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Supporters push safe injection sites to stem overdose deaths in Maryland, but legal questions unresolved

As opioids continue to claim hundreds of lives a month in Maryland, treatment advocates, politicians and others are making another push to permit drug use in certain places where it can be monitored and people can get connected to programs that address their addictions.

Backers, including Baltimore State’s Attorney Marilyn Mosby and City Council President Brandon Scott, came to a meeting Wednesday to promote so-called safe consumption sites and encourage a groundswell of support for state legislation that would establish such spaces. Similar bills have failed in each of the past four years and there has been a federal legal challenge in another state where a site is planned.


“Growing up in the 90s, we had ‘zero tolerance’ and ‘the war on drugs,’ and now we need to try harm reduction because we know those other ways didn’t work,” said Scott, a Democrat who announced this month he is running for mayor. “We have to evolve in the way we operate.”

Scott cited the number of fatal overdoses, which figures show dropped in the first six months of the year in Maryland but remain on pace to exceed 2,300 deaths for the year. The deaths were almost all related to opioids, specifically heroin and the more powerful synthetic drug fentanyl.


Mosby, whose office stopped early this year prosecuting marijuana possession cases, said safe consumption sites, also called safe injection sites, are a racial justice issue because of the high rates of incarceration of black people for drug-related crimes.

Mosby said the sites would treat users as humans with a substance use disorder, rather than as criminals.

“The war on drugs has not made us safe or healthier,” she said. “Removing criminal sanctions helps destigmatize substance use disorders."

Mosby joined dozens of others in the criminal justice field in signing onto an amicus curiae brief in July in United States of America v. Safehouse, a lawsuit by U.S. Department of Justice challenging the legality of a site in Philadelphia.

“There are more than a hundred sites around the world and no reports of anyone fatally overdosing in any of them.”

—  Rajani Gudlavalleti, Baltimore Harm Reduction Coalition

The federal attorneys wrote in a motion seeking a ruling in their favor that “it is unlawful to provide a site for the illegal use of controlled substances, and that the use of heroin, in particular, serves no medical purpose.”

Backers in Baltimore understand the sites remain controversial, putting any new state legislation in doubt. Gov. Larry Hogan, a Republican who has directed millions to stem overdose deaths, criticized the idea in 2017, saying, “It’s absolutely insane.”

Even health officials are not all convinced. Dr. Letitia Dzirasa, Baltimore’s new health commissioner, continues to evaluate “effective means of improving public health,” but can’t yet sign onto safe consumption sites, said D’Paul S. Nibber, a health department spokesman.

“Unfortunately, the legality of safe injection sites is still in question,” he said. “With that in mind, Dr. Dzirasa and the Baltimore City Health Department continue to explore and learn more about the concept of safe injection sites, but will hold on providing a definitive stance as we await more concrete data and for any legal concerns to be addressed.”


“Unfortunately, the legality of safe injection sites is still in question.”

—  D’Paul S. Nibber, Baltimore City Health Department

Supporters, however, believe the challenges can be overcome and they reject the critics’ view that the sites merely allow or even encourage drug use.

A dozen other cities and states have permitted the sites, and officials in those places and supporters in Baltimore consider the Philadelphia case a bellwether for their cause, said Adrienne Breindenstine, spokeswoman for Behavioral Health Systems Baltimore, a nonprofit organization that oversees substance use and mental health services for the city of Baltimore.

The Morning Sun

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That group joined with other service providers and advocates in arranging Wednesday’s meeting at the Institutes for Behavior Resources Inc./REACH, a treatment provider in Baltimore.

The groups set up a tent to show what operating sites look like in Europe and in Canada. They offer chairs and tables, needle exchanges, snacks, stocks of the opioid-overdose antidote naloxone, peer counselors and medical staff for monitoring people using drugs. There are also ways to connect to social services and treatment, in the same building in some cases.

“There are more than a hundred sites around the world and no reports of anyone fatally overdosing in any of them,” said Rajani Gudlavalleti, community organizing manager for the Baltimore Harm Reduction Coalition, who was manning the tent.

Susan Sherman, professor of health, behavior and society at Johns Hopkins Bloomberg School of Public Health, said there is research showing the sites lower the instance of infectious disease such as HIV and hepatitis, the cost of medical care, as well as reducing fatal overdoses and increasing the number seeking treatment.


She likened the movement to the one creating Baltimore’s needle exchange programs, which was controversial when it began in the mid-1990s but succeeded in reducing spread of disease and increasing clients’ contact with health care and treatment providers.

Such sites in Baltimore would also reduce unsanctioned and unsafe injection sites in vacant buildings that she called “abandominiums."

Further, Ricky Morris, who became an educator and advocate after overcoming a substance use disorder, said the sites would restore dignity and hope to people often judged harshly.