What are supervised injection sites, and why are they an issue in Pennsylvania’s U.S. Senate race?

Just two weeks ago, U.S. Senate candidate Mehmet Oz made his most recent visit to Philadelphia’s Kensington neighborhood to talk with residents about drugs and crime.

“If you want help, we’ve got help,” he said to one man, later riding with him and others to Rock Chaplain Ministries, which connects people with detox resources. Oz is a physician who first visited Kensington back in 2017 for an episode of his former daytime TV show in which he filmed a man injecting himself with heroin. He was back in what has been called the epicenter of Philadelphia’s drug crisis earlier this summer as well.

But there’s one kind of help for people in addiction Oz opposes, and he’s using it to attack his Democratic opponent, John Fetterman: supervised injection sites.

Supervised injection sites, where people can bring their drugs to use under medical supervision, don’t exist in Philadelphia despite years of advocacy. Though controversial among many local residents, they’ve proven effective in other countries and have been shown to lower deaths from overdose. Yet Oz labels Fetterman’s support for the sites and other measures aimed at keeping people safe until they are ready for treatment “radical, deadly, and wrong.”

Here’s a primer on supervised injection sites and why they’re an issue in this campaign:

Supervised injection sites, or supervised consumption sites, are spaces where people can use their own drugs under clinical supervision to prevent overdoses. Using drugs by oneself is a leading risk factor for fatal overdose — most overdose deaths in Philadelphia, for example, occur in private homes.

Such sites do not provide drugs to clients; instead, site staff provide sterile needles and other equipment for safer drug use and monitor clients in case they exhibit overdose symptoms.

The sites are controversial in the United States — only two are operating openly, both in New York City — but exist in dozens of countries. No one has ever died in a supervised injection site: Staff at New York City’s sites have reversed hundreds of potentially fatal overdoses since they opened last November.

In 2020, Fetterman tweeted support for efforts to open a supervised injection site in Philadelphia: “Harm reduction reduces harm,” he wrote, linking to a news story about a federal judge’s ruling in favor of the proposed site.

In 2018, FactCheck.org reported, Fetterman said in a podcast interview that, when it comes to battling the overdose crisis, public health leaders and lawmakers should consider all options, including needle exchanges and “even safe injection sites.”

“[You] have to have everything on the table that has a chance of making it better,” he said during the 2018 interview.

In 2015, FactCheck reported, Fetterman told the Nation that he supports decriminalizing drugs — a policy that generally involves removing criminal penalties for possessing small amounts of drugs. Portugal, for example, does not criminally charge anyone caught with a 10-day supply of illicit drugs; the policy has been credited with dramatically reducing overdoses in the country.

Oz references all of this in his latest ad, calling Fetterman’s stances “radical, deadly, and wrong.”

Corey Davis, a lawyer and the director of the Harm Reduction Legal Project at the Network for Public Health Law, a national legal collective, said that Oz’s characterization of supervised injection sites is “at best, misrepresenting the medical literature with which he should be familiar.”

“These sites have been well-researched — all of the research says that they keep people from dying in the moment [from an overdose], which is their main goal,” Davis said.

Safehouse, the nonprofit that has spearheaded efforts to open a site in Philadelphia, has been embroiled in a legal battle over its plans since 2018, when then-U.S. Attorney Bill McSwain sued in federal court to block Safehouse from opening.

McSwain’s case hinged on a 1980s-era federal law colloquially known as the “crack house statute,” which makes it a crime for anyone to operate a facility for the purpose of using illegal drugs. (Then-Sen. Joe Biden was one of the bill’s cosponsors.)

Safehouse countered that the purpose of a supervised injection site is to prevent overdoses, not facilitate drug use. A U.S. District Court judge sided with Safehouse, but the nonprofit lost on appeal and the U.S. Supreme Court declined to hear the case. The nonprofit went back to U.S. District Court on a different legal argument.

Since early 2022, Safehouse and the local U.S. Attorney’s Office have been in talks over the litigation, and the new U.S. attorney, Jacqueline C. Romero, said it’s possible the sides will settle. It’s unclear what form that settlement might take, or how Safehouse would operate if the settlement allows it.

Safehouse representatives declined to comment.

Meanwhile, other states and cities have moved forward with opening or supporting supervised injection sites. New York City, which is in a different judicial district than Philadelphia, opened two sites last year with no pushback from federal officials. Rhode Island’s legislature legalized supervised injection sites in 2021 and is setting up rules for how they operate, Davis said.

Conversely, California Gov. Gavin Newsom vetoed a bill that would have legalized supervised injection sites in the state this April.

“I do think it’s going to happen — it’s going to happen in Rhode Island, it’s just a question of when,” Davis said. “[Efforts in] a lot of other places [that have considered supervised injection sites] have kind of petered out. But if there’s a good ruling and a good settlement in the Safehouse case, maybe that kind of rekindles all of that.”

In Philadelphia, the federal ruling against Safehouse, based on the “crack house statute,” is still a big barrier to opening a site, Davis said. So a Sen. Oz or Fetterman could advocate for its repeal — or reinforcement — based on Pennsylvania’s unique situation in the supervised injection site debate.

Representatives for Oz did not say whether the candidate would pursue further legal action against supervised injection sites. A spokesperson for Fetterman said he supports “comprehensive solutions” to the overdose crisis, including “harm reduction strategies.”

Pennsylvania’s new governor could legalize sites locally. But both gubernatorial candidates in the Pennsylvania race, Democrat Josh Shapiro and Republican Doug Mastriano, have said they oppose the sites.

Staff writers Julia Terruso and Jeremy Roebuck contributed to this article.