Step-by-step: How Philly’s overdose prevention site will work

From entry and observation to “motivational moment” and referral.

What it looks like inside one of Vancouver's Insitesupervised injection facilities

What it looks like inside one of Vancouver's Insitesupervised injection facilities

Elana Gordon / WHYY
michaelawinberg-square-crop-feb2018

Philly’s proposed overdose prevention site had its first day in court this week. U.S. Attorney William McSwain played hardball with Safehouse president Jose Benitez at the federal courthouse on Monday, digging out some specific info on how the facility will operate.

McSwain sued the nonprofit in February, claiming supervised injection would violate the Controlled Substances Act. Safehouse officials rebutted by saying their intended goal was to save lives, not give drugs.

The federal case now playing out is the first in the United States, and will likely set a precedent for the legality of overdose prevention sites around the country.

As supervised injection site supporters rallied outside, McSwain grilled Benitez for over an hour. The spectacle was an evidentiary hearing — a preliminary fact-finding event that’s among the first steps in the litigation process.

It gave the folks involved with the Safehouse nonprofit a chance to explain to a judge why they think an overdose prevention site is appropriate and legal. If one opens in Philadelphia, it has the potential to be the first in the country. Democratic presidential candidate Bernie Sanders recently unveiled a plan that would legalize such facilities nationwide.

At the courthouse, Benitez said the facility would be almost identical to Kensington syringe exchange Prevention Point — where he is also executive director — save for the part where drug use is permitted.

How might it all work? If the overdose prevention site survives federal prosecution, it’ll work like this:

1) Entry

The first step, of course, is to enter the building. But there’s some logistics here that haven’t yet been decided. Namely: will the injection site stand on its own, or be embedded within another medical facility?

Basically, it’ll all depend on whether an existing medical center is willing to take Safehouse under its wing. If not, it’ll set up camp independently.

To the dismay of some neighbors, Safehouse leadership identified five potential locations in Philly’s Harrowgate neighborhood. Sources have told Billy Penn that one of the pitched sites on the 1800 block of East Hilton Street has a political tie to Safehouse leadership.

2) Registration

Right when you enter the facility, you’ll be walked through a brief registration process. You won’t have to give your name. Instead, you’ll be provided with a unique identifier so staff can address you.

This part also includes some basic data collection — generally just info about your demographics so providers can understand who uses the site on a macro level.

3) Health assessment

Think of it like an abridged physical. Before you get any deeper into the facility, the staff members will give you a once-over for any pressing health issues.

If you’re a minor, your journey ends here. You won’t be allowed in the consumption room.

If you’re pregnant, staff will pull you aside and try to refer you to more appropriate services.

4) Medically supervised consumption

Here’s that controversial part you’ve heard so much about.

The consumption room at Safehouse will look a lot like the one at Vancouver’s Insite facility, Benitez said. There will be a handful of cubicle-style booths that open to a nursing station. From there, a designated staffer can watch over everyone as they use their substance of choice.

Some ground rules: There will be no exchange of currency, nor manufacture or sale of illegal drugs. Just use.

5) Staff oversight

Employees won’t administer any drugs — although Benitez conceded that if a patient had a hard time finding a vein, a nurse might help them in order to prevent more injuries.

Nurses will have a handful of tools at their disposal — likely including fentanyl test strips, clean syringes, tourniquets, alcohol wipes, oxygen tanks and a defibrillator. And, of course, an overdose prevention kit with a mask, gloves and the OD reversal medication Narcan.

“The immediacy of being able to provide that to the person by just running around the desk makes a huge difference,” Benitez told the court.

A fuller health protocol is in the pipeline, Benitez said, but not until they get the greenlight from the court.

5) Observation room

Following substance use, patients will be funneled into the observation room — basically a safe space to chill out and come down from the high, accompanied by staffers who are equipped with Narcan.

This basically already exists at Prevention Point, Benitez clarified.

“We do this every day,” he said. “People have consumed outside and then they’ll come in and we observe them.”

6) ‘Motivational moment’

When the whole process is said and done, patients will be pulled aside into the “motivational moment.” Aspirational, sure, but that’s what Benitez is calling it.

Staff will walk people through options for referral to recovery services and encourage continued treatment.

7) Checkout

Ideally, a handoff directly to treatment, or a “Goodbye, for now.”

Safehouse’s next court hearing is scheduled for Sept. 5.

Thanks for reading another Billy Penn story

Seems you’re the kind of person who really digs in. Want more? Sign up for our free morning newsletter, the easy way to stay on top of Philly news.

Thanks for reading Billy Penn

Like the story above, everything we publish is powered by our members. If you enjoy reading, join today: Just $5/month makes more difference than you’d think.

Thanks for reading! We need you.

Reader donations power our newsroom. If Billy Penn helps you feel more connected to Philly, we’d love to count you as a member. Will you join us?

Lock in your support

Reader support powers our newsroom. A monthly membership helps lock it in.

Can we count on you as a Billy Penn sustainer?

Winning the local journalism game

Thank you: Member support powers our newsroom.

Know someone else who might like our work? Invite them to sign up for our free morning newsletter.