‘A facility like this could save them,' says Dr. Thomas Farley, the city's health commissioner
In a nation under siege by a burgeoning opioid epidemic, Philadelphia is among the areas hardest hit. The crisis there is claiming lives at a higher rate than in any other large U.S. city, with drug overdoses in 2017 resulting in an estimated 1,200 deaths.
Behind each fatal overdose is a human being who struggled with addiction until it ultimately took their life.
On Jan. 23, Philadelphia officials announced they want their city to be the first in the United States to open a sanctioned safe consumption site, which they hope will keep some drug users alive long enough to seek treatment.
Already operating in Canada and parts of Europe, safe consumption sites serve as indoor spaces where intravenous drug users can consume illegal drugs under the watchful eye of medically trained professionals who can intervene with life-saving measures in the case of an accidental overdose. These facilities also ensure safe and sterile injection practices, which cut down on the spread of infection and disease – and they serve as a valuable connection to treatment when drug users are ready to quit.
In Portland, a campaign aimed at opening a safe consumption site locally launched in November. Safer Spaces Portland, however, has yet to gain public support from any city- or county-level politicians.
STREET ROOTS SPECIAL REPORT: Safe-injection sites: Seeking a solution to public IV drug use
While Philadelphia is not the first city to grab headlines in its effort to open a safe consumption site, several important prerequisites paved the way to its recent announcement.
In May, the Mayor’s Task Force to Combat the Opioid Epidemic in Philadelphia recommended safe consumption sites as one of 18 solutions that together, it said in a report, “have the potential to turn the tide on the opioid epidemic in Philadelphia.”
Additionally, Philadelphia voters recently elected a district attorney who ran on a progressive platform aimed at reforming the city’s criminal justice system. Support of safe consumption sites from the city’s top prosecutor, Larry Krasner, along with support from the police commissioner, mayor and city council, made the decision to open such a site possible.
But not everyone’s on board. There is pushback from several state-level politicians, including Pennsylvania Attorney General Josh Shapiro, who released a statement in opposition.
One Philadelphia official leading the effort to open a safe consumption space is Dr. Thomas Farley, the city’s health commissioner. He said he expects a safe consumption facility to be up and running in six to 18 months.
Farley recently participated in Philadelphia’s Point in Time Count of its homeless population, where he interviewed several people under a bridge in an area of the city where heroin use is most intense.
This gave him the chance to “really get a sense for what their lives are like and how tough it is to deal with this problem of addiction,” he said.
He saw how easily one of them could make a fatal mistake while hastily injecting drugs under that bridge. But he also saw how a safe consumption site could lengthen what may otherwise be a short lifespan.
“A facility like this could save them,” he said.
Before coming to Philadelphia, Farley served as health commissioner for New York City and worked for the Centers for Disease Control and Prevention and the Louisiana Office of Public Health. Most recently, he was CEO of The Public Good Projects, a nonprofit that leverages mass media messaging to promote health and prevent disease.
Street Roots spoke with Farley several days after the announcement in Philadelphia to find out how various city agencies came to a consensus on such a controversial program and what’s at risk considering the opposition his city faces from higher levels of government.
Emily Green: As the health commissioner for New York City, you advocated for policies that further restricted substance use – such as raising the age of legal tobacco use making the city’s parks smoke free. You seem like an unlikely proponent of safe consumption sites. What happened?
Thomas Farley: I think that they’re entirely consistent. We want people to not start using substances in the first place, and having restrictions on accessibility of those substances is a way to do that. That’s true for tobacco, that’s true for alcohol and likewise for opioids – we are trying to get doctors to prescribe fewer opioids. However, we recognize that some people, no matter what we try, get dependent on these drugs, and in the case of opioids, we are seeing enormous numbers of people dying from these drugs. We want to keep people alive until they can get into treatment. For those folks, enabling them to use in a way where they don’t die, for harm reduction. It’s part of our imperative to save lives.
E.G.: You co-chaired the mayor’s task force that originally came up with safe consumption sites as a recommendation for combatting your city’s opioid epidemic. Also on that task force were the police and prison commissioners and a DEA agent. How did you get law enforcement on the same page as harm reduction advocates?
T.F.: At the time of the task force, law enforcement was firmly opposed to the idea of supervised consumption facilities. But the police commissioner for Philadelphia was at a meeting of other police chiefs, and he spoke to the police chief from Vancouver (B.C.). He was quite taken by the Vancouver police chief’s strong endorsement of the supervised consumption facility there – that it saves lives. His opinion was that it didn’t create crime, it didn’t prevent crime, it wasn’t about crime. It was about saving lives and that he, as police chief, was in favor of that, and so our police commissioner really took that to heart.
E.G.: Seattle has already set aside more than $1 million in funds for a safe consumption site, but on Jan. 23, Philadelphia announced that it wants to be the first city in the U.S. to actually open a site. Has that announcement drummed up any potential funders or operators?
T.F.: During the time we were quietly exploring this, we talked to people who expressed some interest in potentially being an operator and other people who were potentially interested in funding this. It was all very hypothetical at that point, and now we’re going to go back in a much more open and formal way and try to see who’s interested in potentially operating it and funding it. And so we’re optimistic we can put together the different pieces to make this happen.
E.G.: U.S. Attorney General Jeff Sessions has warned that such a site would violate the law, and your state’s attorney general is against the idea, too. What are you risking by moving forward without their approval?
T.F.: I’m old enough to remember when syringe exchange sites were very controversial, and they were opened by many very intrepid people who really just wanted to save lives and prevent HIV from being spread. If you were to read federal law or state law right now, you might say that they are operating out of compliance with that law, but they have operated successfully, including here in Philadelphia, for years and saved many, many lives. In fact, syringe exchange has been maybe the biggest success story in the whole history of the AIDS epidemic. And so I think what’s important is that the laws that are on the books were not written with the intent of preventing a doctor like me from saving lives. And we think that the federal government has more important things to do than to prevent me from saving lives, likewise with other enforcement agencies, so we’re going to go forward in the same way that people just moved forward during the crisis that was AIDS. We have a crisis that’s bigger than that now, and we think that other people will understand why that’s important to do it as we go forward.
E.G.: I was looking at a map of opioid mortality rates in Philadelphia, and much like Portland, there’s a higher rate in certain areas, but deaths are also dispersed throughout the city. What kind of approach are you taking to figuring out what the best location should be and how to get people engaged with that location?
T.F.: All to be worked out in the future, but we certainly know we need to have conversations with City Council members and community organizations and individual people, with parents who’ve lost children, people who are still actively using drugs and people in the treatment world. Out of that, we hope to have a consensus that we can find a site for our facility that is convenient for injecting drug users so that they’ll use it. There’s no point putting it in a place where people won’t use it. But there’s going to be a whole series of conversations before we can figure out what is the optimal place.
FURTHER READING: Portland needs a safe drug injection site (Editorial)
E.G.: Have you thought at all about what you’re going to do when it comes to NIMBYism in that area?
T.F.: Same answer – it’s all about talking to people. My experience has been that so many people have been touched by this crisis, that a lot of people will completely understand the value of this and say, “Yes, I want to be part of saving lives also.”
It’s worth pointing out, the Vancouver site has been studied, and the kind of problems that people see in the neighborhood where drug use is common are actually lessened by a supervised consumption facility site. The number of needles discarded on the ground, the number of people who are injecting in public go down because people are injecting inside rather than outside. And so we’ll certainly discuss that as we have these conversations.
E.G.: And finally, I think it’s important to mention that opening a safe consumption site is just one of many tactics that Philadelphia plans to employ to rein in the opiate crisis. What other innovative methods do you expect will have the greatest impact?
T.F.: We see a lot of the problem as being created by drug companies getting doctors to prescribe opioid pills far too much, and so that’s getting too many people addicted, and so we are working hard to change doctors’ prescribing patterns to reduce their prescribing. For example, we have a media campaign on television that’s warning people about these drugs. We are sending staff into doctors’ offices and talking to them about safer use of these drugs, using them less. Then, on overdose prevention, we recognize that most people who are using across the city will not be close to a supervised consumption site, regardless of where we put it. It’s just too big a city, and the use is too widespread, and so we are distributing tens of thousands of doses of naloxone. Naloxone is available for people to purchase in a pharmacy even if they don’t have a prescription.
We will also be running a mass media campaign, starting in the next month or so, that lets your ordinary citizen know how easy it is to save a life with naloxone. We think when we do that, a lot of people will carry that as part of their obligation to help their fellow citizen out there. And a lot of folks will be saving their neighbors’ lives. So, with all of that combined, we hope to start to see a reduction in the overdose death rate.
Email Senior Staff Reporter Emily Green at emily@streetroots.or g. Follow her on Twitter @greenwrites .
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