Frequently Asked Questions

 

  • GENERAL

    • What is Safehouse? 
      Safehouse is a privately funded, 501(c)(3) tax-exempt, Pennsylvania nonprofit corporation whose mission is to save lives by providing a range of overdose prevention services.

      The leaders and organizers of Safehouse are motivated by the Judeo-Christian beliefs ingrained in us from our religious schooling, our devout families and our practices of worship. At the core of our faith is the principle that preservation of human life overrides any other considerations.

      Safehouse is one element of a much-needed comprehensive plan to address a public health crisis. The organization seeks to open the first safe injection site in the U.S. providing a range of overdose prevention services, including safe consumption and observation rooms staffed by a medical staff prepared to administer overdose reversal if needed. Additional services would include on-site initiation of Medically Assisted Treatment (MAT), recovery counseling, education about substance use treatment, basic medical services, HIV and HCV testing, and referrals to support services such as housing, public benefits, and legal services.

      Safehouse is working with community partners to find suitable locations to deliver this unified range of services.
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    • Where will Safehouse be located?
      Safehouse locations will be determined by community and city input, as well as data that show the areas where the greatest need exists. Safehouse considers it a priority to be a good neighbor, so locations will be selected in consultation with local leaders, businesses and residents.
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    • Who will deliver services at Safehouse? 
      Medically trained professionals, certified peer specialists, recovery specialists, social workers, and case managers specializing in overdose prevention and harm reduction will provide Safehouse services.
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    • When will Safehouse begin operating in Philadelphia?
      Safehouse remains committed to opening as soon as possible, but will only do so once it has legal permission.
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    • Why do we need overdose prevention services in Philadelphia?
      Philadelphia is experiencing an overdose crisis of unprecedented proportion. In 2015, the city’s rate of 46.8 drug overdose deaths per 100,000 residents dramatically outpaced those of Chicago (11.8) and New York (13.7).[1], [2] In 2017, the 1,217 overdose deaths in Philadelphia [3] represented a 34 percent increase from 907 in 2016.[4] In 2018, fatalities slightly decreased to 1,116 overdose deaths.  By 2018,  overdose deaths in the city increased by nearly 200 percent since 2009.[5] As coronavirus locked down the U.S., fatal overdoses in Philadelphia rose through the first six months of 2020. The city is on track to surpass the death toll from 2017, the worst year for fatal overdoses on   record.[6]  Philadelphia has not had a public health crisis of this magnitude in more than 100 years.[7] Across all racial and ethnic groups, more people have died from drug overdose than from homicide.[8],[9]

      This crisis led the Mayor’s Task Force to Combat the Opioid Epidemic in Philadelphia to recommend that the city further explore implementing overdose prevention services and expand treatment access and capacity. Overdose prevention services have a long record of success in reducing harms of injecting heroin and other opioids.[10]
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    • Will Safehouse provide illegal drugs to participants?
      Under no circumstances will Safehouse make available any narcotic or opioid, other than those that are FDA-approved for treating opioid addiction.
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    • Will Safehouse encourage people to use drugs?
      Safehouse will not encourage people to use drugs nor are we aware of any credible evidence that supervised consumption sites result in increased drug use or initiate new users.
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    • How will Safehouse help participants to learn more about treatment for substance use?
      Participants will be presented with rehabilitation options at multiple points during their Safehouse visit, beginning with arrival and the registration process.  A physical and behavioral health assessment will be conducted, and a range of overdose prevention services offered.

      From the consumption area, participants will be directed to the medically supervised observation room and offered on-site initiation of Medication Assisted Treatment (MAT), wound care, referrals to primary care, HIV and HCV testing, social services, and housing opportunities. Upon arrival, participants may choose to go directly to the observation room to access MAT and other services.

      Certified peer specialists, recovery specialists, social workers, and case managers will encourage treatment readiness and facilitate access to medical and social services. As participants leave, additional data will be collected, treatment, medical, social, and legal services will be offered again, and naloxone will be distributed.
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    • How will Safehouse prevent fatal overdoses?
      Medical personnel will always be on duty to observe and assess participants in both the consumption room and the post-consumption observation room. Medical personnel will immediately intervene in the event of an overdose, administering oxygen and/or naloxone. No overdose deaths have been reported at any of the more than 120 supervised consumption sites worldwide.[11],[12]
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    • Which drugs will Safehouse provide supervised injection oversight?
      Safehouse staff will provide supervised consumption for all pre-obtained substances. Safehouse personnel will advise on sterile injection technique and require the use of sterile injection equipment. Safehouse personnel will not insert needles or administer any narcotic or opioid, nor encourage the use of any drug. No consumption by smoking will be allowed unless appropriate ventilation is available.
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  • SAFE INJECTION SITES AND HARM REDUCTION
    • What is harm reduction?
      Harm reduction in substance use treatment is aimed at decreasing the negative consequences of substance use, and it includes elements of safer use, managed use, and medication-supported treatment plans. Harm reduction is designed to address addiction and strives to minimize its harmful effects while recognizing that drug addiction cannot be completely eliminated. Current leading scholarship establishes that a demonstrably effective approach to combating substance use disorder is to encourage treatment while providing harm reduction.[13]
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    • Do safe injection sites exist elsewhere?
      Yes. The first government-authorized supervised consumption room opened more than 30 years ago in Switzerland. Today, more than 120 supervised consumption sites are operating in Europe, Australia, and Canada. The availability of overdose prevention services is increasing as research confirms the effectiveness and the advantages to the broader community. Currently, no such program exists in the United States.
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    • What are the benefits of overdose prevention services?
      Overdose prevention services are part of a multifaceted public health approach to combating the opioid crisis. Extensive research has demonstrated the benefits of overdose prevention services for people who use drugs and the communities where drug use occurs.[14],[15],[16],[17]

      Overdose prevention services:
      • SAVE LIVES by reducing the number of fatal drug overdoses through education on safer use practices, overdose prevention, and intervention.
      • REDUCE THE SPREAD OF INFECTIOUS DISEASES such as HIV and hepatitis C among people who use drugs by providing and requiring the use of provided sterile consumption supplies.
      • CONNECT PEOPLE who use drugs with other health, treatment, and social services.
      • CREATE A SAFER COMMUNITY by reducing drug use in public spaces and publicly discarded paraphernalia.
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    • Is there a financial benefit to the community?
      Overdose prevention services will reduce fatal opioid overdoses. As Safehouse will provide immediate reversal in the event of overdoses, the strain on emergency medical services and health systems will be decreased. By reducing ambulance rides, emergency room trips, and hospital visits, overdose prevention services are expected to save Philadelphia at least $2 million a year in health care costs. [18]

      In addition, by providing a supervised place to consume drugs, fewer people will use drugs on the streets. Less drug paraphernalia will be publicly discarded.
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  • PROTOCOL AND SAFETY
    • Will data be collected at Safehouse?
      Yes. Data will be collected on a range of information points, including: client demographics, needs assessments, utilization, and referrals for treatment. An evaluation of the impact of the services on overdose fatalities and use of drug treatment will be conducted. Data collection and analysis will be conducted in a manner that respects and preserves client privacy and confidentiality.
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    • Do supervised consumption sites increase neighborhood crime?
      No. Considerable research on neighborhoods around safe consumption sites has shown no increase in crime.[19] In fact, a decrease in drug-related crime has been reported.[20],[21] Safehouse believes in a partnership with law enforcement and supports appropriate law enforcement measures to address public safety issues resulting from the opioid epidemic. Safehouse will actively discourage loitering.
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    • What safety and security protocols will exist at Safehouse for both the community and participants?
      Safehouse will provide appropriate security for its facilities and immediate surroundings. All participants will be expected to comply with rules to ensure the safety of participants, employees, volunteers, and the public. Safehouse is developing detailed policies and procedures, which it will post in a conspicuous place on location and on its website.
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    • What are Safehouse’s rules of use?
      Safehouse's rules of use include:
      • No one under age 18 may use the services. Appropriate referrals will be provided to minors.
      • No drug dealing.
      • No drug sharing.
      • No exchange of currency.
      • No sharing of consumption equipment.
      • No participant may help another consume drugs.
      • No staff person may help a participant consume drugs.
      • Staff will not handle controlled substances.
      • Participants seeking consumption services will be required to use Safehouse-provided sterile consumption equipment including injection supplies.
      • All participants must properly dispose of consumption equipment before leaving the premises.
      • Violence, intimidation, and harassment will not be tolerated.
      • All participants will treat the staff and other participants with respect.
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    • Will Safehouse seek a partnership with law enforcement?
      Yes. Safehouse hopes to have a mutually beneficial, productive partnership with law enforcement, as we have a shared goal of making the community safer.

      In Vancouver, police leaders strongly support overdose prevention services.[22] Bill Spearn, a longtime inspector with the Vancouver Police Department, formerly a staunch opponent of the sites, now admits that he was wrong. In May 2018, he said: “If you want to keep these people alive long enough to get them into treatment, you have to give them a space to use.”

      In reflecting on the benefit of Vancouver’s overdose prevention services, Spearn said “it made sense to me that the reason that the number of overdoses that I was attending, or my members were attending, had dropped significantly, was because of Insite.” [Insite is North America’s first public supervised injection facility.][23]
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  • THE LEGALITY OF SAFEHOUSE

    • Does the law allow overdose prevention services like those provided by Safehouse?
      We believe it does. Safehouse’s overdose prevention services are designed to save lives, which is consistent with the intent of federal drug laws.

      We believe that 21 U.S. Code § 856 (“Section 856”) was never intended to apply, and does not apply, to a nonprofit providing a good faith, public health approach to overdose prevention services, including a supervised consumption room. The purpose of a supervised consumption room is to carry out legitimate medical and public health initiatives that offer evidence based interventions effective for encouraging treatment and rehabilitation of individuals addicted to opioids.

      Section 856 prohibits maintaining any place “for the purpose of . . . using any controlled substance.” The purpose of a supervised consumption room is to save lives by preventing fatal overdoses and encouraging participants to enter into treatment. It is intended solely as a place to address the public health crisis of opioid addiction by providing harm reduction and emergency response in the event of an overdose or other medical emergency, in addition to providing counseling about safer injection practices and referrals to other social and health services including referrals to addiction treatment, medical care, housing, and other related comprehensive social and legal services.

      Safehouse's holistic approach to saving lives and providing overdose prevention services is different from the express statutory restrictions set forth under Section 856.

      Philadelphia has a history of creative public health initiatives and prosecutorial discretion. In 1992, then-Mayor Edward G. Rendell and the Board of Health authorized by executive order Prevention Point Philadelphia’s syringe exchange program to protect public health by preventing the transmission of HIV. Syringe exchange in Philadelphia has been found to be an effective harm reduction method. Indeed, syringe exchange has reduced new HIV cases in injection drug users in Philadelphia by more than 95 percent, from 819 cases in 1992 when Prevention Point opened to just 27 cases in 2016.[24] A 2019 study, published in the Journal of Acquired Immune Deficiency Syndrome, estimated that Prevention Point prevented 10,000 HIV diagnoses between 1993 and 2002.[25]
                                                                                                                                      Effective syringe exchange programs also increase the number of injection drug users referred to and retained in substance use treatment. In addition, they increase referral and entry opportunities for social services such as housing, case management, and medical care.[26] Studies also have found that syringe exchange programs do not increase injection drug use.[27]back to top

 REFERENCES:

  1. Division of Health Data and Policy, Illinois Department of Public Health, State of Illinois Comprehensive Opioid Data Report, from Dec. 4, 2017 https://dph.illinois.gov/content/dam/soi/en/web/idph/files/publications/publicationsdoil-opioid-data-report.pdf
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  2. Paone, D. Tuazon, E., Nolan, M., & Mantha, S., “Unintentional Drug Poisoning (Overdose) Deaths Involving Heroin and/or Fentanyl in New York City, 2000–2015,” New York City Department of Health and Mental Hygiene: Epi Data Brief August 2016 (74), from https://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief74.pdf
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  3. City of Philadelphia, Department of Public Health (2018, April). Fatal Drug Overdoses in Philadelphia, 2017, from https://www.phila.gov/health/pdfs/chart%20v3e1.pdf
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  4. Ibid.
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  5. Office of the Medical Examiner, Philadelphia Department of Public Health. (2018). Unintentional Drug Related Deaths by Year 2003-2017. Retrieved on Oct 1, 2018, from  https://public.tableau.com/profile/pdph#!/vizhome/UnintentionalDrugRelatedDeaths/UnintentionalDrugRelatedDeaths
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  6. Aubrey Whelan, Philadelphia Inquirer, Philadelphia may be on the way to a record for fatal drug overdoses in 2020, another COVID-19 consequence (December 6, 2020) from https://www.inquirer.com/health/opioid-addiction/overdoses-philadelphia-covid-opioid-fentanyl-20201206.html              
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  7. Combating the opioid epidemic | Department of Behavioral Health and Intellectual disAbility Services (n.d.). Retrieved Sept. 14, 2018, from https://www.phila.gov/programs/combating-the-opioid-epidemic/
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  8. Ibid.
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  9. The Mayor’s Task Force to Combat the Opioid Epidemic in Philadelphia, Final Report and Recommendations. 2017: Philadelphia, PA, from https://dbhids.org/wp-content/uploads/2017/04/OTF_Report.pdf
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  10. Ibid.
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  11. Alternatives To Public Injection, Harm Reduction Coalition (2016), from https://harmreduction.org/issues/supervised-consumption-services/report/                                                                                                               back to source 11

  12. Kerr, T., Tyndall, M. W., Lai, C., Montaner, J. S., & Wood, E. (2006). Drug-related overdoses within a medically supervised safer injection facility. International Journal of Drug Policy,17(5), 436-441. doi:10.1016/j.drugpo.2006.05.008
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  13. Logan, D.E. & Marlatt, G.A., Harm Reduction Therapy: A Practice-Friendly Review of Research, NCBI (Feb. 2010), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928290/                                           back to source 13

  14. Wood, E. (2004). Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Canadian Medical Association Journal, 171(7), 731-734. doi:10.1503/cmaj.1040774
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  15. Wood, E., Tyndall, M. W., Lai, C., Montaner, J. S., & Kerr, T. (2006). Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime [Abstract]. Substance Abuse Treatment, Prevention, and Policy,1(13), 1-4. doi:10.1186/1747-597X-1- 13; Supervised Injection Services. (2018, August 20). Retrieved Sept. 13, 2018, from https://www.toronto.ca/community-people/health-wellness-care/health-programs-advice/supervised-injection-services/
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  16. Kerr, T., PhD, Tyndall, M. W., MD, Zhang, R., MSc, Lai, C., MMath, Montaner, J. S., MD, & Wood, E., PhD. (2007). Circumstances of First Injection Among Illicit Drug Users Accessing a Medically Supervised Safer Injecting Facility. American Journal of Public Health,97(7), 128-130. doi:10.2105/AJPH.2006.086256
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  17. Wood, E., Tyndall, M. W., Zhang, R., Montaner, J. S., & Kerr, T. (2007). Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction,102(6), 916-919. doi:10.1111/j.1360-0443.2007.01818.x
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  18. Larson, S., Padron, N., Mason, J. & Bogaczyk (2017) Supervised Consumption Facilities – Review of the Evidence. Retrieved from, https://healthdocbox.com/Substance_Abuse/72880022-Supervised-consumption-facilities-review-of-the-evidence-sharon-larson-phd-norma-padron-phd-jennifer-mason-tyler-bogaczyk.html
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  19. Kerr, T., Tyndall, M. W., Lai, C., Montaner, J. S., & Wood, E. (2006). Drug-related overdoses within a medically supervised safer injection facility. International Journal of Drug Policy,17(5), 436-441. doi:10.1016/j.drugpo.2006.05.008
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  20. Wood, E. (2004), supra note 12
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  21. Supervised Injection Services. (2018, Aug. 20), supra note 13
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  22. Mannarino, D., Inside supervised injection sites: How they work in the fight against opioid crisis, WPIX11 NY, May 8 2018, from https://pix11.com/2018/05/08/inside-supervised-injection-sites-how-they-work-in-the-fight-against-opioid-crisis/
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  23. Gordon, Elana, Lessons from Vancouver: U.S. cities consider supervised injection facilities, WHYY, July 5, 2018, https://whyy.org/segments/lessons-from-vancouver-u-s-cities-consider-supervised-injection-facilities/
    back to source 23

  24. Ruiz M., O'Rourke A., Allen S. et al. (Dec. 2019) Using Interrupted Time Series Analysis to Measure the Impact of Legalized Syringe Exchange on HIV Diagnoses in Baltimore and Philadelphia, (Using Interrupted Time Series Analysis to Measure the Impact of Legalized Syringe Exchange of HIV Diagnoses in Baltimore and Philadelphia: Erratum, Feb 2020).                                                                                                                             back to source 24

  25. Philadelphia Department of Public Health, AIDS Activities Coordinating Office Surveillance Report, 2016. Philadelphia, PA: City of Philadelphia (September 2017).
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  26. Des Jarlain, D., & Braine, N., Assessing syringe exchange programs (2004). Addiction, 99(9), 1081-1082. doi:10.1111/j.1360-0443.2004.00800.x
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  27. Frakt, A., Ph.D. (2016, Sept. 2). Effectiveness and cost-effectiveness of syringe exchange programs [Web log post]. AcademyHealth.org, Retrieved Sept. 24, 2018, from https://www.academyhealth.org/node/2211
    back to source 27

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