Overdose prevention sites

Non-elite members of the drug policy network in Philadelphia have been essential to centering harm reduction interventions on the city's policy solution agenda by using grassroots tactics including cooperation, convergence, disobedience, and display - the four main tenets of international harm reduction mobility. I explored this concept using a policy mobility research framework by following the people, materials, and meetings. I conducted semi-structured interviews with both elite and non-elite policy actors in Philadelphia, New York, California, and Washington; reviewed publications, policy documents, websites, research articles, and other records; and reviewed minutes and materials from city task forces, and other pertinent gatherings, conferences, community meetings, workshops, etc. With overdose deaths on the rise, city officials are in urgent need of innovative, evidence-based interventions to expand access to substance use disorder treatment, reduce infectious disease transmission, save healthcare dollars, and above all, prevent overdose deaths. Overdose prevention sites (OPS), a medically supervised setting where people who use drugs can perform safer injections, is one such intervention aimed to minimize the harms of drug use. Over one hundred sites are currently operating across the globe, but no legally sanctioned site exists in the United States, despite the mass of evidence in support of such services. OPS services are a natural expansion of syringe service programs, another harm reduction intervention launched to existence in the United States explicitly due to direct actions in the 1980s and 1990s by chapters of the AIDS Coalition to Unleash Power (ACT UP). Former ACT UP members now hold elite positions in the Philadelphia drug policy network, while existing ACT UP members and other non-elite actors across the nation are actively advocating, organizing, and publicly demonstrating in support of opening an OPS. As a result, the City of Philadelphia is encouraging private and nonprofit sector development to open the first OPS. The acceptance of OPS as a solution at the city level and the significant growth in harm reduction infrastructure in Philadelphia since 2017 is a case of policy learning due to international policy mobility and local activism, which has resulted in an overall shift towards evidence-based harm reduction models. Despite this movement work, there are still no sanctioned OPS currently operating in the United States as legal barriers from the federal government and public pushback fueled by stigma continues to make implementation difficult. To win the fight for Safehouse, set a precedent for the country, and ultimately save lives, the City of Philadelphia and its non-profit partners, activists and advocates, should consider the following recommendations for next steps. In addition to the ongoing practice of cooperation, convergence, disobedience, and display, the city should: 1) start neighborhood-based community advisory boards; 2) create and publish a public safety plan; 3) develop and implement a public education campaign; 4) conduct coalition building; and 5) explore the feasibility of publicly funded mobile OPS units as a pilot project. Importantly, one of the most impactful features of these recommendations would be to ensure the meaningful involvement of people who inject drugs at all levels of planning and provision.