Last month, Philadelphia shut down the “heroin camp” in Kensington, where many homeless people who use drugs had sheltered along the Conrail tracks. As bad as conditions in the camp were, it served an important purpose for outreach workers trying to stem the overdose crisis that killed more than 900 people in this city alone last year. At the camp’s medical hut, they were able to provide people with naloxone, a safe and easy-to-use medicine that immediately reverses a heroin overdose.
Philadelphia needs a better way to reach people who are at risk of overdosing, one that doesn’t leave them on the streets or in inhumane conditions. There is a solution: a supervised consumption site, where people who use drugs can do so in a clean and safe space, with medical oversight and access to social services.
Last spring, I came to Philadelphia to speak to the Mayor’s Task Force to Combat the Opioid Epidemic about my experience managing North America’s first legal supervised consumption facility — Insite, in Vancouver, Canada. I was there when Insite opened in 2003 and stayed for seven years, so I’ve seen the benefits firsthand. During that time, we saw some three million visits — an average of 700 to 900 people every day.
Insite doesn’t provide drugs, and people can’t buy or sell them there. When someone comes to Insite, they can talk to a nurse about their drug use, ask questions about safety, test their drugs for dangerous additives like fentanyl, and if they choose, inject with sterile needles and clinical supervision.
Overdoses do happen at Insite, just as they do elsewhere — but because staff are on hand to administer oxygen or naloxone as needed, everyone who overdoses has been safely revived. Insite also found that making it possible for people to test their drugs for fentanyl helped lower the risk — if they get a positive result, they are 10 times more likely to choose to take a lower dose, which reduces their chance of overdose by 25 percent. This is particularly important because fentanyl is becoming so common in street drugs, and it’s a major cause of fatal overdoses in Canada and, increasingly, in the United States.
But supervised consumption sites don’t just prevent fatal overdoses and stem the spread of infections like HIV from shared needles. They also offer a way to connect people to treatment and support.
When someone visits Insite, they can get a cup of coffee and a friendly conversation. If they need housing, staff there can connect them to social services, and if they are ready to talk about getting treatment to stop using, the staff can help open those doors. In fact, Insite was so successful in referring people to detox that we had to build one upstairs. Then we opened a transitional housing residence above that, for people post-detox who were waiting to get into a treatment program or permanent housing, and a women’s treatment program down the street. An independent scientific study found Insite’s opening was associated with a 30 percent increase in people using detoxification services, as well as increased rates of people entering long-term addiction treatment.
It may seem counterintuitive that giving people a safe place to use drugs makes them more likely to seek recovery. But it makes sense when you realize that treating people with compassion and respecting their dignity creates an environment where they can start making better decisions about their health.
At Insite, we tried to meet people wherever they were in the cycle of addiction and recovery and give them the options to make choices. If they were going to use that day, then they could do so without risk of infection or overdose. If they wanted detox, they could go right upstairs. If they wanted treatment, we could keep them safe and help them find it. And if they relapsed along the way, they knew that they could come back to us and we’d be there to support them.
I understand the concerns some people have about supervised consumption sites — but the evidence shows that they are unfounded. Having access to such a facility doesn’t tempt people to start using drugs — on average, Insite’s users have been injecting for at least 16 years. Research also showed no increase in drug use or drug-related crime in the surrounding neighborhood. In fact, supervised consumption sites can benefit the surrounding community by reducing the likelihood that people will inject drugs in public spaces like bathrooms or parking lots, and ensuring that used needles are disposed of safely.
A study of an underground supervised consumption site that’s been operating in an unnamed American city for the past three years found it had similar benefits — and that its staff had stopped at least four overdoses. Consider the number of fatal overdoses that have occurred in the nearly 100 supervised consumption sites that exist around the world: zero. That’s the single most important argument for supervised consumption sites — they save lives.
Supervised consumption sites are not a magical solution to all the problems associated with illicit drugs. Each facility’s reach is limited to the people who manage to access it, and even with all the help offered, some people continue to use drugs in disorganized and dangerous ways. Still, decades of telling people to “just say no” hasn’t worked. We have to admit that people will continue to do drugs whether it’s safe or not — and that all lives are worth saving. We have to expand access to effective prevention and treatment, but we also need to keep people alive until they’re ready and able to get help.
Recently, hundreds of Philadelphians marched through Kensington, many carrying pictures of the loved ones they’ve lost, to demand the city take action to prevent more deaths. Opening a supervised consumption site is the best way to do that, and Philadelphia could lead the way.
Sarah Evans is a senior program officer with the Open Society Public Health Program. firstname.lastname@example.org