Safe Injection Sites — States Struggle with Viability, Politics and Public Opinion

Last week the California State Assembly passed (by 44-26) legislation to allow San Francisco to open a Safe Injection Site (SIS), despite the federal Justice Department’s contention that such facilities are illegal. The Mayors of both San Francisco and Oakland (where the state’s first SIS will likely be located) strongly support the bill and Governor Newsom is committed to signing it if it passes in the state Senate. State Senator Scott Weiner observed to the press on May 25 that, “California legislators tend not to be intimidated by the Trump administration.”

Earlier this year, the Academy’s Board of Directors decided to support SIS as a legitimate tool for HIV and HCV prevention. We agreed, on the basis of evidence, that Safe Injections Sites clearly reduce overdose deaths, help to improve users’ health and encourage people with substance use disorder to consider treatment. Despite this, the Department of Justice strongly opposes their legalization.

Nevertheless, several US cities are moving toward SIS, including Ithica (New York), New York City, Denver and Seattle. Philadelphia has been leading the way for the last two years with a project called Safehouse. Over 3000 people died of opioid overdose in Philadelphia in the last three years, the highest number of any city in the US. The opening of Safehouse is a goal supported by the Mayor, the District Attorney, the City Council, the City Health Department and numerous community, public health and religious organizations.

Last year, the federal Department of Justice sued Safehouse to block its opening. US Attorney William McSwain argued that the existence of Safehouse would violate the 1986 law against maintaining a place for the use of controlled substances and could result in up to twenty years imprisonment.

Ronda Goldfein, Executive Director of the AIDS Law Project of Pennsylvania and Vice President of the Safehouse board, responded to this last September by applying for a tax-exempt status from the Internal Revenue Service. She described Safehouse as “formed to mitigate a national health crisis which is hitting residents of the City of Philadelphia particularly hard.” Last week, the non-profit status was awarded by the IRS.

This not only enables Safehouse to solicit tax-exempt donations from supporters but also puts two sectors of the federal government at odds with each other. Safehouse contends that it will provide overdose prevention and harm reduction services — all of which are legal. The IRS has validated this definition by recognizing Safehouse as a legitimate non-profit organization.

While this legal dispute drags on, Safehouse is also addressing the problem of Philadelphians who appreciate the value of SIS but do not want such a service in their neighborhood. One possible response under consideration is the conversion of vans into mobile clinics — as is done during blood donation drives.  SIS is already being provided via vans in other countries including Germany, Spain and Canada. As the Philadelphia Inquirer wrote on its editorial page, “If a brick and mortar site is what’s standing in the way of allowing a supervised injection site to save lives, we should instead put it on wheels.”