October 2 will live long in US harm reduction history. A federal judge gave an interim ruling that Safehouse⁠—a nonprofit planning to open the first sanctioned safe consumption site on US soil in Philadelphia’s Kensington neighborhood⁠—would not be violating federal law.

“The ultimate goal of Safehouse’s proposed operation is to reduce drug use, not facilitate it,” wrote US District Judge Gerald Austin McHugh Jr. in his detailed 56-page opinion, “and accordingly 856(a) does not prohibit Safehouse’s proposed conduct.”

Bill McSwain, the US Attorney for the Eastern District of Pennsylvania, filed a motion in February seeking to prevent Safehouse from opening on the grounds that providing a safe space for drug users to inject is illegal under law 856(a)—the so-called “crack house statute” of the Controlled Substances Act.

US Attorney McSwain and his allies then argued in court against both the legality and the efficacy of safe consumption sites—which operate in 10 countries around the world and are shown by reams of evidence to reduce harms and save lives. A June survey showed 90 percent local support for an SCS in Kensington.

The Safehouse leadership was obviously delighted by the verdict, but also sounded caution. Ronda Goldfein, executive director of the AIDS Law Project of Pennsylvania and a member of the Safehouse leadership team, told Filter that the organization doesn’t plan on moving forward until it can clarify certain positions with Judge McHugh. Goldfein did not elaborate on where there may be ambiguities in the ruling.

The group has implied in past conversations that it could be ready to open within a week of any ruling in its favor, but it clearly has concerns that there are details yet to be resolved.

“We have tried to be respectful and methodical in our approach and nothing has changed in that way. We didn’t just bust out there and open up, we have patiently laid out our case,” Goldfein said. “The lives of the people we serve are chaotic enough; we don’t want to add a federal drug charge on top of that.”

However, she also hinted that a second site, outside of Kensington, may already be in the planning stage.

“This case is obviously far from over. We look forward to continuing to litigate it,” said McSwain.

While this victory is hugely significant, the legal battle will continue—an appeal and further litigation are expected. “This case is obviously far from over. We look forward to continuing to litigate it,” said McSwain in a statement after the verdict.

Some local leaders, including Councilor Maria D. Quiñones-Sánchez, whose district covers some of the most impacted areas of Kensington, also remain opposed to Safehouse. “Injection sites have been successfully opened in locations where government has taken responsibility to fund, run and own the programming,” said Sanchez. “We are not there yet.”

Grassroots Activism Paved the Way

But we’re a lot closer. As the city prepares to make history by taking a progressive leap forward on drug policy, it would be remiss not to mention the unsung harm reduction heroes who put a plan in motion for an illicit SCS when the City of Philadelphia still opposed the idea.

It was just over two years ago that I first became aware of a small but determined effort by a group of mostly young activists to establish an SCS in Kensington.

This was during the waning days of “El Campamento”—a secluded encampment of homeless drug users that was closed down by Mayor Kenney’s office in August 2017 under pressure from local political leaders. The move was informed by a narrow view of the city’s devastating overdose crisis and a misinformed media that stoked widespread outrage over the camp.

They were a fiercely determined bunch that included medical students, harm reduction veterans, nurses and former members of the military.

During the frigid winter that followed—as four tent cities sprung up in Kensington, to house people displaced by the closure and to provide temporary shelter for others drawn there by the availability of drugs—I gained the trust of a few key players in the movement to create a new, safe space for people to inject.

I use the term “movement” loosely. They were a fiercely determined bunch that included medical students, harm reduction veterans, nurses and former members of the military. Their brainstorming led to some truly innovative ideas, as they scouted sites on abandoned rail beds and debated racial politics in drug subcultures during weekly meetings.

“You don’t need a physician on site,” one local organizer in the drug user community told me off the record. “It raises the cost considerably without any real added benefits.”

Part of this involved fears of the consequences for any friendly physician involved in an unsanctioned SCS. “Well, you can’t go anywhere near the site,” one member of the group told a doctor who was devoting his time and expertise to overdose prevention. “There already aren’t enough harm reduction-minded doctors. We need you out here.”

The election of reformer Larry Krasner as district attorney and the city’s January 2018 announcement that it would take a hands-off approach to SCS, then saw these radical activists switch their focus to establishing a sanctioned venue (although some have still quietly criticized Safehouse as being more “high-barrier” than necessary).

Against what seemed like insurmountable odds in the summer of 2017, Judge McHugh has now ruled that no doctors should have to go to prison for the “crime” of saving a life.

“I’m still a bit wary of what comes next. The champagne isn’t popping yet.”

The local harm reduction community spent the evening of October 2 celebrating the decision. Sterling Johnson, an organizer at ACT-UP Philadelphia, called the ruling “a major step forward that lays the legal groundwork for safe consumption and other public interventions supporting drug user health care rights.”

Yet Alex Kral a leading researcher on SCS at RTI International, was reluctant to declare victory too quickly.

“Having been at this for 12 years and having had so many victories nullified along the way, I’m still a bit wary of what comes next,” he told Filter. “The champagne isn’t popping yet.”

Photo by Priscilla Du Preez on Unsplash