Last week, the United States Department of Justice filed a lawsuit to stop the opening of a safer injection site (SIS) in Philadelphia, claiming it violates the federal Controlled Substances Act. This misguided action not only places the health of people who use drugs at risk, but undermines goals set by the Trump administration to tackle two public health epidemics plaguing the nation – HIV/AIDS and deaths from overdose.
At safer injection sites, staff provide sterile needles and equipment as well as testing for HIV and Hepatitis C, and linkage to drug dependence treatment for those who want it. These facilities operate in 120 countries and more than 100 peer-reviewed studies have shown they reduce transmission of infectious disease, death from overdose, and increase participation in treatment without increasing crime or drug use in a community. The American Medical Association has endorsed a pilot program for SIS, and the Philadelphia facility would be the first to openly operate in the US.
Opposing this proven public health intervention not only undermines the administration’s pledge to address the opioid crisis, but runs counter to another major Trump administration initiative. In last week’s State of the Union address, the president announceda program designed to end the HIV epidemic by 2030 through targeted funding for HIV prevention and treatment. This ambitious goal is to be applauded, though it won’t likely be realized without changes to the administration’s health and civil rights policies that reduce access to health care for those most at risk of, and living with, HIV, including people who use drugs.
Rather than taking legal action against an approach shown to reduce HIV transmission, there are important ways the Department of Justice could combat the overdose and HIV epidemics. Laws that criminalize drugs for personal use result in an arrest every 25 seconds in the US, and Human Rights Watch and others have documented the devastating harms that result to individuals, families, and communities, including driving people away from health services. Law enforcement should support criminal justice reform, as well as programs that contribute to public health and safety such as syringe exchanges and safer injection sites. Unless the nation’s top law enforcement agency becomes part of the solution rather than part of the problem, the Trump administration’s admirable goals to end the opioid and HIV epidemics will never be realized.