On August 19 a federal judge in Philadelphia presided over the opening salvo of a legal battle with the potential to radically alter the course of drug policy in America—or else demonstrate once again that the US remains years behind its global peers. At the hearing, I observed what could be a significant change in the government’s approach to blocking safe consumption sites.
In February the US attorney for the Eastern District of Pennsylvania, Bill McSwain, filed a civil motion for a preliminary injunction, asking a judge to prevent the nonprofit group Safehouse from opening a safe consumption site (SCS) in Philadelphia on the grounds that it would violate federal law.
The takeaway after a full day of testimony and cross-examination is that the government may be losing faith in its ability to win the motion solely on legal technicalities (some of the subtleties are explained here by Filter’s Sessi Kuwabara Blanchard). Instead, the feds seem to be turning their focus to chipping away at the assertion that Safehouse would save lives.
The evidentiary hearing marked the first time that McSwain’s office and Safehouse personnel—led by Ronda Goldfein, of the Aids Law Project of Pennsylvania, and Jose Benitez, longtime director of the syringe program Prevention Point Philadelphia—have faced off in court.
“What if you reversed an overdose on one day and the individual went out and used and died the next day?”
Before a packed gallery, Ilana H. Eisenstein, an attorney with the firm DLA Piper who is acting for Safehouse, called three expert witnesses—including two physicians who spoke to the power of naloxone to save lives and the complexities of providing treatment to a diverse population with numerous problems beyond drug use.
But it was the cross-examination of Benitez—the only line of questioning conducted by McSwain personally—that stood out.
“Can you say for certain [Safehouse] would save lives?” McSwain asked. “What if you reversed an overdose on one day and the individual went out and used and died the next day?”
A visibly confused Benitez acknowledged that there is obviously no guarantee against such an outcome, but noted that a dead drug user has no chance of recovery.
Despite maintaining the stance that SCS would violate the so-called “crackhouse law” of the Controlled Substances Act—which makes it illegal to own, lease or operate a property used exclusively for the use or sale of illicit drugs—the government’s questioning at the hearing repeatedly focused on the public health impact of SCS.
Sources tell Filter that Safehouse, which counts former DNC chair and Pennsylvania Governor Ed Rendell among its board members, is logistically capable of opening its site as soon as this year.
During a break in the legal proceedings, Rendell railed against the hypocrisy of law enforcement’s opposition to Safehouse. “Over the last two years, more than 2,300 mostly young people have died of overdoses—that’s four times the homicide rate in Philadelphia,” he said. “The system is not working.”
Later, as I drove through the overdose-scarred neighborhood of Kensington, the intended location of Safehouse’s site, the case for SCS seemed more self-evident with every semi-conscious person I passed along the main thoroughfare of Kensington Avenue.
If the government wants to attack the efficacy of SCS, that’s winning territory for harm reduction advocates.
SCS provide people who use drugs with a place to inject or otherwise consume that is staffed by medical personnel trained in overdose reversal and stocked with sterile syringes, naloxone and other harm reduction supplies. Social workers and addiction specialists are often also present. No overdose death has been recorded at such a facility.
While there are around 120 SCS operational around the world (primarily in Europe), Safehouse would be the first legal SCS on US soil.
The nonprofit group’s literature cites the many benefits of SCS. Data from Vancouver, for example, which opened Insite, North America’s first legal SCS, in 2003, has shown that this intervention reduces mortality and sharing of needles, and increases access to addiction treatment. One study showed that Insite offered services to 175,464 drug users in 2017 and reversed 2,151 potentially fatal overdoses that year.
McSwain has previously criticized what he called the “hyperlocal” nature of this evidence.
“Safehouse would not be doing much more than Prevention Point already is doing,” said Eisenstein, during a conversation at the conclusion of the day’s proceedings. “They already offer clean injection equipment and naloxone, the only difference is they would be doing it in a building with medical personnel present.”
Afterwards, a line I have often heard in harm reduction circles echoed in my thoughts: Don’t let the perfect be the enemy of the good.
SCS may not be a panacea for the US overdose crisis, but it would be one big step to protecting public health and extricating the country from a costly and unwinnable “war”—one that contributed just last week to the injuries of six police officers serving a narcotics warrant against a 36-year-old man, who then held an entire North Philadelphia neighborhood virtually hostage during an hours-long standoff.
I returned to the courthouse as the sun was falling in the early evening sky, to ask Benitez, Goldfein and Rendell for their assessment of the hearing. There was an overwhelming feeling of optimism among the Safehouse team. If the government wants to attack the efficacy of SCS, that’s winning territory for harm reduction advocates.
Benitez drew a telling parallel between SCS and a doctor in an emergency room.
“You know when someone comes in with a serious injury, they patch them up and do what they can, but they don’t know what’s going to happen next,” he said. “I think [McSwain’s] whole argument is disingenuous. If we can save one life for one minute, we are at a better advantage than if we didn’t.”
Top photo shows images of overdose victims placed outside the hearing by advocates. Photos by Christopher Moraff.