Some medical groups such as the American Medical Association back pilot safe injection sites as a way of potentially reducing the nation’s rising rate of drug overdose deaths. | AP Photo Trump administration warns California against 'safe' opioid injection sites

The Justice Department is threatening to shut down San Francisco's proposed test of supervised injection sites amid the opioid crisis even before the governor has a chance to sign the pilot program into law.

The looming showdown could affect similar efforts in New York, Philadelphia and Seattle, where officials have grappled with the ramifications of setting up spaces where drug users could shoot up while gaining access to clean syringes, medical professionals and treatment services as an approach to curb opioid addiction and overdose deaths.


Deputy Attorney General Rod Rosenstein said in an op-ed piece in The New York Times that “cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action" and warned that maintaining “any location for the purpose of facilitating illicit drug use” could lead to criminal prosecutions and up to 20 years in prison, hefty fines and property seizure.

But a bill California legislators sent to Democratic Gov. Jerry Brown this week could swing San Francisco's effort into action. The city on Tuesday opened a “mock” injection site at Glide Memorial Methodist Church, which also provides health services in one of its poorest neighborhoods.

"Threatening criminal prosecution — the Trump drug addiction strategy — isn’t how you break addiction," state Sen. Scott Wiener, a co-author of the bill, tweeted Tuesday. "We tried that — the War on Drugs — & it failed. Let’s try strategies that actually work."

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Brown has until the end of September to sign or veto the bill, which would authorize San Francisco to establish a three-year pilot to test the concept.

The effort has the backing of San Francisco Mayor London Breed and local law enforcement. The California District Attorneys Association dropped its initial opposition. But it's still in conflict with federal law: Officials from the U.S. Attorney's Office for the Northern District of California said Rosenstein’s statement speaks for the department.

Breed, whose younger sister died in a drug overdose, has said she's willing to trigger a legal showdown.

Wiener, whose district includes San Francisco, said in an interview that California has a tradition of challenging the federal government on drug policy, pointing to past efforts to legalize medical marijuana and needle exchanges. “The fact the federal government is backwards on so many issues has never been an obstacle to California moving in a progressive direction.”

In Philadelphia, Rosenstein’s warning did little to dampen enthusiasm for supervised injection facilities. City health commissioner Tom Farley hopes to have a site up and running within the year.

James Garrow, a spokesman for the health department, said Rosenstein’s op-ed doesn’t change the evidence showing that overdose prevention sites save lives.

“The federal government should focus its enforcement on the pill mills and illegal drug traffickers who supply the poison that is killing our residents, not on preventing public health officials from acting to keep Philadelphians from dying," he said.

New York City is also considering a proposal to open four safe injection sites.

States have bucked federal drug policy in the past, said Michael Collins, interim director of the Drug Policy Alliance’s Office of National Affairs.

“Our hope would be that this will be viewed in the same light ... the calculation is we want to save lives rather then we want to bow to Jeff Sessions,” he said.

Some medical groups such as the American Medical Association back pilot safe injection sites as a way of potentially reducing the nation’s rising rate of drug overdose deaths.

“Pilot facilities will help inform U.S . policymakers on the feasibility, effectiveness and legal aspects of supervised injection facilities in reducing harms and health care costs associated with injection drug use,” current AMA President-elect Patrice Harris said when the physicians group voted in 2017 to endorse the development of such sites.

Theodore Mazer, the head of the California Medical Association, expressed concern about physician liability. He said in a statement the group will “continue to advocate for proven policies that address the opioid crisis and ensure necessary liability protections for physicians and other health care providers in both state and federal law.”

The controversy has also touched the American Society of Addiction Medicine. The group favors establishing pilot sites, viewing them as a “research opportunity, more so than as a policy,” said Corey Waller, the chair of ASAM’s legislative advocacy committee.

New research, however, raises fresh questions about the effectiveness of the sites. A review of research published in the International Journal of Drug Policy found safe injection sites had no significant effect on overdose deaths or curbing needle-sharing.

Since 2002, the number of opioid overdose deaths has quadrupled, according to CDC data released this month. The crisis shows no sign of slowing down, as the powerful synthetic opioid fentanyl has become a large driver of overdose deaths.

“This is a huge ship to turn around and it takes many, many approaches and many tools,” said Tom Hill, the National Council for Behavioral Health’s vice president of practice improvement. “Communities around our country are looking to [injection sites] as a viable answer. It's not the answer — it's an answer.”

CLARIFICATION: The International Journal of Drug Policy review of research questioning the effectiveness of supervised injection sites was retracted on Sept. 27 after the authors acknowledged “methodological weaknesses” that resulted in an effect size not supported by the pooled data.