PHILADELPHIA _ Philadelphia, with the highest opioid death rate of any major American city, on Tuesday announced plans to encourage the opening of sites where people can inject drugs under medical supervision.
And though the precise locations of Philadelphia sites have not been established, the city could be the first in America to open an officially sanctioned safe-injection site.
The move, announced at a news conference by high-ranking city officials _ but not Mayor Jim Kenney _ places the city at the forefront of confronting the opioid crisis, which killed an estimated 1,200 people in Philadelphia last year, quadruple the homicide rate.
"We are facing an epidemic of historic proportions," said Health Commissioner Thomas Farley, as the room, filled with advocates, erupted in applause.
Farley and others emphasized, however, that the sites _ which they are calling Comprehensive User Engagement Sites (CUES) _ are just one aspect of what must be a major coordinated response.
"We are not naive," said city managing director Mike DiBerardinis. "Nothing you hear today is the solution, but small parts of a larger effort."
Police commissioner Richard Ross stepped up to the podium to say that he still has questions about how such sites would operate, and how his officers would police the areas around them. But, he added, the need to "save lives" has prompted him to keep an open mind about them.
Meanwhile, Kenney spoke a separate news conference about World Wrestling Entertainment's Royal Rumble Week _ to be held this weekend at the Wells Fargo Center.
"I don't know why I wasn't scheduled," to be at the safe injection site news conference, he said. "Honestly. I get five, six pages of stuff and I go through it," Kenney said, sounding frustrated.
"This is not the biggest announcement the city's had," he said. "It's not the biggest thing that's happened in the city. What's the biggest thing is the 1,200 opioid deaths." The mayor said he supports opening safe injection sites.
"We don't want them dying on the street and we want to have a place to administer Narcan if necessary," Kenney said after the WWE news conference. "We also want an opportunity to speak to people about their future and getting their lives straight ... They can't do that under a train bridge or on a train track."
At the same time, he said, the city couldn't open the sites itself. "We're encouraging nonprofit and professionals to do this and hopefully we'll save lives," he said.
Safe-injection sites are well-accepted in Canada and Europe, where they have saved lives and public funds and reduced the public disorder associated with drug use, such as open heroin injection and discarded needles.
Such scenes have drawn national attention to Philadelphia, as camps of people using heroin have swelled under bridges and on the streets in the Kensington area, just a few miles northeast of the booming Center City neighborhood.
City officials described the sites as a "harm-reduction measure," one part of a larger plan to address a crisis that has now claimed lives at a faster rate than at the height of the AIDS epidemic. The concept is simple: save lives first, then help people with addiction get into drug treatment and safe housing.
Rather than operating the sites itself, the city would support private organizations by helping them to secure funding and perhaps locations. Farley said Tuesday that he did not know what it would cost to operate a site, but that the city is hoping that funders will "step forward."
The city also could provide outreach services at each site _ which they're calling "comprehensive user engagement sites" to emphasize the treatment component.
Philadelphia could be the first city in the country to host such a site. Seattle, the only other major U.S. city that is close to opening one, set aside $1.3 million in its budget to open safe injection sites last year. But the sites remain controversial in America _ in Seattle, opponents tried and failed to float a ballot measure that would have banned the sites before they even opened. Yet they have become an established component of other cities' harm-reduction efforts. Toronto, for instance, opened a safe-injection site this summer, and saved 139 people in six months.
An unauthorized safe-injection site has been operating in an undisclosed location in the United States since 2014. Cities like San Francisco, New York, Ithaca and Denver have begun to seriously consider sites. A study in Baltimore found that the city would save $6 million on medical costs connected with overdoses by opening one site.
It's unclear how the city's plans will be received by the federal government. Neither the U.S. Department of Justice nor the local U.S. Attorney's office immediately responded Tuesday to requests for comment about the proposal. While the Justice Department has not responded to Seattle's discussions about opening a safe-injection site, the Trump administration has taken a tough stance against cities that buck its policy goals.
Last month, Attorney General Jeff Sessions rolled back Obama-era policies instructing federal law enforcement to essentially look the other way as states set their own laws regarding marijuana legalization.
Federal lawyers moved last year to revoke several law enforcement grants because of Philadelphia's sanctuary city policy in regard to illegal immigration, but that effort was stopped in court.
Philadelphia officials have been debating and researching the idea of establishing safe injection sites for nearly a year. In May, a mayoral task force on the opioid crisis recommended serious consideration of a safe-injection site, as overdose deaths skyrocketed and crowds of people using heroin flooded streets and parks in Kensington, the heart of the city's opioid crisis.
Last spring, the situation grew so dire that a group of librarians drew national attention for teaching themselves to use Narcan to revive overdose victims on their Kensington library's lawn. City resources stretched to cover more ambulance runs and Narcan packs, handing out 19,000 over a few months.
In the summer, officials worked to close encampments around Kensington where people had been living and using heroin, in some cases for many years. They cleared the library lawn, closed a decades-old camp in a train gulch along Gurney Street, and bricked up an abandoned church that had become a shelter for young people using heroin among the ruined pews. Though the spaces were dangerous and decrepit, for many they offered the only safe places where they could inject heroin around friends who could administer Narcan if they overdosed.
And while the city offered outreach services, closing those spaces in most cases drove people to new refuges, such as under train bridges on Lehigh Avenue.
In the camp at Lehigh and Kensington Avenue, people in addiction said this week that they supported the idea of a safe-injection site and would use it if the city installed one nearby.
"There's nowhere safe," said Christopher Drescher, 40, of New Jersey. He's been using drugs since the age of 12, he said, and earlier this year, overdosed behind a Wawa. It took three Narcan doses to revive him, he said, after someone happened to see him passed out behind the building.
And he felt using heroin in a safe-injection site would be more respectful to the neighborhood and the schoolchildren who often pass by the camps on Lehigh Avenue. People living there try to warn the block when children walk by, he said, so anyone injecting drugs can stop.
Julie S., a mother of five from Norristown who was camping on the opposite side of the bridge, said she thought often of what might happen if one of her own children were to pass by the camp, and takes pains to keep needles off the ground.
A safe-injection site would mean "a safer environment for everyone," she said.
This fall, the city sent a delegation to Vancouver, which opened the first safe-injection site in North America in 2003. "It's the most comprehensive harm-reduction model I've ever seen," said David Jones, the commissioner of Philadelphia's department of behavioral health, after the trip.
The city also commissioned an independent report to study all available research on the sites. They concluded that they reduced overdose deaths, the spread of HIV and hepatitis C, encouraged more people into treatment, and reduced the neighborhood blight of open drug use. On average, public injections and discarded needles were reduced by half in the area around a safe injection site, the report concluded.
