Two major U.S. cities are trying to open facilities to save drug users’ lives, but the Trump administration is trying to stop them, arguing the facilities are no different than crack houses.

Seattle and Philadelphia plan to curb overdose deaths by opening facilities where drug users can ingest illicit substances like heroin under medical supervision. So-called overdose prevention sites are part of a strategy that seeks to reduce harm from drug use. The facilities were first popularized in Western Europe and have made their way to Canada and now potentially the U.S. While controversial and seemingly counterintuitive, over 100 such facilities currently operate in several countries, and public health experts consider them a staple of a robust strategy to prevent overdoses. Even Vice President Mike Pence, when he was Indiana’s governor during an HIV outbreak, implemented a similar program to distribute fresh syringes to prevent new infections.

President Trump campaigned on ending the overdose crisis, but federal prosecutors appointed by his administration are thwarting cities from pursuing effective strategies. Deputy Attorney General Rod Rosenstein promises “swift and aggressive action” if any cities follow through on their plan to implement the sites in the face of a staggering overdose death toll that has led Denver, New York, Seattle, Boston, San Francisco, and Philadelphia to consider implementing them. In 2017, more than 72,000 people died from drug overdoses in the U.S. Among overdose deaths involving opioids, more than 28,000 were due to illicit fentanyl, an uber-potent synthetic opioid manufactured in clandestine laboratories.

While overdose prevention sites are no panacea, decades of research from Canada, Australia, and Western Europe demonstrate their effectiveness, especially in times of crisis. A review of the scientific literature finds that these facilities reduce overdose deaths, public injection, neighborhood disorder, and the transmission of blood-borne diseases like Hepatitis C and HIV in the communities they operate. People who use overdose prevention sites also see improvements in their overall health, and overtime seek out treatment and find a path toward recovery.

“ The only thing these sites encourage is safer drug use for people who are already using drugs and unable to or do not wish to stop. ” — social worker Brooke Feldman

Last February, the Justice Department filed a civil lawsuit against Safehouse, a Philadelphia-based nonprofit that plans on operating the country’s first ever overdose prevention site. The civil suit, also a first of its kind, is a preemptive strike that aims for the facility to be deemed illegal by a judge before it ever opens.

“What’s driving the lawsuit is our responsibility to uphold and enforce the rule of law,” the U.S. Attorney in Philadelphia, William McSwain, said in a statement to The Daily Beast. “ Possessing, consuming or otherwise sanctioning the use of these dangerous narcotics is clearly against the law in the United States.”

McSwain is referring to what’s known as the “crack-house statute,” a provision that penalizes anyone who manages or owns a building where drugs are being used. Violating the statute can result in hefty fines or jail time. Public health and legal experts suggest the “crack-house statute” was never intended to apply to medical settings where people are receiving services that Safehouse would provide, such as wound care, new syringes, and treatment referrals.

Seattle may soon find itself in the same legal bind as Philadelphia. When asked about a site in Seattle, U.S. Attorney there Brian Moran told city officials: “Don’t go there.”

“As the Deputy Attorney General has made clear, the U.S. Department of Justice will not stand idly by and allow consumption sites to open in cities across the U.S.,” Moran told The Daily Beast . Though Moran has not filed a lawsuit like his Pennsylvania counterpart, he calls the plan to do so a “logical path” were Seattle to move forward on the proposed facility to be called Community Health Engagement Locations (CHELs).

The threat of a lawsuit looms large in the minds of Seattle officials like Mayor Jenny Durkan, whose office said she “thinks it is unfortunate that the Department of Justice would move to block a harm-reduction strategy to the opioid epidemic. However, we are not surprised and take these threats seriously. We continue to monitor the Philadelphia lawsuit while evaluating our legal options.”

Ronda Goldfein, an attorney in Philadelphia who sits on Safehouse’s board, told The Daily Beast that a court date has not been set, but that they are prepared to argue their case. “We have consistently maintained that an overdose prevention site, which includes a supervised consumption room and is operated for the purpose of saving lives, does not violate federal law,” Goldfein says. “We’re looking forward to the opportunity to present our arguments.”

Goldfein, also the executive director of the AIDS Law Project in Pennsylvania, sees many parallels between the modern day overdose emergency and the AIDS epidemic. AIDS activists put relentless pressure on the federal and local governments to fund research for treatment and invest in services like syringe-exchange programs that distribute sterile injection equipment to prevent the transmission of blood-borne diseases. The same way activists distributed syringes before it was legal, there are currently underground overdose prevention sites operating in U.S. cities.

“Among our challenges will be to address the stigma of drug use,” Goldfein says. “In HIV work, it’s clear that stigma continues to fuel that epidemic, despite medical and scientific advances in treatment and prevention.” Despite awareness around drug use as a matter of public health, drug users continue to be arrested and criminalized, she says.

The Department of Justice frequently argues that overdose prevention sites condone and therefore “normalize” injection drug use.

“Not only does the existing research on overdose prevention sites suggest that they do not encourage or increase drug use, but that argument just simply doesn't make sense,” said Brooke Feldman, a social worker in Philadelphia who has found recovery from her own substance use disorder. “The only thing these sites encourage is safer drug use for people who are already using drugs and unable to or do not wish to stop.”

A two-and-a-half-hour drive up the coast from Seattle is an overdose prevention site in Vancouver called Insite, which has been operating since 2003 on the Downtown Eastside.

“We know definitively there is a reduction in things like discarded syringes and public injecting upon the opening of these sites,” Ryan McNeil, a research scientist at the University of British Columbia who has studied the effects of overdose prevention sites. “You would think law enforcement groups would get behind that?”

“All these sites do is ensure that people who are using don’t die,” he added.