Philadelphia is a step closer to opening what could be the nation's first supervised site for safe drug injection. But turning the idea into reality won't be easy.
City officials gave the proposition the green light Tuesday. They were armed with feasibility studies, harrowing overdose statistics and the backing of key leaders, including the mayor and a newly elected district attorney.
"There are many people who are hesitant to go into treatment, despite their addiction, and we don't want them to die," said Dr. Thomas Farley, Philadelphia's health commissioner and co-chair of the city's opioid task force. Supervised safe injection sites, he said, save lives by preventing overdose deaths and connecting people with treatment.
While one big hurdle has now been cleared, the details of how safe injection sites would actually work in Philadelphia have yet to be figured out. Who will actually fund and operate a site? Where will it be located? Will users really be safe there?
"We have a long way to go," said Brian Abernathy, first deputy managing director for the city.
Neither city council approval nor special zoning ordinances would be required to proceed, Abernathy said, but the city doesn't plan to actually operate or pay for any sites. Instead Philadelphia officials would play the roles of facilitator and connector with providers of addiction services.
In that way, Tuesday's announcement by the city was more like an open call to potential investors and operators than it was the roll out of a specific plan.
"We took a really really big first step," said Jose Benitez, executive director of Prevention Point Philadelphia, a large nonprofit needle exchange. "It's early to talk about our involvement at this particular point. As the city officials said, there's a lot to consider."
Broadly, the city envisions a place where people would be allowed to bring in drugs and inject them using clean equipment. If someone overdosed, trained staff would respond to prevent death. The sites could save lives and money otherwise lost to hospitalizations and emergency response efforts. Advocates say the sites also could reduce neighborhood problems associated with addiction, like people injecting in public and discarding needles.
A safe, supervised site wouldn't just be about a spot to inject, Farley stressed, but also somewhere people could connect with other services and treatment.
Still, the effort to open a site will likely face many additional hurdles and unknowns, from community buy-in to legal concerns.
For one, Councilwoman Maria D. Quiñones-Sánchez, who has voiced opposition to a safe injection site in her district (one at the heart of the crisis), is wary of the city's plan.
"This notion of letting a private developer or a private person come tell us how this could be done, we're not paying for it, we'll do wrap-around services, so much of that is just up in the air," Quiñones-Sánchez said. "So why make an announcement with no answers?"
Another question: Could such a site be immune from federal prosecution? Realistically no, said Philadelphia official Abernathy, though some legal scholars are exploring potential safeguards.
The city's police commissioner, Richard Ross, has gone from "adamantly against" any injection site to having an open mind. Whether police will take a hands-off approach remains to be seen. So would what the department's role would be, what police officers would be asked to do, and how that would affect the policing of narcotics?
"I don't have a lot of answers," he said.
One point of clarity: Philadelphia's District Attorney, Larry Krasner, has no plans to prosecute.
"What will we do? We will allow God's work to go on," Krasner said, citing state laws of justification that allow the committing of minor violations in the interest of preventing greater harms. "We will make sure that idealistic medical students don't get busted for saving lives and that other people who are trying to stop the spread of disease don't get busted."
After all this, it should come as no surprise that the timeline is really unclear, too. Rollout will take months, at least, leaders have said. Though if it were up to Krasner, one would have opened years ago.
"My biggest concern moving forward with harm reduction is that government takes forever," he said. "When we have three or four people dying every day, nobody can afford to wait."