Pubdate: Thu, 14 Sep 2017
Source: Philadelphia Daily News (PA)
Copyright: 2017 Philadelphia Newspapers Inc.
Author: Aubrey Whelan


Democrat Larry Krasner, the front-runner to become Philadelphia's next
district attorney, says he supports city-sanctioned spaces where
people addicted to heroin can inject drugs under medical supervision
and access treatment, a move advocates see as a promising step toward
making the city the first in the U.S. to open such a site.

His Republican opponent, Beth Grossman, says she's open to discussions
on the matter.

For those on the front lines of the heroin crisis in Philadelphia,
both are encouraging stances in a political arena where the idea can
still be dismissed out of hand. But recently, cities across the
country have begun to consider the possibility of instituting
supervised injection sites; several nations, including Canada, have
used the approach for years.

These sites are as widely supported by medical experts as they are
controversial among the general public and, typically, elected officials.

Pennsylvania Attorney General Josh Shapiro, who has spoken frequently
about addiction as a medical issue, has not supported them. The
interim report from President Trump's commission to combat addiction,
chaired by Gov. Christie, does not mention the idea. Consideration of
a supervised injection site was the most controversial of 18
recommendations in Mayor Kenney's opioid task force report in May. A
status update on the full report, released late Wednesday by the
departments of public health and behavioral health, whose
commissioners co-chaired the task force, said "exploration" of the
notion was in the "planning" stage.

But Krasner says he faced similar opposition when he took the
needle-exchange program Prevention Point on as a client in the early
1990s. He said a safe injection site, like a needle exchange, is just
one tactic in combating an addiction crisis that must be treated as a
medical issue. In a statement released this week, he said that if safe
injection sites could help stave off that crisis, it's a "moral
obligation" to open one in Philadelphia.

"Three die a day in Philadelphia, 13 die a day in Pennsylvania, and
nationally, there are 50,000 deaths a year," he said in an interview
Thursday. "So, yeah, I'm OK with safe injection sites."

Grossman says she has warmed to the idea, citing articles in the
Inquirer and Daily News on librarians who trained themselves to use
Narcan to save overdose victims in Kensington, and of
elementary-school students witnessing a man injecting heroin into his

"If people are willing to talk about it, it's certainly something that
I'm willing to explore," she said.

Both candidates stressed the importance of consulting with residents
in neighborhoods like Kensington, where heroin use is heavily
concentrated. "If they don't want it, that has to be taken into
consideration too," Grossman said. And the legalities of such a site
have to be parsed.

"Who the district attorney is, and their opinion on this, is crucial,"
said Scott Burris, a Temple University professor of public health law.
"Safe injection facilities are neither clearly legal nor clearly
illegal. A district attorney could ask: 'Do I believe this is a bona
fide public health measure and therefore not subject to various kinds
of criminal laws? Or do I think this is a criminal enterprise in
disguise that I'm going to shut down?' "

Burris said a safe injection site is "good public health," but elected
officials exploring the possibility have to work carefully to bring
the public on board.

Still, attitudes are shifting, said Devin Reaves, the executive
director of Life of Purpose New Jersey, an addiction-treatment center,
and a member of Kenney's task force on the opioid crisis. He said he
was met with laughter when, years ago, he first began speaking to
legislators about making Narcan more widely available, or passing good
Samaritan laws that don't penalize drug users who call the police for

"And last year, the physician general signed a standing order that
made Narcan available over the counter in Pennsylvania," he said. "And
we weren't the first state to do it. There are people on the mayor's
task force who were opposed to safe injection sites in the beginning
whose minds were swayed."

Kenney's spokeswoman, Lauren Hitt, said the city will decide over the
next several months whether to "move forward" with a plan for a safe
injection site. She said Krasner's announcement hadn't affected that

"In making that decision, we're evaluating potential legal challenges,
including from the state and federal government, suitable location,
cost, security, and how to address neighborhood concerns," she said,
and city officials were planning to visit a safe injection site in
Canada this fall.

All 18 recommendations from the mayor's opioid task force are
somewhere in the "planning" or "implementing" stages, from expanding
access to medication-assisted treatment for addiction to creating the
ability for emergency rooms to send overdose victims directly to
treatment, which currently is blocked by a maze of bureaucratic hurdles.

Meanwhile, various measures show the epidemic of addiction continuing
to worsen both here and nationally. Philadelphia emergency medical
crews administered the overdose reversal medication naloxone to more
than 3,000 people during the first six months of 2017, up more than 75
percent from the same period last year.

And accidental drug-related deaths, which have been steadily
increasing for several years, shot up during the last three months of
2016 and continued at the same level or higher early this year, a pace
that would end 2017 up 30 percent for the second year in a row.
Accidental overdose deaths statewide were up even more: 37 percent in
2016, according to data collected from county coroners throughout
Pennsylvania by the local division of the Drug Enforcement
Administration. The latest federal data show a 21 percent increase in
total drug mortality - a projected 64,000 deaths nationwide - for the
12 months ending Jan. 31.

The increases everywhere were driven largely by a flood of illicit
fentanyl, most of which is imported from China and then mixed with
heroin, a combination that makes the end product both cheaper and more
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MAP posted-by: Matt