Cerebrum Spring 2022


The Debate Over Safe Injection Sites BY PHILIP M. BOFFEY I N THE FINAL WEEKS OF HIS administration, Bill de Blasio, then mayor of New York, opened the nation’s first two overdose prevention centers to save the lives of people with substance use disorders who inject dangerous narcotics. Such sites are almost certainly illegal under an outdated federal law designed to close places where drug use is prevalent. But is it also unethical or immoral to operate the new sites? Or would it be even more unethical to close them down and leave people struggling with addiction to the mercy of the streets? The section of federal law that seemingly prohibits such sites makes it a felony to own, rent, or operate a location for the purpose of facilitating illegal drug use. Violators can be punished by up to 20 years in prison and served hefty fines. Simply raising that threat was enough to deter Philadelphia from opening a planned site. There were more than 95,000 drug overdose deaths in the year ending in February 2021, an all-time record, according to the Centers for Disease Control and Prevention. The chief culprits were opioids, including fentanyl, heroin, and prescription opioids, among others. The federal statute—dating back to the Anti-Drug Abuse Act of 1986— was designed to close buildings where people would shoot up and often die in shadowy corners in scenes worthy of a Dickens novel.

But the clean, modern facilities that federal authorities are targeting seem a much better option. The new facilities are sometimes called “safe injection sites” or “overdose prevention sites’” to underscore their important public health mission. Shortly after New York City’s first two sites opened in November 2021, reporters for the New York Times described the scene inside. People brought their own drugs to the sites, were provided with clean needles to use, and if they overdosed, were quickly given naloxone to reverse the overdose and save their lives. They were also told about options to receive treatment for their addiction, often crucial information for people struggling with substance use disorders. The sites have been supported by four of the city’s five district attorneys and by Eric Adams, the new mayor, who has a strong police background. The local law enforcement authorities can draw on their experience to understand what cities desperately need to combat rising addiction rates. The arguments against such sites were laid out by Rod Rosenstein, then deputy attorney general for the Trump administration, in an

opinion piece in the New York Time s on August 27, 2018. He called the sites “very dangerous” and said they “would only make the opioid crisis worse.” He claimed drug dealers would flock to the area, destroying the surrounding community. People “do not need a tax-payer sponsored haven to shoot up,” he said. “Injection sites normalize drug use and facilitate drug addiction by sending a powerful message to teenagers that the government thinks illegal drugs can be used safely.” Some opponents of injection sites also raise moral arguments—saying that injection drug use is


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