Safe injection sites are successful internationally, so why did Minneapolis say no?

In 2019, the city of Minneapolis recorded more than 1,300 drug overdoses, the most in at least a dozen years. At the start of that dismal year, Minneapolis Mayor Jacob Frey rejected proposals to open safe places for addicts to use drugs under medical supervision, which advocates say could have contained the 2019 overdose epidemic. 

So-called safe injection sites — a harm reduction model used successfully in dozens of cities around the world — are places for opioid users to ingest drugs safely while nudging them toward drug treatment.

The strategy in the battle against the opioid epidemic is also gaining momentum in some U.S. cities, but not here. 

Members of a Frey task force aimed at curbing the opioid epidemic say they repeatedly raised the idea, but that Frey and his staff rejected it out of concern such a move would endanger important federal dollars. 

Mychal Vlatkovich, a spokesman for Frey, denied that safe injection sites were ever a major part of the task force’s discussions in an email to Minnesota Reformer. 

“The issue surfaced at one subcommittee meeting but didn’t gain further traction,” Vlatkovich wrote. 

But others remember it differently. Audua Pugh, executive director of Off The Blue Couch, a nonprofit based in North Minneapolis that seeks to reduce addiction through outreach, served on the task force and said she personally brought the issue forward during meetings.

“He totally said no about that,” Pugh said of Frey. 

Karl Noyes and Maria Clark, who both worked for the state’s Opioid Response Corps at the time, also recalled the issue coming up many times during task force meetings.

Noyes said the subject was broached in at least five different subcommittee meetings he attended between November 2018 and February 2019. Multiple aides with Frey’s office warned Noyes that opening a safe injection site would jeopardize the city’s federal funding, he said.

“Every single time it was brought up, ‘The mayor isn’t going to support that, it’s not going to be part of the final recommendations,’” Noyes, now an addiction counseling student at Minneapolis College who is also pursuing graduate work at Metropolitan State University, said in an interview. “They played it off like it was such a minor thing.” 

Clark, who currently works at a group home in Minneapolis aimed at helping American Indian drug users, also remembered safe injection sites surfacing multiple times during task force meetings.

“It seemed as if this was a goal people wanted, and it was a hope,” Clark said.

But Frey’s staff gave “a flat-out no” to the idea, Clark said, because it would open up legal vulnerabilities from the federal government.

“Whoever is involved could be arrested, down to the nurses and whoever walks inside,” Clark said she recalled hearing from the mayor’s office.

In another email, Vlatkovich maintained that the mayor supports the idea “when operated by medical professionals and coordinated with additional support and recovery services.” Safe injection sites in other cities are typically staffed by medical professionals who are able to refer users to treatment options.

But he added that Frey “has concerns about government-run safe injection sites.” 

“The Mayor is prioritizing other harm-reduction solutions like increasing access to naloxone, funding a hospital-intervention program for opioid addiction, and supporting medications for opioid use disorder in the Hennepin County jail,” Vlatkovich wrote.

Legal ramifications

Programs that provide unused syringes and needles to people with drug addictions have sprung up around the country, including in Minneapolis, but efforts to establish safe injection sites in U.S. cities have been impeded by legal problems. New York Mayor Bill de Blasio in May 2018 released a plan for four safe injection sites across the city, but the project has stalled. Advocates allege that Gov. Andrew Cuomo has delayed the state Department of Health’s review of the program out of a similar fear of retribution from the federal government.

“Cuomo pretty much wholeheartedly supported this,” said Ken Robinson, executive director of Research for a Safer New York, a coalition formed by syringe exchange groups that is set to study the efficacy of New York’s safe injection sites once they’re created. “He was going to sign an executive order that would authorize it … and he just turned his back on us.” 

Cuomo’s office did not immediately respond to a request for comment. 

In California, a bill that would have greenlit a safe injection site in San Francisco was vetoed in 2018 by then-Gov. Jerry Brown, who cited threats of legal action by the federal government. The proposal was reintroduced last February and passed by the state Assembly in May, but its future is uncertain: Lawmakers said in June they would wait until 2020 to try to push it through the Senate.

There are no legally sanctioned safe injection sites operating anywhere in the U.S., but that could soon change. Safehouse, a Philadelphia nonprofit sued by the federal government last February after trying to set up the nation’s first site, won a legal victory in October. The judge in the case, Gerald McHugh, wrote that the nonprofit’s plan did not violate the so-called crack-house statute of the Controlled Substances Act because the organization’s goal “is to reduce drug use, not facilitate it.” The decision, which is expected to be appealed, was the first federal ruling on the legality of safe injection sites. 

Attorneys general in seven states, including Keith Ellison in Minnesota, have each signed an amicus brief supporting Safehouse against the Trump administration in the lawsuit. (Ellison’s office did not comment on the lawsuit against Safehouse before press time.) 

McHugh’s ruling denied the federal government’s motion, but it wasn’t a final decision. Rebecca Richman, a consultant for Safehouse, said the nonprofit would wait for a final decision before proceeding with its plan for a site. 

“We’re trying to strategize how to move forward to get to that final judgment,” Richman said. “We will not be opening until we’re legally allowed to do so.”

Effective outside of U.S.

The world’s first safe injection site was opened in Bern, Switzerland, in 1986, in response to the country’s growing heroin epidemic. A number of European cities followed soon after, and as of today roughly 100 safe injection sites operate in 66 cities around the world.

The first safe injection site in North America, Vancouver’s Insite, opened in 2003 to mixed reactions from the Canadian public. Since 2003, staff at Insite, one of the most-studied safe injection sites in the world, have overseen more than 3.6 million injections and responded to more than 6,000 overdoses. No one has ever died at Insite.

Safe injection sites are effective, researchers and advocates say, not just because they help avert overdoses. They also reduce the chances that people engage in behavior that can lead to HIV infection, and they make it more likely that people seek treatment. A study conducted at Insite found a statistically significant increase in the number of people taking up treatment a year after the site opened. A 2014 review of 75 studies of safe injection sites — 85% of which were focused on sites in Vancouver and Sydney — found each site fulfilled its harm-reduction aims and none led to an increase in drug use or crime. 

Findings like these inspired Pugh to push the issue during meetings of Frey’s Opioid Task Force. 

“Safe injection sites in other countries work,” Pugh said. “What it shows is that if people have a safe place to use, then the discussion can take place about getting off of it.”

And despite the uncertain legality of safe injection sites in the U.S., an underground site run by a small nonprofit has been operating in an American city since 2014, according to a study by researchers Alex Kral and Peter Davidson published in 2017. The study found the site prevented overdose deaths, reduced instances of public injection and disposal of syringes, and helped direct users to treatment.

“It has the same positive outcomes for the people who use the site” as do those in other countries, said Davidson, a professor at the University of California at San Diego. “There were no detectable negative effects on the surrounding community.”