive behavior by making any particular instance marginally safer, but encouraging more of it as a result.

    The problem.is that you cannot make people who no longer care about themselves, do so. You can encourage them to, but the final decision is theirs.

  • Cathy L||

    From the OHTN report linked from Sullum's September 5 post:

    Petrar et al. found that among Insite users whose injecting behaviour had
    changed as a result of accessing Insite, 71% reported fewer public injections and
    56% reported less unsafe needle disposal (5). Another study found that the
    opening of Insite was independently associated with reductions in public injecting,
    publically discarded needles, and other injection related litter in Vancouver's
    downtown east side (40). In this observational study, an average of four injections
    were observed daily in public spaces prior to the opening of Insite, followed by
    only two after the opening (40). Similarly, 12 needles were found discarded in
    public spaces each day before the facility opened, followed by five after it opened
    (40). Respondents to a survey about SISs in Europe also believed that the
    facilities had reduced the incidence of public injecting and injection litter (2).
  • Cathy L||

    Additionally:

    There was no evidence of increased rates of robbery, theft, drug-related loitering
    or drug-related criminal offences in the surrounding neighbourhood following the
    opening of the Sydney Medically Supervised Injecting Centre (41). Five years after
    its opening, local business owners reported a significant decrease in public
    injecting or publically discarded injecting equipment, and no change in offers of
    drugs for purchase in the neighbourhood (42). Similarly, SISs in Switzerland and
    Germany have reported reductions in the visibility of their public injecting scenes
    (1). Respondents from surveys in six of 15 neighbourhoods with SISs in Europe
    perceived an increase in drug dealing in the vicinity of the facilities or incidents of
    violence in the neighbourhood (2).
  • Diane Reynolds (Paul.)||

    It should be noted that studies on this subject are marked by a widespread reluctance on the part of researchers to causally attribute any increases or decreases in drug-related crime to the opening of an SIF.

    The literature reveals a complex web of interconnected factors, any or some of which, in isolation or combination, could contribute to changes in drug-related crime.

    Most studies noted the role of police activity, in particular.

    For example, a law enforcement "crackdown" on public drug use or dealing might coincide with the opening of an SIF.

  • Diane Reynolds (Paul.)||

    (Indeed, in some cases it was observed that police strategically increased this enforcement, as an incentive to drug users to avail of the injection centre, rather than face arrest for public drug use).

    This increased police activity is very likely to manifest itself as an uptick in the number of arrests and charges for drug-related crime.

    If this happens after the opening of an injection centre, it could lead to the false conclusion that the opening of the injection centre was the cause of the increase.

    Similarly, the availability of certain drugs (particularly heroin) in a certain area, can have a bearing on drug-related crime.

    A heroin shortage, such as that seen in Australia in 2000-2001 , is very likely to lead to a decrease in public drug dealing and drug use (and therefore associated arrests).

    If this happens around the same time an SIF is opened, it could lead to the false conclusion that the opening of the SIF was responsible for the reduction.
  • Cathy L||

    So, you have some general caveats about study methodology and no evidence that there is increasing crime rather than decreasing crime or no effect on crime. Well that was enlightening.

  • Hugh Akston||

    Insite's success with getting people through rehab successfully was depressingly low

    Also, overdose deaths have gone up sharply in the years since Insite opened.

    People like to point out the study that appeared a year after insite opened which showed a 35% reduction of overdose deaths. But now that trend has reversed, and insite officials blame the arrival of Fentanyl.

    Using Insite as the example, even supporters of the SIF conclude the neighborhood is an awful hellhole.

    Not that we don't trust assertions that you whip out of your ass, but do you have any evidence to back up these claims?

  • Diane Reynolds (Paul.)||

    Although Insite is paired with a drug-treatment center, called Onsite, Berner and other critics point out that completion rates are low. Of the 6,500 people who visited Insite last year, 464 were referred to Onsite's detox center. Of those, 252 finished treatment.

    And...

    Coroners spokesperson Andy Watson says last month's numbers were higher compared to last year.

    "[There was] a 12 per cent increase in the number of deaths occurring between July of 2017 and July of 2018," Watson said.

    With the NDP government ramping up access to naloxone and addiction programs, Watson can't pinpoint the reason for the spike in deaths.
  • Hugh Akston||

    One link out of four ain't bad, I guess. Especially if that link reminds us that correlation isn't causation.

  • Diane Reynolds (Paul.)||

    Did I hear a bell, 'cause someone just got schooled.

  • Diane Reynolds (Paul.)||

    "To say that there are not hurdles is not true," Finegood added. "We want to be mindful of the community impact."

    Although the Insite center is a model, the Vancouver neighborhood surrounding it is nothing to emulate, advocates acknowledged.

    "If I came from a city like Seattle and I went to that Insite place, it would scare the hell out of me," Kral said. "I would think, 'Are we going to create one of those?' 
    "
  • Cathy L||

    Sounds like more than half of detox patients finished treatment. Is that low? It doesn't seem low to me at all.

  • Hugh Akston||

    there's an argument to be made that they've condemned the neighborhood to permanent 'distressed' status.

    permanent

    permanent

    Permanent

    PERMANENT

  • albo||

    Since industry left in the 1980s, Philly has been successful built a robust tourism and convention sector. Having a junkie magnet there won't sit well with the town's business community.

    Rendell is a hot air balloon and Mayor Kenney is an inebriated empty suit.

  • Fist of Etiquette||

    Deputy Attorney General Rod Rosenstein has warned that anybody attempting to open an injection site risks getting busted under federal law.

    But to be fair, almost anybody doing almost anything risks getting busted under federal law.

  • colorblindkid||

    This is one of those things that remains highly unpopular but is a good policy, and why I'm a libertarian. Three big issues that libertarians stand basically alone on are this, the elimination of the sex offender registry, and the decriminalization of sex work. All bipartisanly unpopular positions, but ones that in a few decades will be judged to be the correct ones.

  • DesigNate||

    I look forward to all the future supporters of our current positions trying to make it sound like they are the champions of these issues and that libertarians are unserious misogynistic racist who only care about money.

  • Sevo||

    From the Rendell link:

    "They say if getting people like Ray off the streets and into a medical facility means defying the Trump administration, so be it."

    Gee, it was safe to do this until that big poopyhead was elected!

  • Robert||

    Why are such facilities needed if syringes are now OTC?

  • Cathy L||

    The point isn't needle exchange but to have a safe location to inject drugs.

  • damikesc||

    Should we next hire medical professionals to insure they're injecting properly?

  • Hugh Akston||

    Try reading the first paragraph of the article again, slowly. Sound out each word if you need to.

  • damikesc||

    Given how well they managed Gosnell's practice, I bet this site would be completely awesome and all.

  • ||

    It's practically incentivized to make sure that Johnny Trustfund, who wants to spite his Dad, gets a different level of care than Joe Smackaddict, who walks in off the street with no next of kin and uses just to get from one day to the next.

    Not saying I'm against the disparate treatment, just that it will do little to assuage drug warriors or people who believe in equality (of outcomes).

  • Cathy L||

    Jesus christ what the fuck do you even think you're talking about

  • Cathy L||

    Ed Rendell's safe injection nonprofit managed Kermit Gosnell's medical practice? That's pretty weird.

  • damikesc||

    The state is supposed to examine sites to insure that they are safe and clean and all.

    But when it's a progressive sacred cow, they tend to, well, be a little strenuous.

  • Rich||

    Ed Rendell ... says he's willing to go to prison if the feds try to come for him.

    "It can be arranged."

  • Fred Zuccini||

    Rendell going to prison wouldn't be the worst thing that could happen.

  • Dillinger||

    safe location to inject drugs does not compute three times over.

  • Cathy L||

    Why? Does safe location to drink alcohol similarly not compute?

  • sharmota4zeb||

    Meh ... how is this news? My mom's been abusing pain killers ever since that cop across the street started that rumor.

  • DonHonda||

    From one of the most liberal news sources:

    vox dot com /science-and-health/ 2018/8/22/17683364/ safe-injection-sites-study

    Safe injection sites were thought to reduce drug overdoses. The research isn't so clear.

    A new meta-analysis reviewed the evidence on safe injection sites. There's bad news.

    cbc dot ca /news2/interactives /portugal-heroin-decriminalization/

    How Europe's heroin capital solved its overdose crisis

    What Canada can learn from Portugal about opioid addiction, rehab and recovery

    ---No "safe" injection sites

    ---Drugs decriminalized as in personal possession is now a civil violation

    ---Growing, pushing, selling, trafficking of drugs is still penalized harshly

    ---Mandatory drug rehab treating as an illness and health problem

  • Number 2||

    "Mandatory drug rehab treating as an illness and health problem"

    So, in Portugal, if you are caught possessing a controlled substance , instead of being arrested, you are compelled to attend mandatory drug rehab and told that you have an illness?

    What is an enlightened policy that is! Labeling people as I'll and forcing them to undergo medical treatment against their will – – what could possibly go wrong?

  • jdgalt1||

    What would help more is for at least one state to push back against the current hysteria about a so-called crisis of opioid abuse by legalizing over-the-counter sale to adults of opioids made within that state (and thus not part of interstate commerce). If the feds try to prosecute it would give that state an opportunity to get Wickard v. Filburn overturned by the new Supreme Court, which needs to happen.

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