Americans have responded to drug addiction in a number of different ways in recent decades. The War on Drugs of the 1980s and 90s spawned mass incarceration of Black and Brown populations. Some addicts, many of whom have some measure of wealth and privilege, are sent to rehab.
In the face of the opioid crisis of the last decade, there has been a growing recognition of the inevitability of drug use. That attitude change has led to the proliferation of clean needle exchange centers and providing overdose medication like naloxone to drugs users, their families and law enforcement.
In Illinois, one state legislator wants to provide a legal path for another approach: allowing people addicted to drugs to take illegal substances under the supervision of a medical professional.
State Rep. LaShawn Ford (D-Chicago) has proposed the creation of safe consumption rooms — also referred to as supervised injection facilities. Proponents of similar programs around the world argue they allow people who suffer from addiction to take substances in a safe environment and reduce the likelihood of fatal overdoses.
“We know that not meeting people where they’re at to provide the support that they need to end the struggle of a substance use disorder only harms the community with loose needles [and] only harms families with preventable drug overdoses,” Ford said.
Currently, such facilities are illegal in the United States and only exist in Canada, Australia, and 10 countries in Europe. Like other legalized injection programs around the world, Ford’s proposal would not stipulate that facilities provide illegal drugs, but rather allow patients to bring in their own supply of drugs that they buy off the street.
However, Robert Bell, Special Agent in Charge of the Drug Enforcement Administration’s Chicago field division, said that places hypothetical facility staff and patients alike at risk because neither party would know the drug’s exact ingredients or potency — and does nothing to stem the tide of drugs coming into a community.
“When users purchase heroin and fentanyl, those transactions stimulate the illegal drug market by putting money in the hands of profit-driven drug organizations and even violent gangs,” Bell said.
Instead of normalizing intravenous drug use, the DEA recommends drug counseling by medical professionals and occasional, doctor-prescribed medicated treatments.
Attempts at U.S. legalized injection sites
Allowing people to congregate to take illegal drugs has been a legal sticking point for a number of want-to-be consumption rooms in the United States. In Philadelphia, a non-profit called Safehouse has been locked in a legal battle for the past couple of years with the U.S. Department of Justice.
In 2019, the U.S. Attorney’s office for the Eastern District of Pennsylvania filed suit against Safehouse, claiming the organization’s attempts to create a supervised injection facility violated the federal Controlled Substances Act and a clause known as the “crackhouse statute,” which makes it a felony to operate a space dedicated to the manufacturing, distribution or use of illegal drugs.
Safehouse won a preliminary battle in district court when the judge ruled the purpose of a supervised injection facility is the reduction of drug usage, not their encouragement.
However, a federal appellate court ruling earlier this year reversed the lower court and sided with the federal government, opening the possibility for the case to be heard by the U.S. Supreme Court.
Goldfein said despite the legal battle, Safehouse is committed to the cause. She said alternative approaches to addiction are severely needed, as drug overdose rates in Philadelphia are among the highest in the country.
“Safehouse is composed of people of faith and conscience,” Goldfein said. “We believe that if you can save a life, you're required to save a life.”
In recent years, lawmakers in places like California, Colorado, Massachusetts, Utah and Washington have also attempted to pilot a supervised injection program — so far unsuccessfully.
This spring, two state legislatures other than Illinois have also weighed legalizing injection facilities. A proposal in New Mexico successfully passed the House, but did not receive a vote on the Senate floor before the spring session ended.
In February, a proposal to create “harm reduction centers” was successfully approved by the Rhode Island state Senate. Its legislative session is ongoing.
Rhode Island State Sen. Josh Miller (D-Cranston), the chief sponsor of the proposal, said he got the idea after serving on an overdose prevention task force.
Miller said he recognizes the legal hurdles for starting such a program and is working in tandem with the state’s Department of Health and Attorney General’s office in order to offer guidance to potential injection site partners.
“In the last few years we are seeing an increase [in fatal overdoses], and it's not only due to COVID, it's due to the pervasiveness of fentanyl,” Miller said.
Miller says a 25% jump in fatal overdoses in Rhode Island over the last year should add urgency to passing his bill, which is set for debate in the state’s House in the coming weeks.
Models around the world
North of the border in Canada, North America’s first legal injection site fought for years to get an official exemption from Canada’s version of the Controlled Substances Act.
But in 2003, legal injection facility InSite opened in Vancouver and since then, 25 similar programs have opened locations across Canada.
Dr. Mark Lysyshyn, the Deputy Chief Medical Officer at InSite, said Canadian centers like InSite also provide a number of wraparound services for patients, including access to counseling, test strips to determine whether drugs contain fentanyl, and clean needle exchanges.
“We have, you know, typically around 500 injections there a day,” Lysyshyn said. “And, you know, since its opening, there's never been a death due to an overdose.”
Rep. Ford’s proposal also calls for funding of other resources and services at safe consumption sites, including providing condoms, naloxone, educational literature, and drug rehabilitation counseling.
However, Lysyshyn and others will say the primary purpose of supervised injection facilities is not necessarily to lead a patient to drug therapy or eliminate their consumption of drugs, but to engage in harm reduction against such factors as drug overdose deaths and HIV transmission.
Eberhard Schatz, an Amsterdam-based drug policy researcher with the Correlation-European Harm Reduction Network, said the primary aim of supervised injection facilities in the Netherlands at least is to provide a social network for people suffering from addiction.
Schatz’s organization regularly partners with other research groups, including the International Drug Policy Consortium, to evaluate the effectiveness of drug consumption rooms across the globe.
Schatz said building a social network, particularly the volunteer assistance provided by former patients, is what makes supervised injection facilities more effective than centers that just engage in clean needle exchange.
“Clean needles and a place to stay at it is a very important function, but it is maybe just the first step. If you can integrate that in the social environment, that is even better,” Schatz said.
A 2020 meta-analysis of 48 studies showed supervised injection facilities do have a generally positive effect in reducing a community’s level of drug-related crimes, reducing the frequency of people consuming drugs in public, and drastically reducing an area’s number of overdose deaths.
However, a 2005 study detailing the effects of the first supervised injection facility in Sydney, Australia found a slight increase in loitering around the center — a phenomenon that may be politically unattractive.
Schatz said loitering around legalized injection sites is something cities have had to deal with. He cited a facility in Copenhagen, Denmark.
“They have 700 people visiting the room a day. Of course, that is a problem for the neighborhood,” Schatz said. “That exactly was the reason that in Amsterdam they chose to have smaller rooms in the different neighborhoods, so you would avoid this problem.”
Schatz also said the endorsement and cooperation of law enforcement in the Netherlands helped ease the process of legalizing injection sites. Rep. Ford said that would also be key to making safe consumption rooms a reality in Illinois.
“We have to work with the law enforcement in those areas so that the place is a safe place, a safe consumption site, where it's agreed that this place is a place that people are not going to be arrested in,” Ford said.
Ford’s proposal cleared the House Human Services Committee last month and could be heard on the House floor later this spring.
