PHILADELPHIA (AP) — Philadelphia wants to establish safe havens where people can inject drugs, an effort to combat skyrocketing opioid overdoses in the city.
They would be places where people could shoot up under the supervision of medical professionals who could administer an overdose antidote if necessary.
But there are more questions than answers on how it would work and what it would look like, and if it could even legally get up and running.
"We know from other centers that they save lives," Public Health Commissioner Dr. Thomas Farley said in announcing the plans this week. "But it is complicated from a community perspective and it is complicated from a legal perspective."
A look at some questions and answers:
WHY IS THIS BEING CONSIDERED?
Philadelphia has the highest opioid death rate of any large U.S. city. More than 1,200 people fatally overdosed in Philadelphia in 2017, one-third more than 2016. This uptick follows the general surge in drug overdoses in the U.S. Nationally, deaths from drug overdoses skyrocketed 21 percent in 2016. The government figures released put 2016's drug deaths at over 63,000. Two-thirds of the drug deaths — about 42,000 — involved opioids, a category that includes heroin, methadone, prescription pain pills like OxyContin, and fentanyl.
HOW DID PHILADELPHIA END UP IN THIS POSITION?
People travel from across the country for Philadelphia's reputedly pure heroin. The center of the city's opioid crisis is the Kensington neighborhood — the poorest neighborhood in America's poorest big city. Empty factories there have created a prime locale for open-air drug markets and public transit and proximity to Interstate 95 allow buyers from outside the neighborhood easy access, according to the Philadelphia Inquirer.
WHAT'S THE NEXT STEP?
City officials will speak to organizations possibly interested in operating or funding such a facility and will engage with community members to hear their perspectives, said Ajeenah Amir, a spokeswoman for Democratic Mayor Jim Kenney.
Members of the city's opioid task force visited Seattle and Vancouver last year. Amir said the city will take lessons from Vancouver, "but build a model that is most appropriate for Philadelphia. In particular, we intend to have a greater emphasis on engaging drug users and trying to help them enter drug treatment."
DO OTHER COMMUNITIES HAVE SAFE INJECTION SITES?
No U.S. city has established such a site, though Seattle has set aside $1.3 million to create a safe injection site there. And a safe haven where people inject themselves with heroin and other drugs has been quietly operating in the United States for the past three years.
Injection sites are operating in Canada, Australia and around Europe.
At Sydney's Medically Supervised Injecting Centre, more than 5,900 people have overdosed since it opened in 2001. No one has died.
Insite opened in 2003 in the middle of Vancouver's notoriously squalid Downtown Eastside. More than 3.6 million people have injected drugs under supervision by nurses at Insite since it opened. More than 6,000 have overdosed there but none have died.
One clinic in Amsterdam distributes free heroin to long-term addicts as part of a government program created for hardened addicts who might otherwise commit a crime to pay for their fix.
IS IT LEGAL?
The Department of Justice has declined to comment on Philadelphia's plans.
Pennsylvania Attorney General Josh Shapiro said changes in state and federal law would have to be made in order for them to operate legally.
House Speaker Mike Turzai, who is running for the Republican nomination to challenge Democratic Gov. Tom Wolf, called Philadelphia's safe injection plan misguided and a violation of federal law.
Wolf also expressed reservations, saying it presents serious public health and legal concerns. However he didn't say he would stand in the city's way.
HOW WOULD A SAFE INJECTION SITE HELP THE PROBLEM?
Proponents see these safe havens as part of a harm-reduction plan to tackle the epidemics of drug overdose deaths as well as HIV-AIDS.
The idea is to get people who inject illegal drugs inside the facilities so health care can be delivered and they can take advantage of treatment offered and other services.
They see it as just one of many creative approaches that will be needed to solve the opioid problem, including community outreach, more naloxone available in the community as a whole and prevention. The sites have been shown to save the lives of those who shoot up inside.
WHAT ARE SOME CRITICISMS OF SAFE INJECTION SITES?
Critics argue the sites undermine prevention and treatment, and contradict laws aimed at stopping use of deadly illicit drugs.
Jonathan Caulkins, a drug policy scholar at Carnegie Mellon University, said he worries that if a jurisdiction in U.S. chose to establish a safe injection site, the blowback and controversy might take energy from other efforts like treatment and increasing naloxone.
Caulkins said he understands why cities are looking at these extreme solutions.
"They are desperate and people are dying left and right," he said. But he says many studies touting the benefits of the sites don't provide a full picture.
John Walters, drug czar under President George W. Bush, likened the sites to keeping people alive as they are slowly committing suicide.
"In the city of brotherly love the best we can do is watch our brothers die?" he said.