As Torontonians inject fentanyl and other drugs without fear of arrest or fatal overdose, Philadelphia officials are struggling to open the first supervised injection site in the United States.

Despite lessons learned from Toronto and Vancouver, officials with the city of Philadelphia and non-profit Safehouse are so far stymied.

Community rejection of the sites — where users bring and shoot up their drugs under the watchful eye of medical personnel, while being offered treatment options and other services — continues in the face of an overdose death toll outstripping that of any other U.S. or Canadian city.

Ed Rendell, a former Philadelphia mayor and Pennsylvania governor, is on the Safehouse board. He acknowledges a key mistake in trying to get a supervised injection site open, but blames the backlash on “not in my backyard” syndrome.

“You're hearing NIMBY on steroids” from people who know that almost 1,200 Philadelphians fatally overdosed last year, and that action needs to be taken — just not in their neighbourhoods, Rendell said in an interview with the Star.

“If our homicides last year jumped to 1,200 people, we would be calling in the National Guard,” Rendell said. “We believe supervised injections sites can be done with very little intrusion or problems for the community, and we believe it will be nothing but beneficial.

“It's not the answer to the opioid crisis, it's one of several answers — and it will save lives.”

Safehouse officials were part of a delegation to Toronto a year ago. They were followed by another meeting with city officials, including Philadelphia Mayor Jim Kenney, who toured supervised-injection sites in Vancouver and Toronto and talked to activists, public health officials, politicians and police.

Rendell said most of them were “favourably impressed” and encouraged.

“It was really helpful for us to see the variety of settings,” said Eva Gladstein, Philadelphia’s deputy managing director for health and human services. “We saw one (site) within a medical facility that could immediately connect people to other services and also the value of a peer-run site that was less formal and might be more welcoming to other folks.”

Philadelphia is opting for the more formal approach, in which users register and are offered services including drug treatment and housing help, said Gladstein. She added that her city and mayor are supportive of Safehouse but not directly involved in the plans.

After a landlord at a proposed site got cold feet, Safehouse regrouped and said in late February it would open in south Philadelphia the following week. That set off a firestorm, with the local councillor saying a supervised injection site should not be near daycare centres, seniors’ homes or schools.

When another landlord backed out, Safehouse retreated again.

Rendell blames himself.

“My instinct was to have a community meeting, even though some people in the community will never be persuaded no matter what you say,” he said. “But I let (Safehouse officials) talk me out of that and I take the blame for it. I could have stopped it.

“So we are without a home. We are continuing to look for a home but we are also looking at mobile RVs fitted out to our needs. I think that may be the better way to go, temporarily — but eventually we're going to go to a medical building somewhere.”

Vancouver pioneered supervised-injection sites in North America with Insite in 2003. Toronto’s first site was launched in Moss Park in 2017 by harm-reduction activists, who said the death toll had grown too high to wait for government approval.

Now Toronto has nine sites: six provincially funded consumption and treatment services; The Works site within Toronto Public Health offices near Yonge-Dundas Square; and two overdose prevention sites that lost provincial funding.

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The unfunded sites saw 5,500 visits in 14 months, the Star reported in January, and are run almost entirely on private donations by front line workers and volunteers.

While they have saved the lives of many Torontonians, Coun. Joe Cressy, chair of the city’s public health board, says too many people are still dying from drug overdoses.

Government figures reported 118 opioid deaths in Toronto between August and October 2018; that number dropped to 77 in the three spring months of 2019.

Cressy said while delegations from New York City, Boston and Japan have all been eager to see how Toronto handles supervised-injection services, which are now offered in many Canadian cities, he has watched his Philadelphia counterparts struggle to establish a U.S. beachhead.

"Good complex policy is often controversial, especially when you're the first,” Cressy said. In addition to public consultations, Cressy noted that Toronto opened injection sites in three locations at the same time, which may have had the result of watering down opposition to any one in particular.

His advice for Philadelphia? “Follow the evidence and the research. The longer you delay implementing these services the more people will die.”

Cressy says the effort should include “a range of champions and actors — from those in police services who support it, to parents who never thought they'd be advocates for harm reduction but lost their own kids, to those on the front lines.

“Everybody needs to be at the table and the conversation needs to represent all of them.”

Rendell, who took up the cause after a friend’s son fatally overdosed, is undaunted, noting a once controversial needle exchange program is now widely admired.

“Americans have been taught by their politicians that people who use drugs are bad and ought to be in prison for long sentences and we're finding out the folly of that,” he said.

“There's a little bit of a drug-war culture here that never existed in Canada, and that makes it a bit of a harder sell here. But people will accept when they understand.”

“If you could turn the clock ahead five years from now there will be three or four sites, an accepted part of life.”