The opioid crisis is one of the most important issues facing the United States today. In 2018, the Trump administration signed a bipartisan bill aimed at fighting the opioid crisis through coordinated action and expanded access to medical treatment.
Politicians from both sides of the aisle are extremely concerned about the rising number of opioid-related deaths—and for good reason. Approximately 130 Americans die from an opioid-related overdose every day. In 2017, the number of opioid-related overdoses was six times higher than it was in 1999. The question is no longer whether we have an opioid epidemic; it is how we address it.
Safe Injection Sites
In order to try to combat this issue, people are considering opening up safe injection sites. These are places where individuals can come to test the quality of their drugs, obtain sterile injection equipment, and inject their drugs under medical supervision.
While these sites are new to the US, they have become common practice in many other countries around the world. Canada has the oldest safe injection site in North America, Insite, which has been in operation since 2003.
Insite has not experienced one overdose in the entire 15-year period they have been in operation.
Insite and efforts like it have seen fairly remarkable success. Research shows that they significantly decrease overdoses without increasing the amount of drug use. Insite has not experienced one overdose in the entire 15-year period they have been in operation.
Efforts like these are just now gaining traction in the United States. Cities like San Francisco and Philadelphia have recently made efforts to establish safe injection facilities. So why haven't they started operating yet? The answer is fairly simple: there is a strong possibility that they are currently illegal.
United States Code Title 21, Section 865, makes it unlawful to
knowingly open, lease, rent, use, or maintain any place, whether permanently or temporarily, for the purpose of manufacturing, distributing, or using any controlled substance.
This is a fairly obscure section of the Controlled Substances Act that was added at the height of the crack epidemic and is commonly known as the “Crack House” statute. It was intended to discourage people from allowing their homes to be used for drug-related purposes.
Do They Harm Society?
So why are safe injection sites so afraid that they are violating a statute that was clearly passed for an entirely different purpose? The answer lies with the Department of Justice (DOJ).
In 2018, Rod Rosenstein, the Deputy Attorney General of the United States, published an op-ed in The New York Times titled “Fight Drug Abuse, Don’t Subsidize It.” In this article, Mr. Rosenstein made an argument for why he thinks safe injection sites are harmful to society. However, he did not stop with advocacy. Mr. Rosenstein specifically said that “cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action.” He made it clear that anyone hoping to open and operate a safe injection site would face strong opposition from the DOJ. And he was not bluffing.
The federal government is sending a clear signal: if you try to open up a safe injection site, they will prosecute you.
On February 5, 2019, United States Attorney William M. McSwain filed a complaint with the United States District Court for the Eastern District of Pennsylvania seeking a declaratory judgment against Safehouse, a safe injection site set to open in Philadelphia, Pennsylvania, as well as against Jeanette Bowles, its executive director. The complaint asks the court to declare safe injection sites illegal under the Controlled Substances Act. The federal government is sending a clear signal: if you try to open up a safe injection site, they will prosecute you.
So why is the federal government so against the establishment of safe injection sites? If you ask Mr. Rosenstein, it’s because these sites “create serious public safety risks” and “destroy the surrounding community.” However, as we have seen, the evidence leans strongly against the conclusion that safe injections sites pose more public safety risks than they alleviate or that they destroy the communities that surround them. The more likely reason for this strong opposition is that safe injection sites undermine the DOJ’s position that drug use should be treated as a crime rather than a public health issue.
Safe injection sites are built on the premise that our goal should be to reduce the harm caused by drugs—not to punish those who use them. This stands in stark contrast to the DOJ’s position that it is not the harm caused by drugs but drug use itself that we should work to combat. If they allow safe injection sites to open and they achieve the same success they have in the past, this would serve as a huge blow to the DOJ’s current position. People may begin to think that it is the harm caused by drugs—and not drug use in and of itself—that is actually the issue.
Regardless of the true intent behind these actions, it is clear that the DOJ plans to fight safe injection sites tooth and nail. This will serve as a major hindrance for people who are trying to find evidence-based, practical solutions for combating the opioid crisis. It remains to be seen how the court will rule on safe injection sites and whether or not they violate federal law, but the DOJ’s aggressive actions send a definite signal to those hoping to open up one of these facilities: expect fierce opposition.