In July, Rhode Island became the first state in the country to allow the use of secure injection sites statewide. The landmark legislation signed on July 7 will create a two-year pilot program to establish harm reduction centers for people to use illicit drugs under medical supervision. The centers will also provide health screenings, needle exchange and recovery support.
The state’s health ministry is to create regulations for the use of these sites by March 2022, and then cities and counties will have to vote to allow centers in their district. While some harm reduction services will be funded by taxpayers, the state has not earmarked money for safe consumption, which will be funded by the private sector. The permanent establishment of the centers will likely require new legislation in 2024 or thereafter.
But in making the centers work, the state’s recovery community will face a new set of challenges, including membership of counties, convincing neighbors to accept the centers, police cooperation and hope. that the federal government support the law.
Advocates say Rhode Island was the first to pass such legislation in part because of the overwhelming impact of the opioid crisis. Overdose deaths totaled 384 in 2020, according to the state health department. In 2018, the state ranked eighth in the country for drug overdose deaths per capita, according to the National Institute on Drug Abuse. This meant that many politicians understood the crisis on a personal level.
“Many legislators have personally experienced the loss of a family member as a result of an overdose,” says Annajane Yolken, Executive Director of Protect Families First. “There is a lot of understanding that overdose is a public health problem.”
While harm reduction is seen as controversial, advocates say the bill has had relatively little hindsight. Haley McKee is the co-chair of the Substance Use Policy Education and Recovery PAC (SUPER PAC), which has helped advocate for the legislation. McKee, a former incarcerated and former intravenous drug user, attributes the passage of the bill to a tight-knit Rhode Island recovery community, but also to researchers at Brown University whose work on harm reduction helped inform the bill. It helped that the bill’s momentum started with the Rhode Island Medical Society, according to Yolken.
More than 100 safe consumption sites exist around the world and although they have been under-studied, the available evidence shows that they reduce overdose deaths. A 2017 results survey notes a 35 percent reduction in overdose deaths within 500 meters of a consumption site in Vancouver. In addition, more than 80 HIV infections have been prevented there each year. In Spain, overdose deaths have been almost halved in a decade and HIV infections have been reduced by more than 10%. No overdose deaths have been recorded at a safe consumption site. Sites can also divert people who want to treatment: Vancouver, within three years of opening a safe consumption site, has seen 46% of people using the site enter treatment.
There will be challenges even once the Rhode Island centers are in place in 2022. There is no certainty that the police will give injection sites the space they need to thrive, although Representatives from the Rhode Island Police Chiefs’ Association and the Rhode Island State Police serve on the Governor’s Working Group on Overdose Prevention and Response. State downgraded possession of small amounts of most controlled substances from felony to misdemeanor in July, but drug addicts trying to access harm reduction centers could still be arrested in transit.
Some elected officials believe that the lack of hindsight on the part of the police is a sign that the police will act in partnership with defenders, although no formal policy obliges them to do so.
State Senator Joshua Miller, a supporter of the legislation, said law enforcement in the governor’s task force did not express concern about the legislation and did not protest during the the hearing for safe consumption legislation.
“Supporting the community is important and is already part of the process,” Miller says. “This will include support for law enforcement and no one has shown us otherwise.”
But McKee and others are more skeptical, and there is nothing in state law that would prevent police from making arrests before or after visits to centers. “I have nothing positive to say about our Rhode Island police chiefs,” McKee says. “We’ll have to wait and see. ”
Although the law sanctions supervised injection sites and asks the Rotary Department of Health to create a framework for their use, it does not specify where they should go or how much should increase. This will be the next difficult step in the process, as advocates push for the centers to be located in densely populated areas where they can be of greatest benefit. To do this, they will have to face NIMBYism as community members potentially protest against the neighborhood centers.
“The answers I’ve received from some but not all of our lawmakers, and unfortunately they come from the hardest hit areas, is that there are no more social services in my district,” McKee says. She says she and other advocates will continue to meet and engage with people to ensure community buy-in.
It will not be possible to select sites until an advisory committee has been set up and the regulations of the Ministry of Health are established. But Yolken is hoping that more sites will be created across the state to make the law as effective as possible, as people are much less likely to access services that require a lot of travel.
“Rhode Island has a very small town attitude. People joke that you have to pack a sandwich to travel 10 minutes, ”says Yolken.
McKee says officials from Providence and Pawtucket have expressed interest, both towns in Providence County. Providence County would likely benefit from multiple centers – geographic data mapped by Prevent Overdose RI shows that 93 of the state’s 384 overdose deaths in 2020 occurred in the county.
The law also faces an uncertain legal landscape. A supervised consumption site in Philadelphia was blocked in january by a federal appeals court after the Justice Department filed a lawsuit, citing a 1986 law that prohibited landowners from knowingly allowing people to consume controlled substances on their premises. The law was sponsored by then-senator Joe Biden, but advocates believe President Biden’s administration will be less likely to oppose the use of secure injection sites than the Trump administration.
“We are optimistic that this new administration will take the side of saving lives,” said Yolken.
In April, several mayors, including London Breed from San Francisco and Libby Schaaf from Oakland, wrote a letter Attorney General Merrick Garland calling on the Biden administration to drop any threat of lawsuits regarding supervised injection sites.
The medical community and advocates in Rhode Island are hopeful that state law doesn’t run into legal hurdles and establish a national model. As Yolken points out, supervised consumption sites are not an untested model, but would provide a cleaner, richer, and more secure environment than people are used to.
“People have cared for each other in their communities for a very long time, that makes it official,” Yolken said.
Roshan Abraham is the 2020 Next City Equitable Cities Fellow.