By Lise Millay Stevens
On Tuesday, Philadelphia took the seminal step of authorizing medically-supervised facilities where people are permitted to inject illicit drugs, according to a report by the Philadelphia Enquirer. The sites, dubbed Comprehensive Engagement Sites, will be equipped to revive individuals if they overdose by administering naloxone and guide people with substance use issues into treatment. The city will not be responsible for establishing these areas, but will encourage private entities to do so.
Approximately 1,200 Philadelphians succumbed to drug overdose in 2017, the highest death toll of any U.S. city, and distributed 21,700 doses of naloxone last year, which likely prevented further overdose deaths. The burgeoning drug problem spurred the city to explore new options for stanching the flood of destruction.
“We are facing an epidemic of historic proportions,” Philadelphia Health Commissioner Thomas Farley commented. “The people in the city of Philadelphia, our brothers, our sisters, our parents, our children, are dying. And they don’t need to die.” He added, “…we have an obligation to do everything we can to prevent those people from dying.” The Commissioner stressed that the move is just one element in a comprehensive plan to combat the opioid epidemic in the city.
Philadelphia officials estimate that a single safe injection site would save 25 to 75 lives annually along with millions of dollars in public funds and hospital expenses while keeping neighborhoods free of people injecting drugs in public. The Inquirer reports that the idea gained momentum after visiting a similar site in Vancouver and studying data from Canada and Europe.
According to a 2017 article in The Guardian’s U.S. edition, Vancouver established the first safe injection site in North America, called Insite, in 2003. According to information posted by Insite, the injection locations operate under a Health Canada exemption from prosecution under federal drug laws. The benefits to the community, Insite indicates, are that the sites:
Insite claims that since opening in 2003, more than three million people have passed through its doors, some of whom dropped in simply to access health care services such as counseling and information about available detox programs. By 2015, the staff of 10 had intervened in 4, 922 overdoses without a single death. According to Insite, the presence of safe injection spaces “does not lead to increased drug use or crime but instead offers a unique means of building relationships while saving lives, preventing the transmission of HIV and hepatitis C, and spurring more people into detox programs.”
The success of Vancouver’s program led Montreal to open the first mobile supervised injection clinic in North America, and the approval of sites in Toronto and Surrey. However, Insite reports, new government legislation has “made it more onerous to open safe injection sites, with demands that included multiple letters of support, reports detailing statistics on crime and HIV rates and background checks for staff members.”
The restrictive legislation seems counter-intuitive as the mortality from overdose deaths in Canada spiked in 2017 as fentanyl – a drug 50 times stronger than heroin – and other synthetic opioids become widely available. In fact, the mounting death toll of 935 in British Columbia led that provincial government to declare a public health emergency in April of 2016. Other provinces in Canada witnessed similar spikes in 2016 and 2017. Opening more safe injection sites could save lives and help people to seek substance use treatment.
“My hope is that eventually this would be normalised [sic], available to everybody that needs it and just part of routine care,” said, Scott MacDonald, the lead physician at one of the safe injection clinics. “But that’s going to take some time.” He added. “And some of that’s discrimination, some of that’s fear. But with time, with the overwhelming quality and depth of evidence, it’s going to happen.”