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Uproar Follows Philadelphia’s Supervised Injection Site—But Is It Well-Placed?

Taken from Philadelphia Magazine.

Philadelphia, Pennsylvania, has long been one of the heroin hotspots of the United States. Drug Enforcement Administration (DEA) reports have long indicated that Philly has the highest-quality heroin in the nation.

Philly has been hit quite hard by the opioid epidemic. Fortunately, state and municipal governments in places like New England, the Pacific Northwest, and California have implemented programs and resources designed specifically to help people who use drugs.

The City of Brotherly Love was — was being the keyword — set to break ground on a supervised injection facility, or a facility staffed with medical professionals trained to respond to drug overdoses on Thursday, Feb. 27.

Expressions of disappointment and disdain have littered social media, websites, and forward-thinking news agencies since then. The supervised injection site (SIS) would have been the first of its kind in the United States, becoming the 11th country to implement such a facility, following behind Canada, Switzerland, Norway, Spain, the Netherlands, Germany, France, Luxembourg, Denmark, and Australia.

Yeah, It Sucks, We All Wish Philly Got the Supervised Injection Facility

As fans of harm reduction, drug policy reform, etc., it’s safe to say we all wish Philly would soon be home to the long-planned Safehouse-brand supervised injection site. Wish in one hand, spit in the other — that’s how it goes sometimes, right?

It’s not like Philadelphia is flat out of resources to help people who use drugs. Philly is home to some of the most forward-thinking policies, programs, and ideas related to harm reduction and drug policy reform.

Living in rural Tennessee, home of essentially zero drug-user-related resources, I wonder, where’s the support for expanding such resources here?

Why aren’t people seemingly as worried about equalizing the playing field across the United States instead of building up Philadelphia with a stronghold of drug-user-related resources?

I think trying to take advantage of this “failed supervised injection site” wave of popularity might help spread word of area-specific challenges for rural West Tennessee.

What Resources That Help Drug Users Does Philadelphia Have?

According to the City of Philadelphia’s website, the city’s residents are privy to considerably more valuable resources than other cities’ populations, such as Police-Assisted Diversion, for example:

• People stopped by law enforcement for certain minor crimes (e.g. illicit drug possession, buying controlled substances, prostitution, retail theft) in only the 22nd, 24th, and 39th Districts OR people who ask for help from the police, even if they aren’t reasonably able to be charged with one of the aforementioned crimes are eligible for Police-Assisted Diversion (PAD). Put simply, PAD steers a high volume of people eligible to be arrested for petty crimes away from jail and into “supportive, peer-based social services,” says the Philadelphia Police Department’s website.

Some people have proven themselves to use drugs irresponsibly or in a self-destructive manner. These people, of course — at least if they want what’s best for them, that is — shouldn’t be using drugs. I very much fit this bill — even though I constantly experience problems resulting from my drug use, I still use drugs.

Many long-term drug users struggle to outright quit their drug or drugs of choice when it’s primetime for them to do so. Lasting physical and mental effects can seriously improve the likelihood of bad things happening, such as continuing to engage in criminal activity. People who are forced to kick their dependencies and/or addictions in lockup are highly likely to relapse upon release.

Providing medication-assisted treatment (MAT) to incarcerated populations can reduce violence, improve quality of life, prevent inmates from further accumulating any other charges, and reduce the chance of recidivism upon release. Here’s what the Philadelphia Department of Prisons did with MAT:

• Just over two years ago, the Philadelphia Department of Prisons rolled out medication-assisted treatment in the form of buprenorphine (Suboxone, Subutex, Sublocade), naltrexone (Vivitrol), and methadone. Although officials only tested a small portion of their entire female incarcerated population, now MAT is available for all females who are currently incarcerated in the Philadelphia Department of Prisons.
• Speaking of MAT, the city’s Department of Behavioral Health and Intellectual Disability Services operates an around-the-clock MAT treatment facility in the heart of the city. In some cases, opioid-dependent persons who are unable to secure buprenorphine or methadone maintenance right when they feel they need it most are liable to move back to illicit opioids that, as we all know, are much deadlier than naltrexone, buprenorphine, or methadone.

People suffering from opioid use disorder need to get not just referred, but delivered directly to treatment providers so as to reduce rates of relapse, overdose, and other bad opioid-related outcomes from happening. This concept is known as a warm handoff:

• The City of Philadelphia has long known that people suffering from opioid use disorder are disproportionately likely to end up in hospitals’ emergency rooms. Whether the opioid-dependent people end up there because of overdose, unbearable withdrawal syndrome symptoms, or something else, physicians who are currently in charge of patients with opioid use disorder are now given help by the city to assure that such patients end up directly in the hands of necessary treatment providers — whatever treatments that may be.

We’re all familiar with naloxone, the opioid overdose antidote. Although providing naloxone to a municipality’s or state’s populace is one of the lowest-hanging fruits on the harm reduction tree — this is so because naloxone has no real contraindications, has a long shelf life, requires no prescription many places, and is so highly effective against opioid overdoses — Philadelphia’s distribution of naloxone to its people has proven to be an integral part of its multi-faceted response to the opioid crisis, with naloxone-related programs including:

• Giving everyone who has been released from jail within Philadelphia a naloxone prescription.
• Every month, the city holds a free training event during which anybody can learn how to recognize opioid overdose, how to administer naloxone, and otherwise respond to opioid overdoses.
• Here’s another thing: in many places, first responders are the number-one target of the people, government entities, or organizations that have been tasked with distributing naloxone. However, in Philadelphia, city-wide naloxone distribution targets community members, too, in a major fashion.

I’m Sure Philadelphia and the Quaker State Have More Resources That I Haven’t Mentioned

People who live in Philly are obviously more likely to know about all major drug-user-oriented resources that exist than residents of rural Tennessee.

I picked the aforementioned resources from the City of Philadelphia’s website — in particular, a section titled “The City’s Response” — and am sure I mentioned all the major ones.

However, since I don’t live there and haven’t talked to anybody who does live there, residents of Philadelphia and elsewhere in Pennsylvania may have more resources or programs than I’ve mentioned here.

Now, It’s Time to Explain What’s Available to Us Here in Rural West Tennessee

In August 2019, West Tennessee welcomed its very first syringe services program (SSP), A Betor Way. Although, I suppose, it’s “cool” to say that West TN has an SSP in its jurisdiction, since Memphis is in the southwestern-most extreme of the state, only people who live in Memphis, just outside of its city limits, or within a 15 or 30 minutes’ drive to the Birthplace of Rock ’n’ Roll would even think about sourcing clean, free syringes, naloxone, and other harm reduction supplies from either of the two Memphis-based SSPs.

I live in Martin, about 10 minutes south of Kentucky and an hour east of Arkansas. I’m about 150 miles — two-and-a-half hours’ drive — away from Memphis. Even people who live in the southwestern-most extreme of Northwest Tennessee still are at least an hour away from the city, if not closer to 90 minutes.

Like many states, the Volunteer State distributes naloxone to residents of the state. But who ends up getting the naloxone, and who or what organization gives it out?

About two years ago, the state put 13 Regional Overdose Prevention Specialists (ROPS). They primarily give out naloxone to first responders, law enforcement, and, according to the state’s website, people who are at risk of opioid overdose. ROPS give naloxone out at regularly-held training events that are free to attend.

Here’s the bad thing about ROPS — illicit opioid users are highly unlikely to attend the highly-public, town hall-type meetings.

So, what do we have here in rural West Tennessee? Nothing outside of outdated rehabs, exclusionary 12-step programs, drug courts, and profit-minded probation officers, unfortunately. This also holds true for rural Middle Tennessee.

In Closing

After seeing the rash of people speaking out against Philadelphia canceling its plans to house the supervised injection site, I wondered why people weren’t as worried about expanding ground-level programs in places like rural Tennessee.

That’s all I want — resources and programs that help drug users like me in criminally-underserved rural Tennessee.

By Daniel Garrett

I'm a self-employed writer, long-term drug user, and resident of rural Tennessee. Find me on Twitter at @DanielGarrettHR or email me at danpgarr@ut.utm.edu.

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