Editor’s note: In January, a three-judge panel from the 3rd U.S. Circuit Court of Appeals ruled in a 2–1 decision that federal law precludes Safehouse from operating its proposed site in Philadelphia.
“Safehouse admirably seeks to save lives,” the majority opinion says. “And many Americans think that federal drug laws should move away from law enforcement toward harm reduction. But courts are not arbiters of policy. We must apply the laws as written.”
A few countries in Europe in the 1980s tried something new to reduce the harms associated with the use of illicit drugs: A supervised, hygienic facility where people could consume pre-obtained drugs, be monitored for overdoses, have access to counseling, and get referrals to health care and social services, including drug treatment.
Today, about 120 legally sanctioned supervised consumption sites operate in 11 countries globally, including Canada, Germany and Switzerland. Now there’s a proposal for the first supervised consumption site to open in the United States, but the federal government filed a lawsuit to block it from opening in Philadelphia. They argue it violates a section of the Controlled Substances Act that was aimed at making it easier for police to arrest individuals who opened and used buildings to produce, sell, or use crack cocaine.
Medical experts disagree.
In an amicus brief, the Litigation Center of the American Medical Association and State Medical Societies joined the Pennsylvania Medical Society, Philadelphia County Medical Society and about a dozen other organizations to provide information to the U.S. Court of Appeals for the 3rd Circuit that years of evidence show that these facilities provide evidenced-based medical and health interventions that help save lives, offer access to necessary services, and provide support to people who use drugs.
A three-judge panel on the 3rd Circuit heard arguments from attorneys on both sides Nov. 16, 2020.
- The brief cites a wealth of peer-reviewed studies that show supervised consumption sites:
- Minimize the risk of HIV, hepatitis C, and hepatitis B transmission.
- Increase referrals to drug treatment and other health services.
- Minimize public drug use.
- Improve public order and nuisance concerns such as improperly disposed syringes.
- Evidence also shows facilities don’t increase crime or encourage those who have never taken drugs to begin doing so.
“Supervised consumption sites actually further the broad intents and purposes of the Controlled Substances Act, which include an emphasis on protecting public health,” the brief filed in the case, United States of America v. Safehouse, says.
Supervised consumption houses like the one proposed in Philadelphia, called Safehouse, “are a critical component of a comprehensive solution to addressing the harms of drug use” and have the potential “to act as a critical bridge between people who use drugs in Philadelphia and opportunities for treatment and social services,” the brief says.
Reducing drug overdose deaths
Nationwide, more than 71,000 people died of a drug overdose in 2019, including more than 4,400 in Pennsylvania.
Staff at supervised consumption sites do not directly assist in drug consumption, distribution, or administration and do not handle any drugs clients bring into the facility. The staffers do present sterile consumption supplies, answer questions on safe consumption practices, administer first aid if needed, and monitor clients for potential overdoes.
The AMA Litigation Center brief tells the court that while overdoses may occur at facilities operating worldwide, not a single overdose death has been reported because staff can immediately respond, administering oxygen and naloxone, if needed, and calling for ambulance support.
According to research cited in the AMA’s brief, here’s what the data show:
- 3,180 overdoses were reversed at a German site between 2000 and 2013.
- A 68% drop in the number of opioid-related overdose ambulance calls in the area surrounding a Sydney supervised consumption site compared to areas without one.
- Nearly 175,000 client visits to a Vancouver, Canada, supervised consumption site, including 49,000 clinical treatment visits and 6,440 overdose interventions.
“The data speaks for itself—supervised consumption sites effectively treat health emergencies and help prevent certain drug-related harm or death,” the AMA Litigation Center brief says.
AMA policy supports the development and implementation of pilot supervised injection facilities in the United States that are designed, monitored and evaluated to generate data to inform policymakers on the feasibility, effectiveness, and legal aspects of SIFs in reducing harms and health care costs related to injection drug use.