More than 1,200 people died of accidental overdoses in the city last year – could bringing users in off the street be the answer?

This article is more than 2 years old

This article is more than 2 years old

A young man folded over his knees in the stairwell of the El train station at Kensington Avenue and Somerset Street doesn’t look well. A syringe is by his feet.

A voice spoke out: “Yo, we’re gonna Narcan you!”

Another man, who moments before was also passed out on the steps, tears open a package of naloxone hydrochloride, a prescription nasal spray that reverses an opioid overdose. “Don’t use it unless he really needs it,” says the woman who handed it to him.

The nozzle is shoved up the man’s nostril, and a couple of minutes later he snorts in a long breath and his eyes stretch open. Someone shouts “He’s good!” and everyone returns to their business on this corner of North Philadelphia, ground zero for the city’s opioid epidemic.

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Last year, 1,217 people in Philadelphia unintentionally overdosed and died – nearly four times the city’s homicide rate. Nearly nine in 10 of those overdoses involved opioids – prescription pills, heroin or fentanyl.

Now Philadelphia is among a handful of US cities – including Seattle, New York and San Francisco – that wants to open the country’s first safe-injection site, or in the city’s parlance, Comprehensive User Engagement Site (Cues).

A safe-injection site would allow users to come in and use their drugs with medical staff on hand in case of an overdose. They would also be able to get clean needles, or be connected to other services such as detox and treatment. But the priority is preventing deaths.

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“We have to make every effort we can to keep them alive long enough to get them in treatment,” said James Garrow, spokesman for the Philadelphia department of public health.

The city believes setting up a site could save up to 76 lives a year.

But here in Kensington, a neighborhood renowned for heroin use, opinions vary among addicts and those seeking to give them help.

“I’m for it but I also don’t believe that anybody down here would go to these places,” said Jim Kelly, 37, a volunteer at the Last Stop recovery house next door to the Somerset Street subway station. “Because they want to do it as soon as they get it – and that’s coming from experience.”

“I’m pro,” said Damaris Vega, 46, who along with her daughter and grandson was giving out ham and cheese sandwiches, bottled water, watermelon slices and ice pops from the trunk of a car. “It’ll keep the needles off the street. It’ll keep them safer. It’ll save their lives.”

Dennis W declined to give his last name but said he was 35, lived in the neighborhood, and had been sober just over two years. He described a story he heard on NPR about the government-run safe-injection site in Vancouver, which opened in 2003, and how it allows users to come in and unpack their drugs.

“It sounds super weird,” he said. “Obviously if there’s AC and shit, people will want to go in there.”

When he was shooting heroin, he said, he preferred to do it alone at the nearby railroad tracks or in abandoned houses – “places that you die because you’re by yourself”.

Three-quarters of opioid-related overdose deaths in Philly last year occurred in personal residences.

Facebook Twitter Pinterest Mike, 22, a heroin addict who began using opioids when he was 13, pauses to shoot up by a railway underpass in the Kensington section of Philadelphia. Photograph: Spencer Platt/Getty Images

Elaine Gessler, 46, another former user who lives in an apartment the next block over, believed a safe-injection site would help on multiple fronts – from keeping people from shooting up in front of kids to providing them with basic needs like clean water.

“I saw a man this morning right under the El. He had a bar of soap and he was cleaning out an open wound in a puddle,” she said. “They use puddle water to inject and shoot up with that.”

According to Philadelphia’s managing director’s office, the city is still looking for organizations to fund and operate the site, and it does not have a location. A spokesperson said the city doesn’t expect the site to open until next year.

There are also legal questions to iron out.

Safe-injection sites are illegal under federal law. The Department of Justice released a statement last year that said users and workers at the sites could be criminally charged and the properties subject to forfeiture.

Pennsylvania’s governor, Tom Wolf, hasn’t backed the Cues either. His support, drug policy experts say, could deter the feds from taking a hardline approach.

Rallying community support and overcoming local opposition will also take time and effort.

The local author, journalist and radio host Solomon Jones is an outspoken critic of safe-injection sites and what he sees as the “gentrification of addiction”.

“As somebody who now has almost 22 years clean, what is now being called harm reduction is really in my view, and the view of many addicts, enabling,” Jones said.

But his bigger objection is to the difference in “the way crack was treated because it was seen as a black and brown issue and the way that heroin is being treated – both here and nationally – because it’s seen as a white issue”.

Facebook Twitter Pinterest Discarded needles are seen at a heroin encampment in the Kensington neighborhood of Philadelphia. Photograph: Dominick Reuter/AFP/Getty Images

“I think the response is steeped in racism,” he said.

According to a Pew analysis of CDC data, white males have the highest rate of overdose deaths in Philadelphia, with 45- to 54-year-olds hardest hit.

Nationally, non-Hispanic white users accounted for nearly 80% of opioid overdose deaths in 2016. Black users, who make up 12% of the US population, accounted for 10%.

“So if we’re now saying that running a legal drug house is fine for people shooting drugs then we need to give people their houses back, their cars back, their money back – all the stuff that was confiscated from black and brown people during the so-called war on drugs here in Philadelphia,” Jones said. “We need to make the black and brown community whole.”

Gilberto Gonzalez, a graphic designer and community activist in Kensington who ran for state representative earlier this year, worries a safe-injection site in the neighborhood will cause more violence as dealers fight for corners surrounding the site.

Although research on sites in Vancouver and Australia found they did not increase crime in the surrounding areas, Gonzalez is skeptical.

“I don’t know anything about Vancouver but in North Philly, in Kensington, those drug dealers are violent,” he said.

Gonzalez doesn’t oppose helping people with addiction, but says other priorities need to be dealt with first – like drug-free school zones, needle-free parks and outreach to the dealers on the corners.

“I’ve talked to these kids. Most of them can’t read or write but they want a job. Why don’t we get them in community college and certificate programs where they can get skills?” he said. “Why don’t they help them?”