Denver supervised drug use site pending as CO struggles with fentanyl
In November 2018, the city council positioned Denver to be on the leading edge of an alternative approach to addressing illicit drug use and the wave of overdose deaths that was — and still is –sweeping the country.
With a 12-1vote, the council approved a framework for creating a government-sanctioned supervised drug use site in the city. Once opened, the pilot site, also known as an overdose prevention center, would allow people to inject heroin and use other drugs under the watch of medical professionals rather than risking an overdose in their home or car or a park or a public restroom.
The only condition was that the state legislature had to pass a law clearing the way for a supervised use facility in the state. Nearly four years later — with more than 1,200 drug-related deaths recorded in Denver over that span, according to medical examiner data — the Colorado General Assembly has not cleared that path. And now the political hurdles, at least within the state’s borders, seem higher than ever.
In the 2022 session, the biggest piece of drug legislation that passed out of the statehouse focused on creating more resources for combating the widespread distribution and use of illicit fentanyl, a synthetic opioid that killed more than 900 people in the state last year.
The Fentanyl Accountability and Prevention bill directs millions of dollars toward expanding the availability of tried-and-true harm reduction tools such as fentanyl testing strips and opioid overdose reversal medications like Narcan. But the bill’s most controversial element is that it also turned possession of at least one gram of the drug or even one gram of a compound containing the drug from a misdemeanor into a felony.
Fentanyl, long a legal opioid used by doctors but now flooding U.S. cities via illegal manufacturing and distribution rings, is often seen in the form of blue pills that users smoke to get high. It is also being passed off as or laced into other drugs like heroin and cocaine, sometimes with tragic consequences for unknowing users.
“I think everybody agrees that we needed help getting pills off the street and so looking at how to do that was kind of where the fentanyl bill went when it came to personal use,” Alec Garnett, Colorado’s term-limited Democratic House speaker and one of the bill’s primary sponsors, said of the harsher criminal penalties.
Garnett emphasized that he feels the most impactful part of the bill will be forthcoming statewide and community-level public education efforts highlighting the dangers of fentanyl, a similar approach to ad campaigns decrying meth use more than a decade ago.
But Colorado had to take action on possession, the outgoing speaker said. Previous laws making anything under 4 grams a misdemeanor were far too lenient for such a dangerous substance.
“Even in the harm reduction world, no one can really justify 4 grams, 40 pills for personal use,” he said.
The Harm Reduction Action Center, is the state’s largest nonprofit public health agency dedicated to working with people who inject and smoke drugs to reduce the spread of communicable diseases and stem the tide of fatal overdoses. Executive director Lisa Raville knows the political will in the state has shifted since the city council’s action in 2018.
“When I tried to bring up (safe use site legislation) this year, (lawmakers) were much more in the camp of incarceration and criminalization of people who use drugs and thinking they can arrest their way out of drug use which they haven’t been able to do in the last 51 years in the war on drugs,” Raville said.
She’s not giving up on bringing a safe use site in Denver, something she says her organization is well positioned to provide if given the opportunity. The center has been operating a needle exchange program since February 2012 and has served more than 12,450 people during that time, saving more than 3,300 lives through overdose prevention efforts, according to statistics plastered on the walls of its facility at 112 E. Eighth Ave..
Safe use sites aren’t just essential amid the worst overdose crises in U.S. history, they’re also inevitable, in Raville’s view. People are already using public places like Union Station and restrooms at Starbucks and King Soopers stores as defacto safe use sites knowing that if they overdose at least people are around who may be able to help them.
“What you have now are 17-year-old baristas being traumatized. They don’t want to clean the bathrooms because they might come across someone overdosing,” Raville said. “I just don’t know how many thousands of people have to die from a preventable overdose before they let us try something different. It’s going to happen.”
New York opens sites, California says ‘no’
The American drug landscape has shifted over the last four years. Overdose deaths have continued to rise at an alarming rate as fentanyl invades the drug supply making it less predictable and more deadly.
The overdose death rate in Colorado nearly doubled from 2018 to 2021, rising to 31.7 deaths per 100,000 residents last year, according to data from the Colorado Department of Public Health and Environment. The overdose rate figures were age adjusted to ensure a more accurate comparison. Fentanyl and methamphetamine were the primary drivers for that spike.
Zooming in on the capital, the Denver Office of the Medical Examiner recorded 472 deaths involving drugs last year. That’s up from 370 such deaths in 2020 and a 128% increase over the 207 drug-related deaths in the city in 2018. More than half of the drug-related death cases in 2021 involved fentanyl, according to the office.
Driven by the rash of deaths, the country got its first sanctioned safe use sites last year, following in the footsteps of Canada, Australia and a dozen countries in Europe.
Two supervised drug-use sites opened in New York City at the end of November. The city saw a record 2,062 overdose deaths in 2020, according to a report on the two sites published in July.
Authored by researchers from the New York Department of Health and Mental Hygiene and OnPoint NYC, the organization tapped to operate the sites, the report found both locations saw heavy traffic during their first two months in operation. During that time, 613 people used the sites a combined 5,975 times. Most visitors injected heroin or fentanyl. Roughly 76% of participants said they likely would have used those drugs in a public or semi-public location had they not had access to the centers.
Staff members responded to potential overdoses 125 times during the 2-month span. On 19 occasions, they administered naloxone, the generic name for Narcan. No one died of an overdose in one of the centers.
In California, Gov. Gavin Newsom vetoed a bill last month that would have allowed sanctioned drug injection sites in Los Angeles, Oakland and San Francisco. Newsom said he isn’t outright opposed to the concept but wanted stricter limits on the sites and a “strong plan” to make sure they are serving their intended purpose, according to the Associated Press.
Roughly 130 sanctioned safe use sites now operate around the world. Some have been allowing people to come in and use their pre-obtained drugs for more than 20 years, said Beau Kilmer, a director with the RAND Drug Policy Research Center.
“There have been millions of injections at supervised consumption sites globally and there have been thousands of overdoes at them that have been addressed,” Kilmer said. “And I’m not aware of anyone who has died of a drug overdose at one of these brick-and-mortar facilities.”
Kilmer and his colleagues have reviewed dozens of studies into the impact of the sites, not just on participants but also on the surrounding communities. The findings are mixed. Some research has found the centers did not have an effect on the mortality rates in the broader community while other papers link the sites to a drop in overdose deaths in surrounding neighborhoods.
The impacts observed in other countries may not translate well to the U.S., Kilmer warned. Many of the countries that already have the facilities also have better healthcare and transportation infrastructure to link people to services.
Last year, the National Institute on Drug Abuse, a wing of the National Institutes of Health, issued a report in which officials wrote that “given the amount and quality of the existing data, it may be prudent to consider the American Medical Association’s recommendation of developing and implementing (overdose prevention center) pilot programs in the United States” for the sake of gathering more locally relevant data.
The fact that a federal agency would issue that opinion while safe use sites are still illegal is a remarkable step, Kilmer said. This spring, the U.S. Department of Justice signaled it may allow sites to operate with “appropriate guardrails.”
Kilmer estimated that 7,000 safe use sites are needed to accommodate every injection of illicit drugs in the U.S. on a daily basis. That’s not going to happen in the foreseeable future but until more sites are opened and studied, the role they can play in addressing the overdose crisis won’t be fully known, he said.
Polis opposes safe use sites
Even with a nod from federal officials, resistance to the concept in Denver remains strong.
In early August, Terry Hildebrandt, a regular speaker at Denver City Council meetings who advocates for stricter enforcement of drug and urban camping laws through his group Citizens for a Safe & Clean Denver, emailed a list of demands to leaders including Mayor Michael Hancock and Gov. Jared Polis.
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One of his bullet points was the repeal of the 2018 ordinance that opens Denver up for a safe use site with state approval. Hildebrandt wants the concept banned outright in Colorado.
“You don’t fight drug addiction by making it easy for addicts to do drugs,” he wrote in the email.
Hildebrandt may have found a sympathetic ear in the governor’s office. When asked if he would support a safe use site opening in Denver, a spokesman for Polis replied, “The Governor is not open to this and is focused on getting people help for substance use disorders and ensuring that the scourge of fentanyl ends.
“The Governor was proud to sign legislation this session to crack down on dealers and drug rings while improving access to addiction recovery so people can end their addictions to this dangerous poison,” the spokesman said.
Longtime critics and potential new supporters
A new city council has been seated since the 2018 ordinance passed and another new council will be elected next spring in Denver. Among the members that share the dais today, there is disagreement about the value of safe use sites.
District 2 Councilman Kevin Flynn was the lone no vote on the bill four years ago. He’d vote no again, he said. Flynn believes resources are better spent sending naloxone to family members of people who use drugs and business owners in areas where drug use is common so that the supplies are close at hand.
“The fact is most overdose deaths are occurring out in the community, or in private homes, in businesses, and that’s where the antidote needs to go,” Flynn said.
Chris Hinds, whose Council District 10 includes the Harm Reduction Action Center, sponsored a proclamation on Monday recognizing Overdose Awareness Day in Denver. He was among a handful of elected officials and candidates who attended an Overdose Awareness Day event at the center on Wednesday afternoon. He said the action center has been a great neighbor in his district. The organization stays engaged with other neighborhood organizations and its volunteers and staff do weekly litter cleanups.
“If we engage the people and the people say they want it, then I think D10 is a great place for safe use site,” Hinds said. “Again, if the people say they want it.”
Shannon Hoffman, who is running against Hinds in the 2023 city election, also attended the event and said she supports safe use sites.
Heidi Ganahl, the Republican candidate seeking to unseat Polis this fall, toured the Harm Reduction Action Center with Raville on Wednesday. Her tour included visiting the organization’s model safe use booth, complete with syringes and a safe disposal box. Through an aide, Ganahl declined to be interviewed before leaving the event.
The safe use site concept may add at least one new ally after November, but if Republicans take back the state senate, that might not matter much. A 2019 version of the bill that would have allowed the sites was shelved to avoid giving conservatives a talking point.
Democratic State Sen. Julie Gonzales represents west Denver and a portion of downtown and is running for re-election in District 34. She voted no on the fentanyl bill because she felt the public health perspective was discounted too much in favor of a more punitive approach. Asked if she would support safe use site legislation, she said she is “in listening mode” on the subject.
The concept may have an incoming champion. Elisabeth Epps won the state’s most expensive primary race in June when she beat out more centrist Democrat Katie March for the nomination for House District 6. Epps is almost a shoo-in to be elected in the state’s most heavily Democratic district.
A leftist who advocates for the abolition of the American criminal justice system as constructed, Epps said she would be in favor of lifting nuisance restrictions statewide that prevent safe use sites from opening.
“As a matter of policy, we must love our neighbors enough to help them stay alive long enough to get the help they need,” Epps said.
Harm reduction and hardline approach don’t mix
Even if a safe use measure were to pass through the legislature next session, some service providers worry about the effects the fentanyl bill might have.
Dr. Sarah Axelrath, a primary care and addiction medicine specialist with the Colorado Coalition for the Homeless, worries that people who use drugs would avoid coming to a supervised use site out of fear of being charged with a felony for carrying a user’s amount of fentanyl.
Illicit fentanyl is a bad street drug, Axelrath said. Pills are often either too weak or too strong. The high is fleeting and the withdrawals are brutal. Some of the people she works with smoke 40 pills a day.
“How do you do harm reduction and still be tough on crime? I think they shot themselves in the foot to an extent,” Axelrath said of state leaders.
She warned that even more potent synthetic drugs are starting to pop up in other cities. A crackdown on fentanyl may just open the door for something worse. It’s known as the iron law of prohibition.
At Wednesday’s Overdose Awareness Day event, Harm Reduction Action Center board member Joelle Fairchild stood near the organization’s memorial wall. There, among more than a hundred faces of people lost to overdoses, was a picture of her son, Tony Fairchild. He died in 2014 at the age of 27 from a heroin overdose. He had recently been released from jail and his tolerance was low, a common contributor to fatal overdoses. His body was found leaning against a tree on the Creek Creek Trail near downtown.
She only found out after his death that Tony had been a participant in the action center’s needle exchange program. She wonders how things may have been different if he also had access to a supervised use site.
“If he was in a safe facility and someone was there when he overdosed maybe he would still be here telling his story instead of me,” she said.
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