Safehouse Data Narrative
Overdose Prevention Sites (OPS) were first implemented in the 1990s in the Netherlands, Switzerland, and Germany. Also known as Supervised Injection Sites/Services (SIS), Supervised Injection Facilities (SIF), and Safer Consumption Sites (SCS), OPS have been implemented in over 120 locations worldwide and have a solid research base demonstrating positive impact on reducing overdose fatalities, reducing public drug consumption, and not increasing drug use and crime. 
Starting in 2014, the notoriously potent heroin in Philadelphia progressively became regularly contaminated with the synthetic opioid fentanyl. Fentanyl is even more powerful than heroin and has a shorter half-life—meaning people who use it will need to use it more frequently in order to avoid withdrawal symptoms. Within a few years, overdose deaths in Philadelphia skyrocketed from under 500 per year to over 1000 per year.
In 2017, the Mayor’s Task Force to Combat the Opioid Epidemic released a report recommending that Philadelphia "further explore the possibility of implementing" one or more OPS sites.
To further address the epidemic, the city expanded the distribution of naloxone (a medication to reverse overdoses) and increased access to treatment, including medication-assisted treatment. Prior to the COVID-19 pandemic, the number of overdose deaths decreased slightly, as the burden on hospitals, emergency medical services, and other first responders increased. In 2019, Pennsylvania had the third-highest overdose rate in the country.
As coronavirus locked down the U.S., fata overdoses in Philadelphia rose through the first six months of 2020, The city is on track to surpass the death roll from 2017, the worst year for fatal overdoses on record.
We believe the evidence base in support of OPS is sound and we hope to contribute to it with additional research and evaluation. Based on the existing and expanding body of research on the efficacy of OPS, we are confident that Safehouse will see the same positive outcomes found in other OPS.
The evidence shows:
- No fatal overdoses on site at any OPS.,
- Decrease fatal overdoses in the vicinity. Studies from existing OPS locations consistently found lowered overall rates of fatal overdoses following the implementation of OPS.,
- Increase quality of life for neighbors. Researchers found that OPS reduces public use and overdoses and improper syringe disposal. OPS is not associated with increases in crime. The preponderance of evidence supports the view of these sites as producing favorable outcomes not only for [individual drug users] but also for potentially enhancing the well-being of the local community.
- Increase access to drug treatment. In its first three years, 46% of the participants at Insite, the first SIS in North America, entered drug treatment.
- Prevent other health consequences of injection drug use. OPS has been shown to prevent HIV and hepatitis C transmission as well as abscesses and bacterial infections. Preventing these outcomes in Philadelphia is expected to have major costs savings for our health systems.
- Reduced taxpayer burden. OPS can result in significant cost savings to taxpayers by reduced health care costs and overdose response costs.
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- American Medical Association, AMA Wants New Approaches to Combat Synthetic and Injectable Drugs (Jun. 12, 2017)
- Diane E. Logan & G. Alan Marlatt, Harm Reduction Therapy: A Practice-Friendly Review of Research, 66 J. Clinical Psychol. 201 (2010) back to top
- CDC, Drug Overdose Deaths Involving Fentanyl, 2011-2016 (Mar. 21, 2019).
- CDC, Commonly Used Terms: Opioid Overdose (Aug. 28, 2017) back to top
- Aubrey Whelan, Philadelphia Inquirer, Pennsylvania has third-highest rate of drug overdose deaths in the U.S., study finds (June 12, 2019)
- City of Phila., Dep’t of Pub. Health, Opioid Misuse and Overdose Report (Nov. 29, 2018)
- City of Philadelphia, Department of Public Health, Fatal Drug Overdoses in Philadelphia, 2017 (Apr. 2018)
- Pew Tr., Philadelphia’s Drug Overdose Death Rate Among Highest in Nation (Feb. 15, 2018)
- City of Philadelphia, Department of Public Health, Department of Behavioral Health and Intellectual disAbility Services & the Office of the Mayor, City Announces Progress on Opioid Task Force Recommendations (Jan. 23, 2018)
- City of Phila., Dep’t of Pub. Health, Philadelphia’s Community Health Assessment: Health of the City (2018)
- City of Phila., Office of the Mayor, Executive Order No. 3-18 – Opioid Emergency Response Executive Order (Oct. 3, 2018)
- City of Philadelphia, Department of Public Health, Office of the Medical Examiner, Unintentional Drug Related Deaths by Year 2003-2017 (2018)
- City of Philadelphia, Department of Public Health, AIDS Activities Coordinating Office, Surveillance Report, 2016 (Sept. 2017)
- City of Philadelphia, Department of Public Health, Department of Behavioral Health and Intellectual disability Services, Combating the opioid epidemic
- The Mayor’s Task Force to Combat the Opioid Epidemic in Philadelphia, Final Report and Recommendations (2017)
- Pa. Dep’t of Health, Standing Order DOH-002-2016: Naloxone Prescription for Overdose Protection
- Adam Thiel, Fire Comm’r, Philadelphia Fire Department Fiscal Year 2018 Budget Testimony (Apr. 18, 2017)
- David Wenner, PennLive, Pa. Painkiller-Heroin Crisis: Corbett Signs Bill Intended To Save Lives (Sept. 30, 2014) back to top
- UNITED STATES
- Joel Achenbach, The Boston Globe, "Fentanyl-related overdose deaths up sharply among black Americans" (Mar. 21, 2019)
- Health and Human Services (HHS), Facing Addiction in America: The Surgeon General’s Spotlight on Opioids (Sept. 19, 2018)
- Division of Health Data and Policy, Illinois Department of Public Health, State of Illinois Comprehensive Opioid Data Report (Dec. 4, 2017)
- National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse; Phillips JK, Ford MA, Bonnie RJ, editors. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. "Trends in Opioid Use, Harms, and Treatment" (Jul. 13, 2017)
- Irwin A, Jozaghi E, Weir BW, et al. "Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facility." Harm Reduct J 14, 29 (May 12, 2017).
- 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, No. 74 (Aug. 2016).
- Binswanger IA, Stern MF, Deyo RA, et al. Release from prison — a high risk of death for former inmates. N Engl J Med. 356(2):157–65 (2007). back to top
- Armbrecht E, Guzauskas G, Hansen R, Pandey R, Fazioli K, Chapman R, Pearson SD, Rind DM. Supervised Injection Facilities and Other Supervised Consumption Sites: Effectiveness and Value; Final Evidence Report. Institute for Clinical and Economic Review. (Jan. 8, 2021)
- Kastalia Medrano. Filter. Safe Consumption Sites Could Save $4 Million Per Major US City Annually. (Nov. 17, 2020)
- Kral A.H., Lambdin B.H., Wenger L.D., et al. Evaluation of an unsanctioned safe consumption site in the United States. N Engl J Med. 2020; 383: 589-590. (Aug. 6, 2020)
- Johns Hopkins Bloomberg School of Public Health, Safe Consumption Spaces Would be Welcomed By High-Risk Opioid Users. (Jun 5, 2019)
- A large majority of people who use heroin and fentanyl would be willing to use safe consumption spaces where they could obtain sterile syringes and have medical support in case of overdose, suggests a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.
- Park, J.N., Sherman, S.G., Rouhani, S. et al. Willingness to Use Safe Consumption Spaces among Opioid Users at High Risk of Fentanyl Overdose in Baltimore, Providence, and Boston. J Urban Health 96: 353. https://doi.org/10.1007/s11524-019-00365-1 (2019)
- Abernathy B, Gladstein E, Farley T, Jones D. Report on Exploratory Visits for Comprehensive User Engagement Site. (Jan. 22, 2018)
- Kilmer, Beau et al., Considering Heroin-Assisted Treatment and Supervised Drug Consumption Sites in the United States. Santa Monica, CA: RAND Corporation (2018).
- CBC News, Supervised drug sites working, Etches tells province (Sept. 18, 2018)
- City of Toronto, Supervised Injection Services (Aug. 20, 2018)
- Ng J, Sutherland C, Kolber MR. Does evidence support supervised injection sites?. Can Fam Physician. 2017;63(11):866.
- Harm Reduction Coalition, Alternatives To Public Injection (2016)
- Potier C., et al., Supervised injection services: What has been demonstrated? A systematic literature review, Drug Alcohol Depend. 145:48-68. (2014)
- DeBeck K., Kerr T., Bird L., et al., Drug Alcohol Depend, “Injection Drug Use Cessation and Use of North America’s First Medically Supervised Safer Injecting Facility” (Jan. 15, 2011)
- Marshall, B. D., Milloy, M., Wood, E., Montaner, J. S., & Kerr, T. "Reduction in overdose mortality after the opening of North Americas first medically supervised safer injecting facility: a retrospective population-based study". The Lancet 377, 1429-1437 (2011)
- Andresen MA, Boyd N. A cost-benefit and cost-effectiveness analysis of of Vancouver’s supervised injection facility. Int J Drug Policy 21(1):70-6 (Jan. 2010)
- Health Canada, Final Report of the Expert Advisory Committee on Supervised Injection Site Research, "Vancouver’s INSITE Service and Other Supervised Injection Sites: What Has Been Learned from Research?" (Apr. 3, 2008)
- Kerr, T., PhD, Tyndall, M. W., MD, Zhang, R., MSc, Lai, C., MMath, Montaner, J. S., MD, & Wood, E., PhD., American Journal of Public Health, "Circumstances of First Injection Among Illicit Drug Users Accessing a Medically Supervised Safer Injecting Facility" (2007)
- Wood, E., Tyndall, M. W., Zhang, R., Montaner, J. S., & Kerr, T., Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction. 102(6):916-919. (2007)
- Kerr, T., Tyndall, M. W., Lai, C., Montaner, J. S., & Wood, E., International Journal of Drug Policy, "Drug-related overdoses within a medically supervised safer injection facility" (2006)
- Wood, E., Tyndall, M. W., Lai, C., Montaner, J. S., & Kerr, T., Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime. Subst Abuse Treat Prevention Policy. (2006)
- Wood, E., "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. (2004)
- Degkwitz, P., Haasen, C., Verthein, U., and Zurhold, H., "Drug Consumption Rooms in Hamburg, Germany: Evaluation of the Effects on Harm Reduction and the Reduction of Public Nuisance." Journal of Drug Issues. 33(3):663-688. (2003) back to top
SYRINGE EXCHANGE PROGRAMS
- Larson, S., Padron, N., Mason, J. & Bogaczyk, Supervised Consumption Facilities – Review of the Evidence (2017)
- CDC, Program Guidance for Implementing Certain Components of Syringe Services Programs (2016)
- Frakt, A., Ph.D., AcademyHealth.org, "Effectiveness and cost-effectiveness of syringe exchange programs" (Sept. 2, 2016)
- HHS, Implementation Guidance to Support Certain Components of Syringe Services Programs (Mar. 29, 2016)
- CDC, Morbidity And Mortality Weekly Report: Integrated Prevention Services For HIV Infection, Viral Hepatitis, Sexually Transmitted Diseases, And Tuberculosis For Persons Who Use Drugs Illicitly: Summary Guidance From CDC And The U.S. Department Of Health And Human Services (2012)
- Determination That a Demonstration Needle Exchange Program Would be Effective in Reducing Drug Abuse and the Risk of Acquired Immune Deficiency Syndrome Infection Among Intravenous Drug Users, 76 Fed. Reg. 10038 (Feb. 23, 2011)
- Logan, D.E. & Marlatt, G.A., Harm Reduction Therapy: A Practice-Friendly Review of Research (Feb. 2010)
- Des Jarlain, D., & Braine, N., Assessing syringe exchange programs, Addiction, Vol 99:9, 1081-1082 (2004) back to top
SAFEHOUSE DATA NARRATIVE REFERENCES:
Mary Clare Kennedy, et al., Public Health and Public Order Outcomes Associated with Supervised Drug Consumption Facilities: a Systematic Review, 14 Current HIV/AIDS Report 161 (2017).
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Potier, C., et al., Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend, 2014. 145: p. 48-68. " Studies show after review of seventy-five relevant articles, that supervised consumption sites “were efficacious in promoting safer injection conditions, enhancing access to primary health care, and reducing overdose frequency,” that they are “associated with reduced levels of public drugs injections or dropped syringes,” and that such sites “were not found to increase drug injecting, drug trafficking or crime in the surrounding environments”
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Kral A.H., Lambdin B.H., Wenger L.D., et al. Evaluation of an unsanctioned safe consumption site in the United States. N Engl J Med. 2020; 383: 589-590. (Aug. 6, 2020).
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Aubrey Whelan, Philadelphia Inquirer, Pennsylvania has third-highest rate of drug overdose deaths in the U.S., study finds (June 12, 2019).
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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).
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Kral A.H., Lambdin B.H., Wenger L.D., et al.
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Milloy, M.J., et al., Non-fatal overdose among a cohort of active injection drug users recruited from a supervised injection facility. Am J Drug Alcohol Abuse, 2008. 34(4): p. 499-509
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Kral A.H., Lambdin B.H., Wenger L.D., et al.
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Wood E, Kerr T, Small W, Li K, Marsh D, et al. 2004. Changes In Public Order After The Opening of a Medically Supervised Safer Injection Facility for Injection Drug Users. Canadian Medical Association Journal 171:731-4
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Armbrecht E, Guzauskas G, Hansen R, Pandey R, Fazioli K, Chapman R, Pearson SD, Rind DM. Supervised Injection Facilities and Other Supervised Consumption Sites: Effectiveness and Value; Final Evidence Report. Institute for Clinical and Economic Review, January 8, 2021.
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Laura Huey, What is Known About the Impacts of Supervised Injection Sites on Community Safety and Wellbeing? A Systematic Review, Sociology Publications (2019).
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Armbrecht E, Guzauskas G, Hansen R, Pandey R, Fazioli K, Chapman R, Pearson SD, Rind DM. Supervised Injection Facilities and Other Supervised Consumption Sites: Effectiveness and Value; Final Evidence Report. Institute for Clinical and Economic Review (January 8, 2021): "In fact, “PWUD dismissed the possibility of a honeypot effect in which a SIF attracted PWUD or crime to a neighborhood, noting the long-established poor conditions of neighborhoods where SIFs are generally located, and that SIFs serve people who live nearby.”
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Huey, supra, at 16
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DeBeck, K., et al., Injection drug use cessation and use of North America's first medically supervised safer injecting facility. Drug Alcohol Depend, 2011. 113(2-3): p. 172-6
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Larson, S., Padron, N., Mason, J. & Bogaczyk, Supervised Consumption Facilities – Review of the Evidence. (2017)
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Kastalia Medrano. Filter: Safe Consumption Sites Could Save $4 Million Per Major US City Annually. (Nov 17, 2020)
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Larson et al.
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