When the city’s HIV epidemic was raging more than 25 years ago, Prevention Point Philadelphia began what was then a controversial program: A needle exchange. A year later in 1992, then-Mayor Ed Rendell signed an executive order that effectively overrode state law and legalized the possession of syringes in the city of Philadelphia.

Today, Prevention Point is one of the most recognizable organizations in the city fighting the opioid epidemic. And Rendell’s executive order and the city’s interpretation of the law was never successfully challenged.

While needle exchanges remain controversial in some circles, experts in the health community and harm reduction advocates say another strategy to fight drug addiction — the concept of supervised injection sites — is the next logical step. And some say it could even see a similar legal runaround.

“There is legal uncertainty about whether or not you can do this,” said Scott Burris, the director of Temple University’s Center for Public Health Law Research and a member of the mayor’s Opioid Task Force. “It’s pretty clear the city has the authority to take evidence-based public health measures and fund or implement them.”

It’s not easy to just decide 'we’re going to arrest those dirty doctors.' Scott Burris, director of Temple's Center for Public Health Law Research

Of 18 major strategies under consideration by the mayor’s Task Force to Combat the Opioid Epidemic, the idea of establishing a supervised injection site — or a place where individuals can use illegal drugs in the presence of medical professionals — is by far the most contentious. When the task force released strategies under consideration earlier this year, it didn’t commit to establishing a supervised injection facility, but only committed to further researching the matter.

In a progress report released this month by the task force, officials indicated the recommendation of further exploring “comprehensive user engagement sites,” or supervised injection facilities that offer a variety of social services, was still in a planning phase. It noted city officials are “exploring the issue by consulting with experts and reviewing studies of user engagement facilities that allow safe injection.” It also noted a delegation of city officials will visit a site this fall.

James Garrow, a spokesman for the city’s Department of Public Health, said details for that “fact-finding mission” are still in the “very early stages” of planning. He said regarding the site visit planned for this fall, “who, where and when have not been finalized.”

Much of that planning is related to potential legal challenges that could arise if the city established a supervised injection site. Without legislation at the state or federal level explicitly allowing such a facility, there’s always the potential that litigation could follow or that law enforcement could shut the place down. In theory, the State Police could come in. The Drug Enforcement Agency could raid the facility.

Burris says the question is: Would they?

“When you have this much evidence, and if you’ve got the community support in places where there’s a lot of street drug use, it’s not easy to just decide, ‘we’re going to arrest those dirty doctors,’” Burris, who is personally in favor of establishing a supervised injection site, said. “Imagine nurses being carried out in handcuffs.”

There are currently more than 60 supervised injection facilities operating in Europe, Australia and Canada; however, there are none in the United States, which is in the midst of working to address a worsening opioid crisis. Several other jurisdictions are studying the idea, including Ithaca, N.Y., where its mayor suggested a safe injection site, and legislation was introduced at the state level to approve the facility. Officials in Seattle this year approved the establishment of a supervised injection site.

The first legal supervised injection site in North America opened in Vancouver in 2003. The location, called Insite, has provided services to 3.6 million people. More than 6,000 people have overdosed there, and none have died.

Last year, more than 900 people in Philadelphia died of a drug overdose. The city’s on pace to see more than 1,200 deaths this year. Those on the more progressive side of the efforts to fight the opioid epidemic say supervised injection sites serve as a harm reduction measure that could cut down on the number of drug overdoses and the amount of disease spread through needles.

Burris said the political conditions now are “even more favorable than they were for needle exchange.” Mayor Jim Kenney, a first-term Democrat, has indicated he’s open to learning more about safe injection facilities, and the concept has broad support among other local politicians. However, Police Commissioner Richard Ross has expressed concern, telling Fox29 “to have police officers present during the administration of an illegal narcotic would be problematic.”

While Pa. Attorney General Josh Shapiro has not supported the idea, Larry Krasner, the Democratic nominee for district attorney and the favorite to win election in November, came out last week in support of supervised injection facilities. He said in a statement that “we can reduce [the opioid crisis’] corrosive effects on our city.”

“If there’s a chance that SIFs can reduce the harms that this national crisis is inflicting on our city, our communities and our loved ones, we have more than an opportunity,” he wrote.

“We have a moral obligation.”

Republican nominee Beth Grossman has also indicated she’s open to exploring the concept. Burris said the the fact that both DA candidates are speaking favorably about the issue bodes well for the city and any legal challenges that could arise.

“If you have a DA who thinks it’s legal and you have a health commissioner who thinks it’s an important public health step and a mayor who is supportive,” he said, “then you don’t have to go through the state.”

For Burris and his colleagues considering the viability of a safe injection site in Philadelphia, it’s not the law that’s the largest barrier to establishing a facility. Rather, the issues at-hand are more or less questions of process: Is there enough money to fund this? How does the city manage opposition? How do the ensure safety and security? Where should the site be located? And how can the city ensure it operates with integrity?

“If there was a will and a way,” Burris said, “I think the law would not stand as a big barrier.”