Safe Injection Sites, Part I

A look at one city’s approach

(Photo Left) Could Philly tolerate a safe injection site facility, like this one in Vancouver? Photo via Wikimedia Commons.

Nothing sounds scarier to some in our region than this lead sentence in news reports circulating last month: “Top Philadelphia officials are advocating that the city become the first in the U.S. to open a supervised injection site, where people suffering from heroin or opioid addiction could use the drugs under medical supervision.” (newsworks.org)


The city’s decision to get into the heroin/fentanyl injection business has sparked heated debates everywhere from city council chambers to the corner bar. No one can doubt that opioids/fentanyl abuse is a public health crisis. But, is there a public health solution?


Before we take sides in this one, we thought it best to answer one fundamental question: What the heck is a “supervised injection site (SIS)?”  We are not looking for a technical definition but rather a practical description.  What does one look like inside? Where is an appropriate location for one? How would it impact the neighborhood in which it is situated?


While cities like Seattle and San Francisco are moving toward such sites, they are not there yet. As it turns out, there is one city that has had such an SIS since 2003. It’s called Insite, and is in Vancouver, Canada. This past September Mcleans.ca answered our questions for its readers. (For the full article go to bit.ly/canadasis)


Here’s what it looks like inside:  “[Users enter] Insite, where they will give a name — pseudonyms aren’t discouraged — to a receptionist, and sit inside a waiting area until they are called into a large space behind a locked door. Once there, they will pick up fresh, sterile equipment, sit at one of 13 mirrored, stainless steel booths, and fix. Nurses may sit or stand next to the users as they inject. This takes an average of 20 minutes … Used equipment is tossed into a stainless steel receptacle. Staff wipe down the booths. Before returning to the street, drug users can rest inside Insite’s ‘chill room.’ Addiction treatment and primary care services are also offered to anyone interested.”


Here’s what it looks like just outside the facility: “It sits smack in the middle of an eye-popping outdoor drug market and shooting gallery. Here’s a snapshot: a urine-soaked alley, directly behind Insite. A man squats on the broken pavement, poking a needle into an open, bleeding wound in one arm … Just up the street sits another woman … [she] collapses, becoming unconscious; she is suffering an overdose. Without immediate help, she may die … paramedics show up on bicycles. Nine responders, in all. The woman is given an injection of naloxone, an antidote for fentanyl, the potent, synthetic opiate which she has almost certainly consumed. … The responders return to their vehicles or ride away on their bikes. More sirens scream. Another ambulance races to the scene of an emergency down the street. It never stops.”


Nothing screams NIMBY (Not In My Backyard) than heroin addicts sticking needles in their arms, overdosing, and non-stop emergency response sirens.


What can we make of some really good life-saving business being done inside the facility and a dystopian nightmare street scene happening outside the facility?  Let’s ask the Canadians.


“‘The neighborhood will look worse than what you remember from 14 years ago [when Insite opened],’ acknowledges Patricia Daly, chief medical health officer for Vancouver Coastal Health, the public authority that oversees and funds Insite. … ‘But it didn’t make things worse. It didn’t encourage drug use. Injection drug use has been declining since Insite opened. [In the late 1990s], the HIV infection rate was the highest in the world among DTES [Down Town East Section] injection drug users. It has declined. Overdose deaths declined. Life expectancy has improved by ten years.’”


And what did the conservative-backed study find five years into the SIS operation?  “No evidence of increased drug trafficking, loitering or petty crime in the vicinity of Insite; no increase in the amount of open drug use in the area around the facility. … Providing drug users with sterile equipment and clean facilities and treating overdoses in the premises had actually saved taxpayers’ dollars, while reducing workloads for paramedics and hospital emergency room staff.”


Next week:  The debate rages on all sides — a look at the players and what they think.




Safe Injection Sites, Part I

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