Last week, US Deputy Attorney General Rod Rosenstein took aim at a once-fringe public health movement that’s now gaining political traction due to the rising death toll of the opioid epidemic.
In a forceful op-ed in the New York Times, Rosenstein slammed so-called safe injection sites, where people can use heroin and other drugs under medical supervision without threat of law enforcement. Prompted by California’s recent approval of one such site in San Francisco, he said drug users need treatment, not “a taxpayer-sponsored haven to shoot up.”
Roughly 100 safe injection sites exist in 66 cities across the world, but the US has yet to open one, despite a relentless overdose epidemic that killed nearly 72,000 Americans last year. The problem has gotten so dire that at least 20 cities, counties, and states have started to talk about opening these sites — despite the threat of a federal crackdown.
“Because federal law clearly prohibits injection sites, cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action,” Rosenstein wrote, citing the 1986 “crack house statute” banning anyone from “operating a facility for the purpose of manufacturing, distributing, or using any controlled substance.”
The opioid epidemic is driving debates around the country over safe injection sites, where people can use heroin under medical supervision. Follow This is now streaming on Netflix.
It’s a battle that’s pitted the public health community against law enforcement in recent years, echoing similar fights over needle exchanges at the height of the AIDS epidemic.
We dug into the controversy in an episode of the Netflix documentary series Follow This, showing viewers how a massive safe injection site in Vancouver has reversed thousands of overdoses over the past 15 years, and meeting the people fighting for — and against — a proposed site in Seattle.
Although the issue has made national headlines about big cities like Seattle, San Francisco, Philadelphia, and New York City, similar proposals have popped up all over the country. Here’s a look at where the discussions have happened so far — and the likely battlegrounds for a war against the feds.
Safe Injection Site Proposals
In January of 2017, Seattle became the first city to declare its intention to open a safe injection site. But since then, the political and economic hurdles of actually doing so have been made clear: The city has now ditched plans to open up a brick-and-mortar facility in favor of a mobile van unit. What’s more, at least a dozen cities and two counties surrounding Seattle have since banned the sites outright. A controversial attempt to ban a site in Seattle gathered nearly 50,000 signatures last year, before being tossed out by the courts for infringing on public health department.
Still, for now, it does look like Seattle’s site will happen, making it the only place in the US where a local government has not only endorsed a site but funded it: Late last year, the city council dedicated $1.3 million from its budget to set it up.
“The crack epidemic really ravaged many cities around the country and the response was to jail people — that perpetuated a cycle of poverty,” Seattle councilmember Rob Johnson told BuzzFeed News on Follow This.
“We as elected officials have to stand up and own those previous decisions, but we also have to make sure we don’t repeat them.”
A year later, in January of 2018, Philly — which city officials say has the worst fatal overdose rate in the nation among large urban areas — became the second place in the US poised to open a safe injection space.
“We cannot just watch as our children, our parents, our brothers, and our sisters die of drug overdose,” Thomas Farley, Philadelphia's health commissioner, said in a statement in January. “We have to use every proven tool we can to save their lives until they recover from the grip of addiction.”
Unlike Seattle, Philadelphia’s health department said it would not be funding or operating the site, but rather would support any private sector development. Philadelphia is still looking for an operator and funding to do so, and advocates are pushing the city to consider funding it itself.
City officials say they’re ready, if necessary, to fight with the Justice Department.
“The federal government should focus its enforcement on the pill mills and illegal drug traffickers who supply the poison that is killing our residents. Not on preventing public health officials from acting to keep Philadelphians from dying,” James Garrow, a spokesperson for Philadelphia’s Department of Public Health, said in a statement in response to the DOJ on Tuesday. “Instead of threatening cities and states, they should bring positive solutions to the table that will save lives.”
Safe injection advocates in California were dealt a blow last year when a bill to allow the facilities in eight counties with high overdose fatality rates — including San Francisco and Los Angeles — stalled in the legislature. But after a city task force evaluated the public health evidence and concluded in favor of launching a safe injection program, the city of San Francisco pushed ahead on its own, first saying it would open a site by July 1, then falling back on opening a “model site” at a local church for public viewing in late August.
Last week, California’s state legislature passed an amended version of the bill that would throw the weight of state support behind San Francisco’s efforts to open up a space. The state is still waiting for Gov. Jerry Brown to sign it into law.
NEW YORK CITY AND ITHACA
In May, New York became the fourth city to announce it would move forward with safe injection spaces, as Mayor Bill de Blasio declared his intention to open four sites across the city.
A report released in conjunction with his announcement stated that in 2017, overdoses in New York City killed 1,441 people, more than in any year on record — and more than from suicide, homicide, and motor vehicle accidents combined.
A week later, Ithaca Mayor Svante Myrick, who has long been an advocate for safe injection spaces, sent a letter to New York Gov. Andrew Cuomo requesting approval to open a site in Ithaca as well.
Both cities are still waiting for Cuomo and the state health department’s approval, and Cuomo has called it a “complicated issue,” especially with regards to law enforcement. Cuomo’s challenger in the upcoming Democratic primary, actor Cynthia Nixon, has criticized him for not moving more swiftly.
Like much of New England, Vermont has been hit hard by the opioid crisis, with an estimated 75 overdose deaths in the first six months of 2018.
A bill that would have limited criminal liability for anyone operating a safe injection space in the state of Vermont stalled in the legislature in early 2017. The state’s attorney for Chittenden County, Sarah George, later assembled a commission to study the idea and came out strongly in favor of the state legalizing the sites. “I am confident this will save people's lives,” she said.
The announcement of the commission’s support prompted the US attorney in Vermont to issue an official response, stating, “[Safe injection facilities] are counterproductive and dangerous as a matter of policy, and they would violate federal law.”
Meanwhile, the city of Burlington is slowly moving forward on its own. A resolution passed by the Burlington City Council in July of 2018 directed city officials and community stakeholders to begin logistical discussions about opening a facility.
Attempts at the state level to open up a safe injection space in Denver were squashed earlier this year when a Republican-led legislative panel rejected a bipartisan bill to allow the city to move forward with its plans.
But at least two Denver city council members have visited the Vancouver site to observe how it works. And in July, the mayor released a strategic plan to address fatal opioid overdoses in the city that included an initiative to “reduce barriers to a safe use site.”
City councilmember Albus Brooks told BuzzFeed News that he has been working on public outreach on the issue and that “there is now community support.” He will be introducing legislation in the fall to open up a privately funded facility in Denver.
“Denver is ready for a phase one of these safe consumption sites,” Brooks said.
According to news reports this summer, public health officials in Madison are currently researching supervised injection sites, and the mayor has stated that he’s looking forward to learning more about the idea.
In Maine, where 354 people died of an opioid overdose in 2017, the state legislature rejected a bill in 2017 that would have allowed for the creation of a state-sanctioned, privately run safe injection space.
But advocates in Portland have been granted the ability to form a subcommittee of the Portland Overdose Task Force to discuss the issue. Mayor Ethan Strimling has said that he’s “very deeply” open to exploring the idea of safe injection sites.
Last September, city councilmember David Grosso sent a letter to the director of the district's Department of Health, asking the agency to look into safe injection sites. Mayor Muriel Bowser responded by saying she would send the health director to Canada to observe Vancouver’s site and report back any findings.
In June of last year, the Boston City Council hosted a heated debate about setting up a safe injection site in the city.
But in July of this year, the state Senate in Massachusetts rejected a proposal to establish a legal safe injection space, deciding instead to form a commission to research the issue.
The vote came shortly after Massachusetts US Attorney Andrew Lelling released a statement saying, “I cannot envision any scenario in which sites that normalize intravenous use of heroin and fentanyl would be off limits to federal law enforcement efforts.”
Massachusetts Gov. Charlie Baker had also publicly stated that he was “kind of a hard sell” on the safe injection issue.
Massachusetts governor Charlie Baker had also publicly stated that he was “kind of a hard sell” on the safe injection issue.
In February of 2018, the Missouri House introduced a bill to authorize local health departments and community-based organizations to establish safe injection sites.
“I think everybody needs support in changing the trajectory of their future,” said state Rep. Karla May of St. Louis, who introduced the bill. The bill was not passed into law.
The Rhode Island Medical Society asked Gov. Gina Raimondo to create a working group to look into supervised injection sites as part of a bigger effort to reduce opioid fatalities in the state. The group met with a policy adviser from the governor's office in May.
“This is something that we are continuing to look into,” Joseph Wendelken, spokesperson for the Rhode Island Department of Health, told BuzzFeed News.
In December of last year, Karyl Rattay, the health director of the state, said at a Health Care Commission meeting that Delaware public officials were in early discussions about the possibility of bringing a safe injection site to the state. As of March 2018, those discussions have remained in preliminary stages, she said, as Delaware watches how other cities and states implement the sites.
“I do hope in the interim that we do see some more openness to people thinking about whether [safe injection sites] could be a good strategy for Delaware,” she said. ●