A nonprofit group in Philadelphia is fighting in court to be allowed to open the first facility in the country for people to use illegal opioids under medical supervision. The group, called Safehouse, has the backing of local government, yet faces a legal challenge from federal prosecutors.
The idea of supervised injection sites is to offer people a space where they can use drugs under the supervision of trained medical staff, who are prepared with the overdose-reversal drug naloxone. Such sites supply clean needles and other supplies, but users bring their own drugs.
After people are finished taking drugs, staff can talk to them about accessing treatment, legal counseling, housing and other social services.
"If you find a place that accepts the fact that you're going to be consuming drugs and still offers you services in a non-judgmental way, you're going to start to trust them," says Ronda Goldfein, the vice president and co-founder of Safehouse. "And once there's a trust relationship, you're more inclined to accept the range of treatment they're offering, which includes recovery."
Supervised injection sites operate in Canada, Europe and Australia, but one has never officially opened its doors in the United States. The group that runs Safehouse is hoping to launch its site sometime this year.
Opioid overdoses — especially from highly potent fentanyl — continue to rise around the country, and health officials in several other cities, including Seattle, New York and Denver and elected officials in Massachusetts, Vermont, and New Jersey have discussed similar injection site proposals.
But U.S. Attorney for the Philadelphia area William McSwain is trying to stop them
"These are folks who have good intentions," says McSwain. "These are folks who are trying their best to combat the epidemic, but we think this step of opening an injection site is a step that crosses the line."
McSwain and the Trump administration sued Safehouse in February. The prosecutors cited so-called "crack house" laws that make it a crime to own a property where drugs are being used.
Safehouse, in response, assembled a team of a dozen pro bono lawyers and earlier this month counter-sued the government in federal court in Philadelphia, setting up a dispute that legal experts say has the potential to test the limits of the law.
The Safehouse legal team maintains that drug laws from the 1980s were never meant to apply to a medical facility in the midst of a modern public health crisis.
"Safehouse is nothing like a 'crack house' or drug-fueled 'rave.' Nor is Safehouse established 'for the purpose' of unlawful drug use," Safehouse lawyer Ilana Eisenstein asserted in the filing, writing that the federal law cited by prosecutors, the Controlled Substances Act "does not regulate medical treatment or the practice of medicine."
The nonprofit's lawyers also argue in court documents that shutting down its proposed injection sites would violate the group's Judeo-Christian convictions about "preserving life," thus violating the Religious Freedom Restoration Act, a 1993 federal law that protects people from being prevented from exercising their faith.
"[This] service is an exercise of the religious beliefs of its Board of Directors, who hold as core tenets preserving life, providing shelter to neighbors, and ministering to those most in need of physical and spiritual care," Eisenstein wrote to the court.
Advocates compare a supervised injection site's life-saving potential to how syringe exchanges helped reduce deaths during the AIDs epidemic.
"If we feel like this is in our power to make this happen, or go down trying, we owe it to all those we've lost," Goldfein says.
Because of the legal uncertainty surrounding supervised injection, most efforts to open such sites around the country have stalled.
The legal confrontation with the federal government came as no surprise. Deputy Attorney General Rod Rosenstein told NPR last year that if any effort to open a supervised injection sites moves forward, the response would be swift and aggressive.
"If local governments get in the business of facilitating drug use ... they're actually inviting people to bring these illegal drugs into their places of business," Rosenstein said in August. "If you start down that road, you're really going to undermine the deterrent message that I think is so important in order to prevent people from becoming addicted in the future."
In Philadelphia, top public officials including the mayor and district attorney endorse the injection site proposal.
"I'm a public health official whose job it is to prevent needless deaths," says Philadelphia Health Commissioner Tom Farley. "The evidence is clear that these facilities save lives, while serving as an entryway to drug treatment."
Yet city leaders say no public money would be devoted to opening the facility. Instead, Safehouse is on its own to raise private money, something the nonprofit's members say they are continuing to do despite the legal tussle.
Both parties in the lawsuits agree on one thing: Much is riding on the outcome.
Whatever the court decides in this case could reverberate around the country, either paving the way for injection sites, or, perhaps permanently blocking them.
"You know, this is something that I think people will be looking at as, in a sense, a test case that will have implications in other districts," McSwain says.
The court fight is not the only hurdle Safehouse faces as it aims to open this year.
Political resistance has also been mounting in Philadelphia City Council — fanned by opposition from neighbors.
"It's ridiculous what they're even trying to do," resident Joe Capriotti told WHYY. Capriotti lives not far from a site being considered by Safehouse. "Everything is wrong with it."
In Philadelphia's Kensington neighborhood, one of the nation's largest open-air drug markets, an opioid user named Joe is also awaiting the decision.
Joe is only being identified by his first name since he uses illegal drugs. He's 35, from New Jersey and he used to sell mortgage loans for a living. He's been in treatment before, but recently relapsed. And he says, dangerous synthetic opioids are cheap and easy to acquire in Kensington.
"It's sad to see the people that are dying, man. I've had so many friends die and so many people that are on this ... they're not the same person. And I'm not the same person," he says.
Joe stands among discarded needles right across the street from a building Safehouse is considering moving into. Over the din of a noisy train track platform nearby, other users talk quietly with him before injecting drugs into their arms, just feet away from city police officers patrolling the neighborhood.
Joe says he has almost died from an opioid overdose. If the injection site opens, he says he would quickly become one of its clients.
Right now, he and his friends use drugs in abandoned buildings, alleyways and fast food bathrooms where fatal overdoses can happen quickly, without anyone there to help. It would be so much better, he says, to have medical staff standing by.
"I think it going to save lives and not take lives," he says.