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Philadelphia Plans Supervised Drug Injection Sites


Philadelphia has the highest opioid death rate of any major American city.

THOMAS FARLEY: We had about 1,200 overdose deaths in the last year.

GARCIA-NAVARRO: Thomas Farley is the Philadelphia health commissioner.

FARLEY: By comparison, at the worst year of the AIDS epidemic, there were 935 deaths in Philadelphia. So this is a crisis of truly historic proportions, probably a public health epidemic that's biggest in the last century.

GARCIA-NAVARRO: A health crisis, Farley says, that demands an innovative solution. This past week, the city greenlit plans for a privately run supervised drug injection site - a clean, safe space where drug users can shoot up under watch of a doctor or a nurse who can revive them if they overdose. If it opens - and it's still in the early stages - Philadelphia would be the first U.S. city to allow one.

FARLEY: What we want to do is for every person who is addicted to opioids - get them into treatment. But we recognize that there are going to be some people who simply will not go into treatment. Heroin gives you a better high than methadone does. And so for those people, we don't want them to die.

GARCIA-NAVARRO: An injection site comes with plenty of controversies - fears of normalizing drug use, questions about federal law enforcement and if they'll look the other way, backlash from the neighborhood where the site ends up. For some guidance, Philadelphia has looked to another city, Vancouver, Canada. They have several government-funded supervised injection sites. The first, named Insite, opened in 2003.

MARK LYSYSHYN: You know, we have weeks where they're reversing 120 overdoses per week.

GARCIA-NAVARRO: Dr. Mark Lysyshyn is one of Insite's medical health officers. He says the supervised injection sites have never had a fatal overdose in their facilities in the 15 years they've been open. So what does one of these sites look like?

LYSYSHYN: It looks a little bit like a health care facility. They would check in at the front desk. And they would be given a number. They'd be eventually called in the injection room, assigned a booth. And then at the booth, they would prepare their own drugs using sterile, harm-reduction supplies that we provide. They would use their drugs under the supervision of registered nurses.

And then if they were to experience an overdose, they would be resuscitated using oxygen, naloxone and other methods. And then after they'd finished using the injection room, they'd move to a chill-out area where they could be observed for a little bit to make sure they don't have a delayed overdose. And then they could grab a juice or a coffee and then go back about their day.

GARCIA-NAVARRO: And I've read that some users come in three or four times a day.

LYSYSHYN: Yeah. I mean, we hope that users will come to the site for all of their injections. And so people who are using heroin on a regular basis typically inject two to three times a day. And so they will often come to the facility for all those injections.

GARCIA-NAVARRO: Part of the criticism in this country, at least, has been about whether or not this is just simply enabling long-term drug use. What is your view?

LYSYSHYN: Well, I mean, what it's enabling is people to stay alive. And so you can't access treatment, or you can't go into recovery if you're not alive anymore. So it allows people to stay alive and get to a place in their life where they can contemplate treatment. Not everybody does that, but some people do.

GARCIA-NAVARRO: What would you say the challenges are because you've had this long experience? For a city like Philadelphia that is considering opening these facilities, what would you say is the biggest challenge?

LYSYSHYN: Well, I think there are a lot of challenges. But, you know, there can be challenges from local businesses or people who live in the area, police. But what we found here in Vancouver is that all of those groups come to support these facilities once they open because they do improve community order. They - you know, they don't increase crime. And they do help people who currently need a lot of help in these neighborhoods.

GARCIA-NAVARRO: Plans for a safe injection site in Philadelphia are moving forward. Health Commissioner Thomas Farley says they will be one piece of a larger strategy.

FARLEY: There's a lot of work we need to do to put this in place, including engaging local folks in the planning. But what we've basically said is we think that this is something we should pursue as a way to save lives.

GARCIA-NAVARRO: That was Philadelphia's health commissioner, Thomas Farley, and Dr. Mark Lysyshyn, a medical health officer at Vancouver Coastal Health. Transcript provided by NPR, Copyright NPR.