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Safe injection sites offer a place for people to use drugs under medical care, but some worry if these sites come to Maryland that they could be targeted by police.
Safe injection sites offer a place for people to use drugs under medical care, but some worry if these sites come to Maryland that they could be targeted by police. (Liz O. Baylen/Star Tribune/TNS)

It has been several years since a bill to create safe consumption sites for people who use drugs to do so under medical supervision was first introduced into the Maryland General Assembly.

These facilities are expected to open soon in Philadelphia after a recent court victory, and it won’t be long before they come to Maryland too. It is no longer a question if safe consumption sites will come to the state and Baltimore, but when. And when they do, policymakers ought to ensure that all who use them enjoy equal access as well as protection from criminal charges for minor drug possession — especially black and brown people affected by mass incarceration.

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As a doctor specializing in primary care and addiction medicine at Johns Hopkins, I have seen firsthand how the opioid epidemic hurts people of color. In my clinic, which serves a large black and Medicaid population, patients actively seeking treatment for their opioid addiction may miss appointments due to criminal justice involvement, lack of transportation, or other social barriers — leaving them vulnerable to a fatal overdose.

In large metropolitan areas across the country, overdose death rates are rising most steeply among black people who use drugs. Safe consumption sites save lives by having a medical professional observe people using pre-obtained opioids and administer the overdose reversal agent naloxone, or Narcan, when needed. One study found that 78% of people who use drugs in Baltimore would be willing to use a safe consumption site.

Maryland policymakers ought to take heed. In cities like Baltimore, where relationships between communities of color and law enforcement are often fraught, safe consumption sites might not feel safe for everyone. This concern was voiced at a community meeting I attended last week in Dundalk, hosted by the Open Society Institute and the National Council on Alcoholism and Drug Dependence.

One man feared that safe consumption sites would be implemented as privileged spaces in middle-class white neighborhoods, while poor black and brown people would continue to inject drugs in street alleys and abandoned rowhouses. A woman depicted a scene like that in The Wire, when police officers mistakenly arrest a group of young black men en route to “Hamsterdam,” a drug-tolerant zone in Baltimore established by the Western District commander without the knowledge of officers from other districts. While the fictional scene is a comedic one, the real possibility of the blocks adjacent to a safe consumption site becoming a hot zone for drug arrests is no laughing matter.

Safe consumption sites in Maryland should be paired with legal safeguards preventing arrest for possessing a small quantity of drugs within a pre-specified radius of the facilities. In addition, the state should educate law enforcement officials on the benefits of safe consumption sites, including overdose prevention, reduced transmission of HIV and linkage to drug treatment. Perhaps most important, members of black and brown communities who use drugs should be involved in the creation of the sites at every step from choosing locations to design to advertisement.

Policymakers should remember the slogan of the Vancouver Area Network of Drug Users, the grassroots organization that successfully lobbied for North America’s first safe consumption site: “Nothing about us, without us.” To be sure, Maryland lawmakers should be careful not to write a law so liberal with respect to drug possession as to invite federal prosecution. The Drug Enforcement Administration classifies heroin as a Schedule I drug, meaning it is considered to have a high potential for misuse and no medicinal value. Yet, marijuana, which has been decriminalized in Maryland as well as other states, also falls under Schedule I.

Baltimore State’s Attorney Marilyn Mosby has declined to prosecute marijuana possession cases. It would be reasonable to ask her office to do the same for heroin possession by individuals utilizing a safe consumption site. In my clinical practice, I have seen the racially disparate impact of drug policies once touted as the key to break the cycle of mass incarceration. I am struck by how readily white patients access medical marijuana dispensaries, while black patients rarely do so. It would be a shame if safe consumption sites benefited only white people who use drugs —or worse, if law enforcement were to exploit the facilities as targets in the failed and racist drug war.

Maryland policymakers ought to create safe consumption sites that are a safe and welcoming space for all who use drugs, particularly vulnerable populations in Baltimore.

Jasleen Salwan (jsalwan1@jhmi.edu )is a doctor focusing on primary care and addiction at Johns Hopkins.

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