The Science

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. [1][2][3]

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.[4] 

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.[5]

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.[6]

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.[7]

 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.[8]
  • Decrease fatal overdoses in the vicinity. Studies from existing OPS locations consistently found lowered overall rates of fatal overdoses following the implementation of OPS.[9],[10]
  • Increase quality of life for neighbors. Researchers found that OPS reduces public use and overdoses[11] and improper syringe disposal.[12][13] OPS is not associated with increases in crime.[14][15] 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.[16]
  • 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.[17] 
  • 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.[18]
  • Reduced taxpayer burden. OPS  can result in significant cost savings to taxpayers by reduced health care costs and overdose response costs.[19][20] 
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  1. 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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  2. 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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  3. Kral A.H., Lambdin B.H., Wenger L.D., et al. Evaluation of an unsanctioned safe consumption site in the United StatesN Engl J Med. 2020; 383: 589-590. (Aug. 6, 2020).
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  4. The Mayor’s Task Force to Combat the Opioid Epidemic in Philadelphia, Final Report and Recommendations (2017)
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  5. Id, supra, at 23.
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  6. Aubrey Whelan, Philadelphia InquirerPennsylvania has third-highest rate of drug overdose deaths in the U.S., study finds (June 12, 2019). 
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  7. Aubrey Whelan, Philadelphia InquirerPhiladelphia 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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  8. Kral A.H., Lambdin B.H., Wenger L.D., et al. 
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  9. 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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  10. Kral A.H., Lambdin B.H., Wenger L.D., et al. 
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  11. Id.
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  12. 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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  13. 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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  14. 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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  15. 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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  16. Huey, supra, at 16 
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  17. 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 
    back to reference 17 source

  18. Larson, S., Padron, N., Mason, J. & Bogaczyk, Supervised Consumption Facilities – Review of the Evidence. (2017)
    back to reference 18 source

  19. Kastalia Medrano. Filter: Safe Consumption Sites Could Save $4 Million Per Major US City Annually. (Nov 17, 2020)
    back to reference 19 source

  20. Larson et al.
    back to reference 20 source