Pennsylvania set to ban supervised drug use sites, in setback for harm reduction

Pennsylvania lawmakers are set to pass a new ban on supervised drug consumption, effectively ending a Philadelphia nonprofit’s long-running effort to offer a sanctioned substance-use site meant to prevent overdose and death.

A bill outlawing sites that “knowingly” provide a space for drug consumption passed a committee vote by a wide margin on Tuesday. It now advances to the full state senate, where it is also expected to pass. Gov. Josh Shapiro, a Democrat, has expressed strong opposition to supervised injection sites in the past, and is expected to sign the legislation.

While supervised consumption advocates argue that the service would prevent overdoses, reduce disease transmission, and potentially help people access addiction treatment, local lawmakers say the bill reflects their constituents’ opposition to sanctioned drug use sites.


“I see the pain and suffering addiction causes every day in my district,” Christine Tartaglione, a Democratic state senator who represents a portion of Northeast Philadelphia and authored the bill, said in a statement. “I believe it is imperative that Pennsylvania be in the business of helping people access recovery, not empower addiction.”

If the new law is enacted, it would represent the latest flashpoint in a long-running national debate over harm reduction, a philosophy that aims to avert the worst consequences of substance use, like death and disease, while recognizing that demanding instant abstinence is rarely practical.


It may also indicate a rightward lurch in U.S. attitudes toward harm reduction, and the country’s response to its drug epidemic more broadly. While the Biden administration has expressed unprecedented support for harm reduction, many Americans remain hostile to the approach.

Some harm-reduction tools, like syringe exchanges and fentanyl test strips, have gained a degree of acceptance, but supervised consumption is still largely taboo. Pennsylvania advocates had high hopes for a planned site in Philadelphia, however, and say the legislation would deal a demoralizing blow to local efforts to avert overdoses and save lives.

“It really highlights, overall, where the Democratic Party is moving,” said Jordan Scott, a regional field organizer for the Pennsylvania Harm Reduction Network. “The message it sends to people who use drugs is: You don’t matter.”

For drug policy veterans, the move is just the latest example of politics interfering with efforts to address the country’s long-running addiction crisis. Many politicians are wary of the controversy that accompanies supervised consumption, and the Pennsylvania law may represent an attempt to avoid a ballot-box liability in 2024, said Regina LaBelle, a former Biden administration drug policy official and the director of the O’Neil Institute’s Addiction and Public Policy Initiative.

“Drug policy is never at its finest when it becomes politicized,” she said. “They want to take this off the table — it’s something they have to deal with next year.”

Similarly, the legislation could help the White House avert a political headache. When President Biden took power in 2021, he inherited a drawn-out legal battle between the Department of Justice and Safehouse, the Philadelphia nonprofit that announced plans to offer supervised injection services but was thwarted by a Trump administration lawsuit.

The Biden administration had two choices: Drop the lawsuit and allow the clinic to open, enraging conservatives, or continue the Trump administration’s hardline approach, angering harm reduction advocates and many progressives.

Instead, though, the DOJ has dragged its feet on the lawsuit. Pennsylvania lawmakers’ move to preempt Safehouse from opening effectively takes the decision out of the White House’s hands.

Offering medical supervision as people consume drugs that can cause overdose, like heroin and fentanyl, is among the most controversial tactics employed to prevent overdoses. But in recent years, as U.S. drug deaths have surpassed 100,000 annually, the strategy has gained support among some public health advocates. While critics argue that supervised injection condones drug use, studies from cities including Vancouver and Barcelona show that offering the service can lead to a marked reduction in overdose deaths.

In the U.S., supervised injection has long been viewed as illegal. When Safehouse attempted to offer the service in 2019, the Trump administration sued to stop it, citing a 1986 law that makes it illegal to maintain a space for the purpose of facilitating drug use. (That bill’s author: then-Sen. Joe Biden.)

By and large, however, public health experts have acknowledged that supervised injection can be a useful tool in the nation’s fight against drug overdoses. Even the typically cautious Nora Volkow, the director of the National Institute on Drug Abuse, offered a tacit endorsement of supervised injection sites at a STAT event late last year.

“The ones that have done the research have shown that it has saved a significant [percentage of] patients from overdosing,” she said. “Those conditions do document that, in those circumstances, it can save lives.”

Currently, only a few supervised consumption sites are in operation around the U.S. — and none have formally received the federal government’s blessing. Most notably, the nonprofit OnPoint NYC opened two supervised consumption sites in Manhattan late last year. Rhode Island has legalized supervised consumption sites as well, though it’s unclear when a planned site in Providence will open. The Biden administration has largely ignored the efforts.

Given the Biden administration’s inaction and local policymakers’ hostility, the path forward for supervised consumption services will likely entail asking forgiveness, not permission, LaBelle predicted.

“I don’t think it puts a stop to these types of programs,” LaBelle said. “It will just mean that they’ll occur on a one-by-one basis, in an unsanctioned manner.”

Despite their effectiveness at reducing death and disease transmission, harm reduction tactics are already controversial among politicians from both major parties. While Democrats, broadly speaking, are more supportive of harm reduction tactics, many have drawn the line at supervised consumption. Most notably, Gov. Gavin Newsom of California — a potential future presidential candidate — vetoed a bill last year to allow several pilot supervised consumption sites to open, citing potential “unintended consequences.”

Politicians’ resistance, Scott argued, is rooted largely in stigma — not in any objective assessment of which policies are most effective at saving lives.

“The opposition to overdose prevention centers all boils down to some arbitrary definition of morality, and opinion,” Scott said. “We shouldn’t be drafting laws based on opinion. We should be drafting laws based on research.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.

Source: STAT