Advocates for overdose prevention sites say their yearslong effort to provide places in Maryland where people can more safely consume illegal drugs finally may be gaining traction.
Also known as supervised injection sites, the facilities offer clean needles and other supplies to people who use drugs. Trained staff can intervene in opioid overdoses and connect people to treatment and other services. Similar sites in other countries have a track record of reducing fatal overdoses, which hit record numbers in the United States and in Maryland during the coronavirus pandemic.
The first bill allowing them was introduced in the Maryland General Assembly in 2016. It and subsequent bills were met with resistance, with former Gov. Larry Hogan calling the proposed sites “absolutely insane.”
Supporters of a new draft bill that would authorize six pilot locations in the state have reason to be more optimistic this time. While campaigning, Gov. Wes Moore, a Democrat who took office last month, had expressed support for more drug treatment and harm reduction programs, though he has not addressed overdose prevention sites specifically.
The outcome is not a given. It’s not clear if the U.S. Department of Justice under the Biden administration would be more amenable to the sites than the Trump administration, which used the U.S. Controlled Substances Act’s “crack house” provision to stop sites intended for drug use. The scope of support in the legislature and among members of the public is still unknown.
Advocates had “so many private conversations with people who are like, ‘Of course this makes sense, but it’s never gonna happen here,’” said Rajani Gudlavalleti, director of mobilization at Baltimore Harm Reduction Coalition.
Gudlavalleti co-founded BRIDGES Coalition in 2017 to raise support for overdose prevention sites. Now, in its seventh year, she and others believe opposition is softening as the overdose epidemic continues to claim more than a half-dozen lives a day around Maryland.
“I think this year we have our best chance yet of passing legislation due to years of community education by advocates and public officials,” said Michael Camlin, a program manager for Open Society Institute Baltimore, a nonprofit group also supporting the sites.
“We now have the support of the mayor, members of the council, members of the community,” he said. “We have strong bill sponsors and who we believe is a sympathetic governor.”
Baltimore’s Democratic mayor, Brandon Scott, and the city health commissioner, Dr. Letitia Dzirasa, said they support such sites.
Carter Elliott, a spokesman for the governor, said: “Gov. Moore is committed to minimizing the negative consequences associated with substance abuse, and will ensure that those suffering have access to compassionate, quality care.”
A strategy to ‘decrease tremendously the chance of dying’
Sitting at a table and facing a mirror, Candy Jovan dipped the end of a fentanyl test strip into a metal “cooker.” Grabbing a length of blue rubber, she tied it around her upper right arm, demonstrating how someone might inject drugs with sterile supplies.
This mock site was set up in the middle of the Charles Theatre’s crowded and dimly lit lobby on a recent weekday night. With the real deal, partitions would give clients privacy, while mirrors would allow staff to monitor from behind, said Jovan, the communications manager for the Baltimore Harm Reduction Coalition. Trained staff would answer questions and administer naloxone, a medication that reverses opioid overdoses. There might be couches providing a comfortable space to have a meal or play cards.
New York opened the nation’s first sanctioned overdose prevention sites in 2021, following similar operations in 120 countries, including Australia, Canada, and some European nations.
“They decrease tremendously the chance of dying,” said Susan Sherman, a professor of health, behavior and society at The Johns Hopkins Bloomberg School of Public Health and lead author of a 2017 Abell Foundation report on overdose prevention sites in other countries.
The report found the sites reduced overdose deaths, spread of disease, crime and public use of drugs. They encouraged people to enter drug treatment, according to Sherman, and a separate study found health care systems saved $7.8 million for each $1.8 million invested in the sites.
A draft bill that proposes authorizing overdose prevention sites in Maryland would allow community-based organizations to open up to six pilot locations — two each in urban, suburban and rural areas. They would not be located in residential areas.
In Baltimore City and other parts of the state, they would likely be housed along with needle exchanges and other drop-in services, BRIDGES members say.
In addition to staffing the overdose prevention sites, workers would also refer people for addiction treatment, reproductive health care, and testing for HIV, viral hepatitis and sexually transmitted diseases, according to the bill.
“It’s not just a place people come in and use drugs, but they come in and find integrated services,” Sherman said.
The legislation does not provide state funding. Gudlavalleti said that would fall to nonprofits such as the Abell Foundation, which has in the past expressed openness to funding sites, and Open Society Foundations, which backs the New York sites.
For now, supporters in Maryland and elsewhere will continue campaigns to win over state lawmakers, local officials and the public.
Efforts have fallen short recently in other Democratic-led states, where supporters believed leaders would be more welcoming. California Gov. Gavin Newsom vetoed a bill to create supervised injection sites, fearing the plans were insufficient to ensure safety. New York Gov. Kathy Hochul refused to fund them until questions about their legality were resolved.
At a bill hearing in 2020 in Maryland, then-state Sen. Delores Kelley, a Democrat who represented Baltimore County, said, “It might be needed, but I can’t think of anyone in this room who would want this on their block.”
In response, BRIDGES launched a “Yes on My Block” campaign, encouraging Baltimore City residents to sign a petition supporting overdose prevention sites. So far, the group has collected 630 signatures, according to Gudlavalleti.
There have also been concerns about condoning drug use. In testimony in 2021, the Maryland Board of Nursing said sites could increase the risk to public safety because health care professionals could legally use the sites and then report to work.
“There has not been any further discussion or public statement from the Board of Nursing,” the board stated in response to a request for comment about the testimony.
At the federal level, the Department of Justice sued operators of a Philadelphia site called Safehouse in 2019 to prevent its operation, citing U.S. drug law. Safehouse officials maintained the law didn’t apply because the site was for “public health initiatives” and encouraged treatment.
Safehouse and the Justice Department are now negotiating, according to media reports. Justice officials did not respond to a request for comment about Safehouse or any potential guidance to allow other U.S. sites.
It’s not clear that a resolution of the Safehouse case would affect other sites, absent a larger regulatory change, but lawmakers are pushing ahead.
State Sen. Shelly Hettleman, a Baltimore County Democrat who intends to sponsor the bill this year, said she’s “cautiously optimistic.” She and Del. Joseline A. Peña-Melnyk, an Anne Arundel Democrat and another sponsor, plan to have in-depth conversations with colleagues in the coming weeks.
“It treats addiction not as a criminal offense, but as a public health issue,” Hettleman said. Overdose prevention sites seem “to be working in New York and I don’t see why they can’t in Maryland.”
Nation’s first overdose prevention sites paving a path for Maryland
In November 2021, OnPoint NYC opened the first two official U.S. overdose prevention sites without permission from federal or state authorities.
Some Baltimore and state officials have visited the East Harlem and Washington Heights centers. The organization says 2,300 people have used the sites more than 55,000 times with 700 overdoses prevented and 1.5 million hazardous items, such as used needles, diverted.
Officials also estimate they saved $20 million in hospital and emergency medical costs. Camlin, of OSI Baltimore, said more was saved on police responses.
In New York, there have been community concerns about a site directly across the street from a school, said Jason Beltre, director of community initiatives at OnPoint NYC, during a panel discussion sponsored by BRIDGES, OSI Baltimore and Maryland Public Television on Jan. 24. He said, however, that OnPoint NYC prevents syringe litter and public drug use near schools and parks.
Jim Muratore, pastor of St. Luke’s Church on The Avenue in Baltimore’s Hampden neighborhood, said his church is willing to host a site.
In 2018, the Lutheran church began hosting a syringe exchange program that now serves about 75 people. Neighbors had expressed concerns that Hampden would become a destination for people who use drugs from around the city, but that didn’t happen, Muratore said.
Muratore has used Narcan four times to reverse overdoses in the church’s bathroom. He said that shows the need to expand services to include a safe consumption space, though he sees “a lot of fear” when he talks to neighbors about that.
“I do think the more we talk about, the more familiar we become with the concept, the more we can witness it in action, that it will grow into an acceptable idea,” he said.