“People know that our shower list fills up quickly,” Beddis said. She says the drop in center is one of only two places unhoused people in Kensington can consistently take a shower. Visitors can also pick up safer use supplies like drug testing strips, get clean clothes and snacks, or simply hang out—lounging and chatting under the center’s neon purple lights and framed posters of the Philadelphia Eagles. 

“It really is a community,” Beddis said. “If somebody spills their coffee, we have our regulars that will jump up and be like, ‘Just give me the mop. I’ll take care of it,’ you know what I mean?”

Kensington and the people who live, work, and use drugs in this small neighborhood on the city’s northeast side have drawn scrutiny in the run up to Philadelphia’s May 16 Democratic primary, which will likely decide the city’s next mayor.

In a tightly-run race animated by issues of crime and public safety, debates on substance use have honed in on Kensington’s opioid crisis and significant unhoused population. All five of the leading candidates say the city needs to end what’s widely described as an “open-air drug market” and increase policing in the neighborhood. At least two of these candidates also propose raising the police budget. 

But local critics of a law enforcement-first approach to substance use worry that it may elevate overdose risks and perpetuate harm against people who use drugs, especially in Black and Latinx communities that already experience more policing. Instead, they hope the city’s next mayor will embrace harm reduction—a set of public health and social justice strategies aimed at protecting the dignity, autonomy, and rights of people who use drugs.

The city government’s response to substance use and the overdose crisis has thus far involved a complex patchwork of departments including police, public health, behavioral health, and homelessness services, and dozens of others, with guidance from the mayor’s office. Meanwhile, grassroots organizers in the city are locked in a years-long battle with state and federal officials to create a space for safer drug consumption. The proposal, championed by a nonprofit called Safehouse, has enjoyed some support from city officials since 2018 but has been delayed by lawsuits and now state legislation, even as similar sites have appeared in New York City. 

The next mayor will oversee the city’s response to the ongoing overdose crisis and shape its policies, wielding powers like its budget proposals, executive orders, or appointing the police commissioner. The mayor’s position on an overdose prevention site may also make or break the proposal in light of some state politicians’ ongoing efforts to preempt the sites. 

“The next mayor must take research about the effectiveness of harm reduction techniques seriously,” said Shoshana Aronowitz, an assistant professor at Penn Nursing who studies racial equity in substance use treatment and works with several harm reduction organizations across the city. 

A skyrocketing overdose crisis

Over 1,200 Philadelphians died of accidental overdoses in 2021—the highest number ever recorded. The potent opioid fentanyl has found its way into stimulants such as methamphetamine and cocaine, and an increasingly unpredictable drug supply, plus a lack of adequate prevention resources are driving up overdose rates citywide, especially in its Black and Latinx communities. A 2021 city report recommended using the phrase “overdose crisis” rather than “opioid crisis” to more adequately capture this impact. 

Much of Philadelphia’s current response infrastructure dates to 2017, when Mayor Jim Kenney convened a task force to determine how to “combat the opioid epidemic in Philadelphia.” The task force’s final report called for easier access to medication assisted treatment, in which doctors prescribe drugs called methadone and buprenorphine to relieve withdrawal symptoms and reduce the risk of overdose. It also advocated increasing access to naloxone, which can help reverse overdoses, expanding drug treatment court, and providing additional resources for housing and jobs training. 

As fatal overdose rates continued to increase, however, Kenney declared an “opioid emergency” in Kensington and directed law enforcement to reduce “open-air drug use and sales.” Since then, the police have increased foot patrols in the neighborhood, seizing cash and drugs and making over 2,500 arrests in 2022 alone.

Since 2020, a harm reduction program within the city’s department of public health has been distributing naloxone and fentanyl test strips through street-based outreach and training Philadelphians on how to spot and reverse overdoses. The city also funds some of the work of a Kensington-based harm reduction nonprofit offering syringe exchanges. And the department of health has committed to reducing overdoses that involve stimulants 20 percent by the end of 2023, according to its strategic plan. 

All five leading mayoral candidates have expressed some vision of treatment for people who use drugs, but Rebecca Rhynhart and Helen Gym’s proposals most resemble this existing plan. Both have expressed support for medication assisted treatment. 

A spokesperson for Gym’s campaign told Bolts the candidate would “improve prevention, [drug] testing, and treatment outreach,” especially in “underserved Black communities in North, Southwest, and West Philadelphia, where overdose rates are rising.”

Candidate Jeff Brown has advocated for drug treatment through the criminal legal system. 

“Drug court [is] a very effective way to have a good outcome, because you monitor their substance use. If they fall off the wagon, they have a choice. Do you want to go to jail for your crimes, or do you want to go back to treatment?” he said at a recent candidate forum about public health.

But Aronowitz warns that not all treatment options are created equal. “We know what doesn’t work,” Aronowitz said, “And that is expecting people to just quit cold turkey and be fine, because we know that that’s associated with extreme overdose risk.” 

“When a politician says we need more access to treatment, that’s not enough,”she continued. “We need to know if they’re going to fund the things that work and defund the things that not only don’t work but are potentially harmful.” 

The battle over Safehouse

Advocates doing harm reduction work in Philadelphia are pushing the city government to expand its focus on keeping people alive, beyond offering treatment, and they have fought to establish an overdose prevention site in Philadelphia, an effort the city government nominally supports. Such sites, also known as safe drug consumption sites, are places people can use pre-obtained drugs more safely, in the presence of staff trained to spot and reverse overdoses. 

As of July 2022, more than 120 overdose prevention sites existed in ten countries across the world, and no fatal overdoses had ever taken place in one. But they remain controversial in the United States. So far, only two such sites exist in the country, both in New York City, where staff have reversed more than 700 overdoses in the less than two years since they were created. Rhode Island legalized the creation of a pilot site in summer 2021 and is set to open one in early 2024. California governor Gavin Newsom last year killed legislation that would have allowed San Francisco, Oakland, and Los Angeles to establish their own sites. 

In Philadelphia, efforts to open such a site have been caught for years in a protracted battle pitting harm reduction advocates and some city officials like DA Larry Krasner against the U.S. Justice Department, some state politicians, and opponents in law enforcement, business, and residential communities across the city. 

The struggle dates to a recommendation from Mayor Kenney’s 2017 opioid crisis task force to explore creating a space for safe consumption. In 2018, a nonprofit called Safehouse launched with the aim of opening a site in the city. But soon after, a U.S. Attorney appointed by President Donald Trump sued Safehouse invoking a federal law which prohibits “maintaining drug-involved premises” where criminalized drugs are manufactured, distributed, or used. 

In February 2020, the federal judge’s ruling in Safehouse’s favor led the group’s leaders to announce the site’s imminent opening in South Philadelphia. But after vehement opposition from neighbors, the plans folded in just two days. In 2021, a federal appeals court reversed the ruling that had cleared the way for Safehouse to open, relaunching the legal battle.

The plan remains uncertain at this time. Settlement talks between Safehouse and the U.S. Justice Department have been ongoing for over a year. Local opposition exploded last month, when a group including the police union and business associations filed a petition to step in as party plaintiffs in the lawsuit, fearing that the Biden Administration would reverse its position. 

Opponents to the site scored a decisive win earlier this month when Pennsylvania’s state Senate voted to ban overdose prevention sites anywhere in the state on a bipartisan 41-9 vote.

The bill was sponsored by Democratic Senator Christine Tartaglione, whose district includes parts of Kensington. She told The Philadelphia Inquirer that she opposes “prolonging and allowing a system of state-sponsored addiction in Pennsylvania.” 

The bill now sits in the state House’s Judiciary Committee. If it passed the chamber, it would move on to Governor Josh Shapiro, a Democrat who has indicated he opposes safe consumption sites.

Meanwhile, five Philadelphia city council members introduced a local bill on May 11 that would prevent an overdose prevention site from being created anywhere in their districts, an area amounting to about half the city. Councilmember Quetcy Lozada, whose district includes Kensington, led the effort, saying that such a site would only worsen the neighborhood’s struggles with drug consumption. 

“We cannot continue to allow them to find ways where they can continue to remain in the same cycle,” she told Inquirer. The bill would still need to get a committee hearing and be voted on by the entire city council—a process that may not happen before the council’s summer recess beginning in July—before going to the mayor to be signed. 

In public statements and court filings, Kenney’s administration has supported efforts to open an overdose prevention site, and remains supportive even in light of the new city and statewide bills. Whether the next mayor supports Safehouse would likely be critical to its chances given that the proposal is assailed from many quarters.

Among mayoral candidates, Helen Gym, a former teacher and city council member embraced by activists on the left, is the only one to have directly stated support for an overdose prevention site, though she did so before the protracted legal battle over Safehouse. 

“[Safe injection sites] are among the most promising new approaches to come forward while we work to end the opioid crisis. I support establishing one in Philadelphia,” Gym said in 2017. Her statement at the time added momentum for the proposal by giving it a prominent supporter on the city council. Gym has recently offered more circumspect answers in public comments, and did not respond to Bolts’ question about whether she currently supports opening a site in the city.

Another leading candidate, former city controller Rebecca Rhynhart, expressed measured support for the proposal. “I won’t take a tool that experts say saves lives off the table,” she told Bolts. “But I would not put a safe injection site in any neighborhood that does not want one.”

“I think that the debate over safe injection sites in Philadelphia has clouded the bigger issue which is what is the comprehensive plan for dealing with the opioid crisis in our city,” she added. 

Three other major contenders—real estate mogul and former councilor Allan Domb, grocery store magnate Jeff Brown, and former councilor Cherelle Parker—all oppose the sites. Parker has been a strident opponent since Safehouse’s efforts to open a site in early 2020, when she participated in the city council’s mobilization against the opening. 

“We should not be participating in a ‘I know what’s best for you’ decision making where we use safe injection sites as solutions,” Parker said in a debate on April 18.

Policing a public health crisis

The role of policing has proved broadly divisive in the mayoral primary, and yet the five leading candidates support increasing police presence on the ground in Kensington, distancing themselves from advocates who worry it would exacerbate criminalization. 

Gym and Rhynhart each said they would do so by reallocating existing police funds to prioritize Kensington, while increasing the police budget overall is a central component of both Domb and Parker’s platforms.

A spokesperson for Gym’s campaign told Bolts the candidate will take a “public health and resident-focused, community-led response,” mentioning a focus on neighborhood improvements, trauma support, and mobile crisis units, but did not detail how increased policing will fit in. 

Rhynhart’s campaign website states that she will attempt to disrupt public drug use by focusing on dealers, with a mix of warnings for “non-violent dealers” and arrests for “those committing violent acts.”

Sheila Vakharia, who helps lead research at the Drug Policy Alliance, warns that the line between people using drugs and people selling drugs is much more fluid. 

“There’s this idea that there is this big bad demon-ish seller and this poor victim user and oftentimes the seller is racialized. The victim is also racialized, but differently,” Vakharia said. “And oftentimes all of this can create heroes and villains.”

To both Aronowitz and Beddis of Savage Sisters, ending the overdose crisis requires a solution beyond what has been proposed by any candidate in the Philadelphia mayor’s race: addressing the toxicity of the criminalized drug market. They argue instead for access to a safe supply of criminalized drugs in a way that clinical and community-led programs have modeled across Europe and Canada, but which has not been piloted in the U.S.

“The way we regulate alcohol is safe supply,” Aronowitz said. “We make sure it’s not poison, and that when you take a drink, you can reliably know how much alcohol is in it.” 

But even if those goals are still far off, at the very least, they say, the city government should meet communities impacted by the overdose crisis with resources and care—not criminalization.

“Our friends have necrotic limbs. Can’t access treatment. Can’t access housing. Can’t access compassionate pain management. Can’t even get a shower,” Savage Sisters’ founder and executive director Sarah Laurel wrote on LinkedIn last month.

“It’s time we respond to this public health crisis accordingly.”

The post How Will Philadelphia’s Next Mayor Tackle the Overdose Crisis? appeared first on Bolts.

The existence of these providers, authorized by a 2016 law, serves as a recognition by the state that promoting safer drug use can reduce one of the nation’s highest overdose mortality rates. Advocates for harm reduction have also warned lawmakers that this first step is far from adequate.

For one, the program has been embraced by leaders mostly in Maryland’s more urban counties, preserving barriers to safer drug use in rural areas. Even then, participants are only shielded from arrest and prosecution if they constantly carry a small card proving they’re registered in the program.

Otherwise, getting caught with a syringe or other tools to consume drugs in Maryland can lead to a felony charge and up to four years in prison; lesser paraphernalia charges can still carry hundreds of dollars in fines—not to mention collateral consequences associated with incarceration, court debt, and a criminal record. 

“We are calling it a health crisis on the one hand, but on the other we are treating it as a criminal offense,” Marguerite E. Lanaux, lead public defender in Baltimore, told Bolts. 

While over most of the past decade officials in Baltimore ruled out charging people for low-level drug offenses, the new state’s attorney rolled back those policies earlier this year, worrying local reformers about the future of prosecution in Maryland’s largest city.

Making people register with a government-sanctioned program to obtain safe supplies is no solution, said Harriet Smith, director of education and services at the Baltimore Harm Reduction Coalition, during her testimony at a statehouse hearing in February. “You can’t lose the card and you have to keep it on you at all times. You have to hope that the police officers in your area will trust that the code on the back of the card corresponds to you and not someone else,” Smith told state lawmakers. “I don’t know about y’all, but I lose business cards constantly—and I’m not experiencing homelessness. 

She added, “Requiring people to keep a tiny piece of paper and find it during a tense interaction with law enforcement interactions is unreasonable and a deterrent to taking part in this public health program.”

Smith and other harm reduction advocates had gathered at the state house to support House Bill 173, a proposal to lessen criminal penalties for drug paraphernalia. The bill proposes to cut maximum penalties for possession of “controlled paraphernalia”—defined in the bill as syringes, needles, gelatin capsules, glassine envelopes and various chemical agents meant to dilute or enhance drugs—down from four years to one, and from a $25,000 fine to a ceiling of $1,000. 

The bill also clarifies that such charges only apply to people manufacturing or selling drugs, as opposed to people who simply use them. However, Smith noted that the distinction is often blurry, since many who use drugs also sell them.

Sponsoring the paraphernalia bill is state Delegate David Moon, a Democrat and self-described civil libertarian who ran for office in part because he wanted to decriminalize drug use. Frustrated that in Maryland, and so much of the country, those working to treat substance use as a health issue and not a criminal one must settle for baby steps, Moon confesses that he believes his own bill doesn’t go far enough; he’d prefer total decriminalization of paraphernalia meant for drug use. 

“I need to get the votes to pass it,” Moon told Bolts. “Unraveling the drug war, unfortunately, does not move at the pace I would necessarily move at in our state.”

Even in more liberal states, people like Moon often find it painfully difficult to sell people in power on the concept of harm reduction, a broad set of strategies meant to help people who use drugs stay alive and as healthy as possible. Advocates say they don’t seek to enable drug use but rather to build a society more conducive to safety and addiction recovery.

The approach is backed by piles of research from all over the world: studies consistently show that providing safe drug-use supplies and safe places to consume drugs saves lives and prevents disease. Conversely, research shows that criminalization is ineffective—and in fact counterproductive—as a strategy to cut down on drug use and on overdose deaths.

“This is a health crisis. This is not a criminal justice or criminal legal crisis we’re in. Other countries get it and we just don’t,” Nicole Hanson-Mundell, who works on re-entry for formerly incarcerated people as executive director of the Maryland organization Out For Justice, told Bolts. “It’s incredibly harmful for this country and this state to continue this practice of incarceration as the only tool to teach a lesson or help someone understand or hand down a consequence. It’s really lazy policy.”

Smith said that in her experience, it’s not enough to present lawmakers with evidence of harm reduction’s public-health benefits.

“The lessons we grow up with, what we’re inculcated with in terms of the myths of drug use, those are just as strong as studies,” she said. 

Harm reduction has gained some traction in American halls of power and is even now endorsed by President Joe Biden, a leading architect of the country’s “war on drugs” while a U.S. senator. But groups working to make drug use safer remain chronically underfunded, and, as Moon has found, even the most modest legal reforms in this area can be heavy lifts.

Every state but Alaska criminalizes drug paraphernalia in some form. In a majority of U.S. states, life-saving fentanyl test strips remain illegal. (Maryland legalized them in 2018.)

Proposals to operate supervised drug-use sites have ignited political firestorms, even in some of the most progressive-leaning places in the country. Democratic California Governor Gavin Newsom last year vetoed a bill to allow supervised drug injection sites, and a 2019 effort to legalize those sites in Colorado flamed out right after launching and is only now being rebooted. Advocates in Maryland are hoping these sites will one day be legalized in the state, but their political path is far from clear.

Even the paraphernalia policy Moon himself calls inadequate has been stalling for years in Maryland. In 2021, a similar bill made it all the way to the desk of then-Governor Larry Hogan, a Republican who had signed the earlier bills to legalize test strips and to set up the syringe services, but Hogan vetoed it because, he said, it was “dangerous” and would facilitate drug use and sales.

“I’m on year nine doing this crap,” said Moon, who was first elected in 2014. “People die, and we fail to reduce intravenous disease transmission.”

Though the bill is not as ambitious as Moon would like, many regard it as an important step. HB173 is endorsed by a wide range of public health groups, among others, and Moon is confident it’ll pass the legislature, as it did last time. (The bill cleared the House on March 2 and now sits in the Senate.) Unlike Governor Hogan, new Maryland Governor Wes Moore, a Democrat, has been outspoken in support of alternatives to incarceration, and would be expected to sign the bill into law.

Lanaux, the public defender in Baltimore, said policymakers evaluating HB173 should consider the way paraphernalia possession is actually charged. It leaves no question as to whom this statute is meant to target, she said.

“At the end of the day, if paraphernalia is the charge, the person being charged is a user, not a dealer,” Lanaux told Bolts. “Dealers are charged with more serious offenses. So, this is not addressing drug dealing. It is punishing users.”

Lanaux and other public defenders told Bolts they believe that people in rural areas will continue to face disproportionate hurdles to safe use, even if Moon’s bill passes. In addition to the fact that most safe-supply providers are in the more populous counties of Maryland, the crisis of overdose deaths is a relatively fresh one in rural and suburban areas of the state; substance-use deaths have tripled, or more, in many places that a decade ago suffered only a handful of them every year. 

Smith said HB173 plays an important part in reducing stigma around drug use, particularly in areas where the overdose crisis is relatively new.

“I think it will mean that people are much more likely to grab supplies for their loved ones,” she said.

Baltimore has long been home to a plurality of substance-use deaths in the state, but prosecutors lately haven’t been as hard on people dealing with addiction. The state’s attorney in Baltimore for the past eight years, Marilyn Mosby, had adopted a presumptive do-not-prosecute approach to low-level offenses such as paraphernalia possession. 

“If you go to some of the outer counties, the ones further out are always going to continue to prosecute” for paraphernalia as long as the option remains, said Joshua Speert, acting district public defender for two counties west of Baltimore. “Other counties didn’t stop charging small theft or drug possession just because Baltimore did.” 

Ivan Bates, the new lead prosecutor of Baltimore who ousted Mosby in the summer of 2022, has reversed her approach. He announced earlier this year that he was rescinding Mosby’s policies of declining to charge some low-level cases and would instead ramp up the prosecution of “quality-of-life offenses.”

Bates’s office did not respond to a request for comment on how it will approach paraphernalia cases going forward in light of its opposition to declination.

Moon and others wish the state would simply eliminate the option of prosecuting paraphernalia possession by people dealing with addiction issues, and thereby start to create some parity among counties’ respective approaches to drug use and treatment.

“If it can be charged,” Speert said, “it’s gonna be charged.”

The post Maryland Inches Forward on Harm Reduction to Fight Overdoses appeared first on Bolts.

At first glance, a Dutch safe consumption site looks like any other clinic. Patients walk into a sterile medical environment and are taken to a cubicle with a sink to wash their hands. From there, they approach a metal table, where they take illegal drugs, under supervision from trained medical professionals.

Each of the more than two dozen safe consumption sites across the Netherlands provide a hygienic, judgment-free space where drug users, typically five at a time, can bring their drugs and consume them without having to worry about legal repercussions while under the care of medical staff who help minimize risk. 

“Suddenly, people that are normally out on the street who are completely alone and isolated find a place where they actually have a connection,” says Roberto Pérez Gayo, a policy officer with Correlation European Harm Reduction Network, and coordinator at International Network of Drug Consumption Rooms. His research into dozens of safe injection sites has found that, besides protecting people’s lives who may otherwise overdoses, these spaces can also at their best provide other services that meet clients’ various needs in tandem: addiction, the need for housing, medical care and mental health challenges.

Safe consumption sites have helped the Netherlands reduce overdose deaths since a peak in the 1980s, and the nation has since become a global leader in the movement for safe consumption. But as overdose deaths spike more than 5,000 miles away in California, Governor Gavin Newsom just this August killed legislation that would have allowed cities to set up similar safe consumption sites. 

Newsom vetoed Senate Bill 57, which would have created a pilot program allowing Los Angeles, Oakland, and San Francisco to open safe, supervised spaces for people to use drugs without violating state law. After his predecessor vetoed a similar measure, Newsom told voters during his 2018 campaign that he would be “very, very open” to safe consumption sites if elected. But in a letter explaining his own veto this year, he claimed that opening the sites “could induce a world of unintended consequences,” such as “worsening drug consumption issues.”

However, study after study has found the opposite; that offering people a safe place to use drugs can significantly improve public health. Indeed, there has never been a reported overdose death in any official safe consumption site in the world. Advocates for harm reduction in the Netherlands say the country’s experience shows the importance of working collaboratively with policymakers, law enforcement, city leaders and most importantly, local residents to create places where potentially harmful drugs can be used safely. 

Machteld “Mac” Busz is Executive Director of Mainline, a quarterly magazine and advocacy organization that was founded in 1990 on the principle of harm reduction, encouraging the safer use of drugs instead of abstinence, and advocating for the treatment of addiction through a public health approach instead of incarceration. 

“We know that [safe consumption is] going to prevent all sorts of infectious diseases. It improves people’s quality of life, and it reduces overdose death,” said Busz.

While the Dutch have famously tolerated cannabis use and in the 1970s decriminalized use of many hard drugs, few services existed for those seeking to consume drugs safely at the height of the crisis in the mid 80s. An estimated 25,000 people used regularly, sometimes in public, and often shared needles, which littered parks and city streets. HIV spread to as many as a quarter of the country’s intravenous drug users; overdoses were a top health concern and drug-fueled street crime was rampant. 

On display in the hallway leading to Mainline’s offices is one portion of a multipart photo exhibit “House of HIV” exploring the HIV epidemic through the lens of the communities affected by it, created on the 40th anniversary of the first reported case of HIV in the Netherlands. 

House of HIV chronicles how activists mobilized to distribute clean needles and methadone, educating users about high-risk behavior. One black and white photo shows an activist giving a police officer a copy of Mainline, part of a years-long campaign to convince officials to abandon the criminalization of addiction for a harm reduction approach. Law enforcement officials went on to become important advocates of harm reduction and safe consumption sites, Busz says. 

After a decade of advocacy from organizers and lawmakers, the Netherlands authorized safe consumption sites in 1996. By 2019 there were 37 operating across 25 cities, the highest concentration in the world. 

While selling drugs like heroin remains illegal today, drug users in the Netherlands are met with resources, not incarceration. The sites offer access to clean needles and alternatives to heroin, such as methadone, as well as educational materials about harm reduction, social services, housing and healthcare. Proponents say this approach is responsible in part for the Netherlands having a tenth of the overdose rate that exists in the U.S., as well as a far lower crime rate.

“People resort to crime out of necessity,” says Busz. “If people instead can access a substitution program where at least they don’t have to chase after their drugs and money anymore, that leads to a significant reduction in crime,” she says, noting studies that have shown these alternatives to incarceration are also far more cost-effective. 

But it’s a mistake to think simply opening safe consumption sites can solve the opioid epidemic, says Gayo. The Dutch experience has found that these sites are most effective when paired with comprehensive social services, such as housing where consumption is allowed, and mental health support. 

Some sites operate within existing housing or medical facilities that serve areas struggling with addiction. Others serve marginalized populations, such as migrants or those experiencing housing insecurity, by offering a place to foster community. Once inside, users find a space that resembles a living room with couches and tables where they can consume drugs, rest, or listen to music with others. Staffers stand by in case of emergencies and build relationships with clients.

This communal environment helps officials connect clients with medical, mental health and drug treatment as well as educational and employment opportunities.

“Each of these facilities has to be contextualized within particular communities,” says Gayo. “Drug consumption rooms work, but in order to work, we need to have a bigger conversation about how to tackle the social inequality that produces negative health outcomes in marginalized and underserved individuals and communities.” 

The number of safe consumption rooms in the Netherlands has fallen as intravenous drug use decreases, with the population that continues to use these drugs aging. Experts attribute this to both the success of the educational efforts of the harm reduction movement, and shifting drug consumption habits among younger generations.

Overdose has been the leading cause of accidental death in the United States since 2017, a trend largely driven by the increased use of fentanyl, a synthetic opioid that is lethal even in small amounts. In California, 10,416 people died of an overdose in 2021, nearly double the 2018 death toll. And by April 2021, the national overdose death rate had climbed nearly 30 percent from the previous year, according to the CDC. 

Meanwhile, the U.S. also has the highest incarceration rate in the world; 1 in 5 people behind bars are charged with drug offenses, or nearly 400,000 people, a disproportionate number of whom are Black and Latino.

The failure of mass incarceration to dissuade drug use, the growing rate of overdose deaths, and the ample evidence that safe injection sites can decrease these deaths has created a growing demand in the U.S. for a different model.

For years, an underground network of safe injection sites have operated across the country, staffed by trained personnel who risk legal repercussions. A 2020 study published in the New England Journal of Medicine reviewed data from one such unsanctioned site—whose location was kept secret by researchers—and found it averted dozens of overdoses over five years without a single fatality.

Last year, the U.S. opened its first two authorized safe injection sites in New York City. Facing a spike of overdoses during the pandemic and after years of planning, the city forged ahead with the plan without authorization from state authorities who said it required further study. They have reported averting 300 overdoses since opening last November. 

Critics of safe consumption sites, however, frequently invoke images of neighborhoods flooded with drug users from across an entire region who disrupt local communities. 

“Fueling the drug epidemic with drug dens and needle supplies is like pouring gasoline on a forest fire. It merely worsens the problem,” California Senate Republican Leader Scott Wilk wrote in opposition to the measure without citing any evidence to back these claims.

San Francisco is still considering moving forward with opening safe consumption sites regardless of Newsom’s veto. They would be run through local non-profit organizations in a model similar to New York’s. 

“We will keep working with our community partners to find a way forward” tweeted Mayor London Breed, who has spoken about her sister’s death from an overdose and who supports injection sites. She said she was “disappointed” by Newsom’s veto. The bill was introduced by state Senator Scott Wiener, who represents San Francisco and called the veto ”tragic.”

In the Netherlands, safe consumption activists figured out how to win over critics and helped make safe injection sites accepted as a social norm. Their placement must comply with local and regional regulations, is based on where there is need, and “is negotiated with communities,” says Gayo. “Some communities feel more comfortable having a facility close to the neighborhood, and others don’t.” To avoid overcrowding and disrupting local communities, the more than two dozen sites are distributed across the country. 

To succeed, leaders of the safe consumption sites must work in constant collaboration with their neighbors as well as authorities, who must be responsive to their needs, says Eberhard Schatz, a longtime researcher and harm reduction advocate. 

The AMOC safe consumption site in Amsterdam consults with a neighborhood commission whose members include representatives of local neighborhoods, community centers, law enforcement and the coordinator of the consumption site.

Close coordination between these stakeholders can help decrease crime and public nuisance complaints, says Gayo.

The sites maintain a close collaborative relationship with law enforcement and local hospitals and clinics, who help connect users with the facilities and can respond in case of emergencies. “The facilities have a direct line with [first responders],“ says Gayo. 

Advocates in the Netherlands offer words of support for the U.S. harm reduction movement. “These are people that are taking matters in their own hands when you have a government that doesn’t care about you and just lets you die,” said Busz, who notes the parallels between the Netherlands three decades ago and the U.S. today. 

“Here the first drug consumption rooms and needle exchange programs were all led by drug users themselves in the beginning,” taking on considerable personal risk, said Busz. Government-supported drug injection sites were the result of activists proving to opponents that they can save lives without increasing crime. 

Busz says the state support is critical to acquire the necessary funding for success. “With all everything that we know now and evidence base that it is there… they should be backed by the state from the start.”

The post In the Netherlands, Safe Drug Consumption Sites Are Saving Lives. The U.S. Is Resisting. appeared first on Bolts.