Case 2:19-cv-00519-GAM Document 1 Filed 02/05/19 Page 1 of 8 IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA UNITED STATES OF AMERICA, Plaintiff, v. SAFEHOUSE, a Pennsylvania nonprofit corporation; JEANETTE BOWLES, as Executive Director of Safehouse; Defendants. : : : : : : : : : : : : Civil Action No. __________ COMPLAINT FOR DECLARATORY JUDGMENT While our country is in the midst of an opioid epidemic, this is not the first time we have faced a drug crisis. From crack cocaine, to methamphetamine, to heroin and fentanyl, our country has faced the challenge and tragedy of drug addiction for many years. Congress and the President have sought to address the challenges of drug addiction, abuse, and diversion with the Controlled Substances Act (“CSA”), enacted in 1970. The CSA established a comprehensive and carefully balanced regulatory scheme that has been updated and revised over time, but remains in full force and effect. Among other things, the CSA created a tiered structure of controlled substances based on their risk of abuse and medical purpose; controlled the flow of these substances from their manufacture through the distribution chain; established important record-keeping requirements; determined which substances were illegal without an administrative application and waiver; and established a comprehensive scheme for the treatment of those afflicted with substance use disorder through narcotic treatment programs. Case 2:19-cv-00519-GAM Document 1 Filed 02/05/19 Page 2 of 8 The legislation’s calculated scheme includes the prohibition of certain conduct involving controlled substances. Most relevant to the suit at hand, the CSA provides that it is wholly unlawful to manage or control any place, regardless of compensation, for the purpose of unlawfully using a controlled substance. Defendant Safehouse seeks to disregard the law and override Congress’ carefully balanced regulatory scheme by establishing, managing, and controlling sites in Philadelphia that will allow individuals to engage in the illicit use of controlled substances, namely, heroin and fentanyl. For purposes of this action, it does not matter that Safehouse claims good intentions in fighting the opioid epidemic. What matters is that Congress has already determined that Safehouse’s conduct is prohibited by federal law, without any relevant exception. To prevent Safehouse from violating federal law, the United States asks the Court to declare illegal the Defendants’ proposed establishment and operation of a place for the unlawful use of controlled substances. Plaintiff, the United States of America, by and through its attorneys, alleges as follows: 1. This is a civil action seeking declaratory judgment under the Declaratory Judgment Act, as amended, 28 U.S.C. § 2201, and under the Controlled Substances Act, as amended, 21 U.S.C. §§ 801 et seq., and its implementing regulations, 21 C.F.R. §§ 1301 et seq. JURISDICTION AND VENUE 2. This Court has jurisdiction over this action pursuant to 21 U.S.C. §§ 856(e), 843(f), and 28 U.S.C. §§ 1331, 1345. 3. Venue is proper in the Eastern District of Pennsylvania pursuant to 21 U.S.C. § 843(f)(2) and 28 U.S.C. § 1391(b). 2 Case 2:19-cv-00519-GAM Document 1 Filed 02/05/19 Page 3 of 8 PARTIES 4. Plaintiff is the United States of America. 5. Defendant Safehouse is a privately held Pennsylvania nonprofit corporation located at 1211 Chestnut Street, Suite 600, in Philadelphia, Pennsylvania. Safehouse was formed in or around August of 2018. 6. Safehouse seeks to establish and operate one or more sites in Philadelphia where, among other things, intravenous drug users will be permitted to use illegal controlled substances (primarily, heroin and fentanyl) in “consumption rooms” under medical supervision (hereinafter, “Consumption Room(s)”). 7. Defendant Jeanette Bowles is the Executive Director of Safehouse. FACTUAL ALLEGATIONS 8. Existing nonprofit community organizations, such as Prevention Point Philadelphia, provide a wide range of medical and non-medical services intended to reduce the harms of the opioid crisis in Philadelphia. These services include, but are not limited to, access to addiction treatment, wound care, clean needle exchange, social services, testing, free distribution of the opioid overdose reversal medication Naloxone (Narcan), and training on how to administer Naloxone. 9. Safehouse states on its website that its mission is “sav[ing] lives by providing a range of overdose prevention services” in Philadelphia, including “[m]edically supervised safe consumption and post-consumption observation.” (See Safehouse FAQ, attached hereto as Exhibit A). 10. Safehouse further states on its website that, upon arrival at “Safehouse facilities,” drug users – called “participants” – who seek supervised consumption will be directed to a 3 Case 2:19-cv-00519-GAM Document 1 Filed 02/05/19 Page 4 of 8 Consumption Room where they will be provided with syringes and related paraphernalia by Safehouse staff, who will observe them while they prepare and inject illegal narcotics within the Safehouse Consumption Room. (Id.). 11. “[P]articipants” will then be sent to an “observation room,” where they will be “offered on-site initiation of Medication Assisted Treatment (MAT), wound care, and referrals to primary care, social services, and housing opportunities.” (Id.). Safehouse states that it will “provide overdose reversal and other emergency care” and “advise on sterile injection technique,” but its staff will not “administer any narcotic or opioid,” nor will they make any such drug available “other than those that are FDA-approved for the treatment of opioid addiction[.]” (Id.). 12. Heroin and fentanyl are controlled substances. 21 U.S.C. § 812; 21 C.F.R. §§ 1308.11, 1308.12. Heroin is a Schedule I substance, and fentanyl is a Schedule II substance. 21 U.S.C. § 812(c) (“Schedule I” at (b)(10); “Schedule II” at (b)(6)). 13. Knowing or intentional possession of Schedule I or II substances such as heroin or fentanyl, without satisfying certain exceptions that do not apply to Safehouse participants, violates federal law. 21 U.S.C. § 844(a). 14. The Controlled Substances Act, 21 U.S.C. §§ 801-971, provides, in pertinent part, that: it shall be unlawful to . . . manage or control any place, whether permanently or temporarily, either as an owner, lessee, agent, employee, occupant, or mortgagee, and knowingly and intentionally rent, lease, profit from, or make available for use, with or without compensation, the place for the purpose of unlawfully manufacturing, storing, distributing, or using a controlled substance. 21 U.S.C. § 856(a), (a)(2). 4 Case 2:19-cv-00519-GAM Document 1 Filed 02/05/19 Page 5 of 8 15. Section 856(a)(2) applies to any person who “manage[s] or control[s] any place” that they “knowingly and intentionally . . . make available for use, with or without compensation . . . for the purpose of unlawfully . . . using a controlled substance.” Defendants’ operation of Consumption Rooms would do exactly that. 16. Therefore, Defendants will violate section 856(a)(2) of Title 21 if they open a Consumption Room. 17. Defendants have publically stated their position that the operation of such a Consumption Room would not violate federal law and that they intend to open one or more Consumption Rooms notwithstanding section 856 of Title 21 of the United States Code. (See Exhibit A). 18. By a letter to Safehouse’s President and Vice President dated November 9, 2018, the United States Attorney for the Eastern District of Pennsylvania, William M. McSwain, advised Safehouse that its planned operation of one or more Consumption Rooms would clearly violate federal law. (See Nov. 9, 2018, letter, attached hereto as Exhibit B). The government requested assurance that Safehouse would comply with federal law, and advised that the government would pursue appropriate legal remedies should Safehouse fail to ensure its compliance. Id. 19. By letter dated November 26, 2018, Safehouse’s President and Vice President advised the government that Safehouse would not comply, asserting, “[w]e respectfully disagree with the conclusion that Safehouse’s proposed consumption room would violate federal law.” (See Nov. 26, 2018, letter, attached hereto as Exhibit C, at 1). 5 Case 2:19-cv-00519-GAM Document 1 Filed 02/05/19 Page 6 of 8 20. On or about December 24, 2018, Safehouse announced that it had retained DLA Piper to represent it in potential litigation against the United States regarding Safehouse’s legality. 21. In or around January 2019, Safehouse hired Defendant Jeanette Bowles as its Executive Director. 22. Upon information and belief, Defendants will imminently open one or more Consumption Rooms in Philadelphia. Defendants’ initial plan was to be operational by January 2019, although they may have recently pushed back the opening to March 2019. 1 COUNT I Violation of the Controlled Substances Act, 21 U.S.C. § 856(a)(2) – Declaratory Judgment 23. The United States repeats and re-alleges Paragraphs 1 through 22 as if fully set forth herein. 24. Pursuant to 21 U.S.C. § 856(a) and (a)(2), “it shall be unlawful to . . . manage or control any place . . . and knowingly and intentionally . . . make available for use, with or without compensation, the place for the purpose of unlawfully . . . using a controlled substance.” 25. Defendants intend to manage and control one or more Consumption Rooms in Philadelphia and they will knowingly and intentionally provide a place for drug users to use controlled substances unlawfully, such as heroin and fentanyl. 26. Accordingly, Defendants imminently will violate 21 U.S.C. § 856(a)(2). 1 Colleen Slevin, Denver is latest city pushing for 1st US drug injection site (Nov. 28, 2018), https://www.apnews.com/86a3aca99f72489082fcfa7ff0ab3a83 (“A private nonprofit is raising money for a supervised injection site in Philadelphia but has pushed back its potential opening date from January to mid-March, the group Safehouse said.”). 6 Case 2:19-cv-00519-GAM Document 1 Filed 02/05/19 Page 7 of 8 27. Pursuant to 21 U.S.C. § 856(e), “[a]ny person who violates subsection (a) of this section shall be subject to declaratory and injunctive remedies as set forth in section 843(f) of this title.” 28. Section 843(f), provides, in turn, that “the Attorney General is authorized to commence a civil action for appropriate declaratory or injunctive relief relating to . . . [section] 856 of this title.” 21 U.S.C. § 843(f)(1). 29. Under 28 U.S.C. § 2201(a), “[i]n a case of actual controversy within its jurisdiction . . . any court of the United States, upon the filing of an appropriate pleading, may declare the rights and other legal relations of any interested party seeking such declaration, whether or not further relief is or could be sought.” 30. Declaratory relief is especially appropriate where illegal conduct is imminent. 31. The United States is accordingly entitled to appropriate declaratory relief through this civil action pursuant to 21 U.S.C. § 843(f) and 28 U.S.C. § 2201, stating that Defendants’ establishment and operation of any Consumption Rooms will violate section 856 of Title 21 of the United States Code. 7 Case 2:19-cv-00519-GAM Document 1 Filed 02/05/19 Page 8 of 8 PRAYER FOR RELIEF WHEREFORE, the United States respectfully requests that judgrnent be entered in its favor and against Defendants declaring that Defendants' establishment and operation ofany Consumption Room, or similar sites made available for the unlawful use of controlled substances, will violate 2l U.S.C. $ 856(a)(2). Respectfully submitted, Dated: February 5, 2019 JOSEPH H. HI.JNT Assistant Attomey General Civil Division 4,h.,*'4/L il42- '-/ WILLIAM M. McSWAIN JAMES M. BURNIIAM Deputy Assistant Attomey General Civil Division United States Attomey GUSTAV W. EYLER Acting Director AVID Assistant United States Attomey Consumer Protection Branch Chiel Civil Division JAMES J. GILLIGAN Acting Director Federal Programs Branch T. ANDREWE. CLARK BRYAN C. HUGHES ERIN E. LINDGREN Assistant United States Attomeys Eastem District of Pennsylvania Assistant Director Consumer Protection Branch JACQUELINE COLEMAN SNEAD Assistant Director 615 Chestnut Street, Suite 1250 Philadelphia, P A 19106-447 6 TEL: (215) 861-8200 Federal Programs Branch DANIEL K. CRANE-HIRSCH Trial Attomey Counsel Consumer Protection Branch TAMRAT. MOORE Senior Counsel Federal Programs Branch Co-Counsel for the United OW D. States 8 for the Uniled States rs44 (R4 Case 2:19-cv-00519-GAM Document 1-1 Filed 02/05/19 Page 1 of 3 06,17) cryIL COVER SHEET The ci!il cover sheet and the information contained herein nerther replace nor supplement the filing and servic! of pleadings or other papers as req ired b! lar\ - except provided by local rules ofcoun This fonrl approved by the Judicial Conterenc.€ ofthe United States in Seplember 1974. is required for lhe use ofthe C crk f.C oun for the JS ,+4 as DurDoseofinirialingrhecivildockersheet.4;t}1'.s7R{/(zo.\'.so:\Ir-t7I,AGEo1.lHlstoRM) l. (e) ' ' PLAINTIFFS DEFEINDANTS L-nit€d Stites ofAmerice (b) County of Residence of First Lisred SAFEEOUSD, r Penncylvanir Corlnr.rtion; Jernclte Dowles, hec. Dirertor of Srfehooce Plaintiff Phitrdehhir (I:X(' EPT IN U.S. P LU MI I:I; Count) ofResidence ofFirst Listed CASI, NOTE: (C) Anome\s ,rr-, \7oh'. ]JJR$. anJ t(h'phnh -\tun,hlh O O u.s. covemmeflr Plainlitr 2 3 O 1 onbt PTF DEF ofThis State Ol O I fi:or Dtwtsil]t C6es Go ennent N.,t a Porly) Citizen Dversity Citiz.o ofAnoiher (lndicote <-tuzenship of Padies in lten DefcDdant (lfKnd / CITIZENSHIP OF PRINCIPAL PARTIES fl,."ax r" n(heBo'fotflontt Federrl Q{.slion lU-S- US Govnlrn.ni III. III) stare Cid?ri or Subj€d ofa IV. NATURE OF SUIT otoe ot -.Y honc Boxth T( O I l0 Inslrance n D O U 120 O O 130 140 NeSotiabl€ Instrumenl O l5l Medicare Acl O 152 Recovdy of Maull.d O O O at tl tl O O O 320 Assadr- Libel Ovlrpaym.nl of veter-d 's acncfiB 160 Sto.kholdec' Surrs 190 Other Contract 195 Contract Product 196 Fl" 210 120 230 240 245 290 & Sled6 O 310 Fedeml Employers' O O 340 Mnine 145 Manne Producl Liability chise O O Tons ro Lad Ton Product Liability All OrhsRe:l Prop€ny d 362 O O IrJury - 625 Drug Relared Seizure of Properry 21 UsC 881 690 Crher O O O 380 Ofter Personal Property Damage 385 Eopeiy Danage a, O 720 Labor/Mmagemetrt Relanons 740 Railway Labor Act 75 I Fanily and Medical o 6 36 Fo.eisr N.,rion 422 ApFal28 USC 158 421 Wilhdrawal 28 USC t57 Hrb..! Corp$r O O al 463 Alicn Daaine. 510 Moiiods ro Vacare 790 other Labor Lilrgaton 791 Employee Rettemeor Inme S€turir_ Act Emplo)mE! O 446 Arner. VDisabilitics - O 448 Edu.ation Oiher O O O O Olt!i; 540 M.mdanus d 4lOAnrihn O O O 430 Barks .nd Barking 450 ConDcrce 830 Pacnt - Atb.eviared 835 N"w Drug Aplicatiot Pat 840 862 Bleck LuDs (923) 863 DlwCEIww (4{5(s) 864 SSID Titte XVI 865 RsI (405(9)) O O Corrupl Ors,arizalions 480 Coosuncr C.edit 490 Cablo"Sa TV O SSosedriries/CoEnoditiee X890 O O Ff,DERAI, T.\-X SUITS O t70 Tax6 (U.S. Plaintiff or Defendart) D.potution Ra.k t€€r lofluenc€d a'd ,{60 .r?0 Tradcmat 86t HIA (r395ff) $aI. a, Exchange Olher $alulory Achons 891 Agricukural Acis 893 EnvirorrDcrral Mare! 895 Frc.dom of hfomation d8 Arbirarion O t99 AdminisfEriv€ Proc.dure AclReview o. Aped of I]It}IICRATIO\ O O 312e(z)) Reapponion nent PROP'RTY Ri(.]FTS O & otter 176 Qua Tatn (31 USC 820 CopFights O t7l IRS-Third Pnty O 530 Gemrrl O 535IM Penalty 175 Fals€ Claims Acr 400 O O O d 26lJSC ?509 AccoImodadons O ,145 AEer. *[tsabiliiics - s. O o o O O C, 442 Empiolm€l t Ho$ing O Farr Labor Slardards o 5 -5 Incorporrred ordPrincipal Place ofBusin€rs Itr Anothcr State XI'ITfiXETEEIIT I,AB{)R PTF DEF d4 E4 Place lncorporated or Principal ofBusiness In This Stat€ AA\KRI'PT'I' O 368 Asb€sros Personal and one t o\ Jor Defenlta,'0 Click here for: Nature ofsuit Code Descri O O PRISO\ER ?f,TITIO\S O 441 O al ProdEt Liability O 441 Voaing O INJIRI' 365 PersoMl lnjur-v Product Liability 367 Heallh Cae/ Pharmaceulical Personal Injury PERSONAI PROPf,RT}' O 370 olh€r Frud O 710 O 371 Truth in L.nding l'{edical l,ralpractic. CIYTI- RI(;HTS O 4a0 olher Civil Rights Lad Cood€nnaiion FoElo$lrE Reit l.ense & Ejeqrnart O 3 Liabilit! d Injury O3 Injury Producr 350 Molor Vehicle 155 Molor Vehicle Product Liability 360 Other Persoral P€rsd O 2 Produd Liabilit) O Liab'liry 153 Recovery of I O O Liabilirr- Stud.{r Lo3trs (Exclu&s vdcrans) at O Liability 150 Recovery of Overpaymeni & Enforcsefl t of Jud8xnenl Pf,RSONAL O 310 Airplrne 315 Anphne Producl O2 IiaTIirfiIIilrrIS rII TS PERSONAL INJUR'T' M*ine MillerAcI qllaEEll!- CASI'S ONLL IN LAND CONDEMNATION CASES. USE THE LOCATION OF TTIE TRACT OF LAND INVOLVED, Attofiteys Unikd Strtes Atfortre/s Offic€ 615 Cheshut Street #125O Phil.d€Iphi+ PA lerOo 2r&E6r€2()() ll. BASIS OF JURISDICTION ar,-", ") n(n. Borontt/ X Defenda IN II,S PI".IINTIFF Agency D..inoE 950 Constitutio0atity SlaG 9atutcs of 462 Nairnlizalion Application 465 Olher lmnisrarion J50 Civil tushts 555 PrisoB Condition 5m Civil Delaft€ Coodihons of Coofinement V. ORIGIN r2"." - .:' n one Box ontr) o 2 Rernoved fiom * otie-"I Proceedine Stete Court O3 O4 Rcmandcd fiom Appeuate Coun you arc VI. CAUSE OF ACTION VII. REQUESTED IN O 6 Mulridismcr Litigation - O Transfer t MultidisEio Litigation - Direct File tng ofcause 0 COMPLAINT: VIII. RELATED CASE(S) IF ANY DATE relief cnscr rr tms ts A cr-Ass AcrroN AMOUNT DE\I.{\D CHECK YES only ifdemanded in complainl: S UNDER RULE 23. F.R.CV.P. J J[!RY DEMA:\-I,: O Yes DOCKET NUMBER L:DCE ATT]RE OF ATTORNEY Febmory5,2ole RECEIPT b or O 5 Transfened from Reopened Arolher Disrict Reinstated APPLYING IFP ORD JUDCE MAG, JUDCE Xuo Gr\ v, . . c;-1 1 Case 2:19-cv-00519-GAM Document 1-1 Filed 02/05/19 Page 2 of 3 l.iNITEDSTATESDISTRICTCOt:RT Mf\J..... FOR THE EASTERN DISTRICT OF PEl'JNSYLVANIA DESIGNATION FORM (to be used by counsel or prose plamttff to tnd1cate the category of the case for the purpose of assignment to the appropriate calendar) U.S. Attorney's Office, 615 Chestnut Street, Suite 1250, Philadelphia, PA 19106 Address of Plaintiff: - - 1211 Chestnut Street, Suite 600, Philadelphia, Pennsylvania Address of Defendant: Place of Accident, Incident or Transaction: RELATED CASE, IF ANY: n/a Date Termmated Judge Case NumbeL Civil cases are deemed related when Yes 1s answered to any of the following quest10ns ls this case related to property mcluded man earlier numbered sutt pendmg or w1thm one year prevtously termmated action m this court? YesD No[{] 2 Does this case mvolve the same issue of fact or grow out of the same transaction as a pnor sutt pending or w1thm one year previously termmated action in this court9 YesD No[{] 3 Does this case involve the vahd1ty or mfrmgement of a patent already m sutt or any earlier numbered case pending or withm one year prev10usly termmated actton ofth1s court? YesO No[{] 4 ls this case a second or successive habeas corpus, social secunty appeal, or pro se c1V1! nghts case filed by the same md1v1duaJ? YesD No[{] I certify that, to my knowledge, the within case this court except as noted above DATE related to any case now pendmg or within one year previously terminated actton m February 5, 2019 Attorney ID #(if applicable) CIVIL: (Place a '1 in one category only) A. Federal Question Cases: B. 01 0 2 O 3 lndemmty Contract, Marme Contract, and All Other Contracts FELA Jones Act-Personal Injury Antitrust Patent Labor-Management Relations Civil Rights Habeas Corpus Secunties Act(s) Cases Social Security Review Cases All other Federal Question Cases 01 0 2 O 3. O 4 B 0 7 O s -"9\0 7 1 \ (Please specify) 21 2a use Diversity Jurisdiction Cases: 0 4 O 6 O 5. 0 7 0 s 0 9 Insurance Contract and Other Contracts Airplane Personal Injury Assault, Defamatton Marme Personal Injury Motor Vehicle Personal Injury Other Personal Injury (Please specify) Products Lmb1lity Products Lmbihty - Asbestos All other D1vers1ty Cases (Please specify) USC 1331, 1345 1 ARBITRATION CERTIFICATION (The effect of this certification 1s to remove the case from ehg1b1hty for arbitration) I, .__G_r_e_g_o_ry_B_._D_a_v_i_d___ counsel of record or pro se plamttff, do hereby certify rsuant to Local ClVll Rule 53 2, § 3(c) (2), that to the best of my knowledge and behef, the damages recoverable in this c1v1I action case ex eed the sum of$150,000 00 exclusive ofmterest and costs. x DATE 1ef other than monetary damages ts sought. 02/05/2019 Attorney ID J\iOTE A tnal de novo will be a tnal by JUI)' only 1f there has been compltance with r RC P 38 C"' 609 (5, 2018J FEB -5 201s # (if applicable) Case 2:19-cv-00519-GAM Document 1-1 Filed 02/05/19 Page 3 of 3 IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA CASE MANAGEMENT TRACK DESIGNATION FORM United States of America CIVILACTION NO. SAFEHOUSE, a Pennsylvania nonprofit corporation; : Jeanette Bowles, as Executive Director of Safehouse : In accordance with the Civil Justice Expense and Delay Reduction Plan of this court, counsel for plaintiff shall complete a Case Management Track Designation Form in all civil cases at the time of filing the complaint and serve a copy on all defendants. (See $ 1 :03 ofthe plan set forth on the reverse side of this form.) In the event that a defendant does not agree with the ptaintiff regarding said designation, that defendant shall, with its first appearance, submit to the clerk ofcourt and serve on the plaintiff and all other parties, a Case Management Track Designation Form speciffing the track to which that defendant believes the case should be assigned. SELECT ONE OF THE FOLLOWING CASE MANAGEMENT TRACKS: (a) Habeas Corpus - () Cases brought under 28 U.S.C. $ 2241 through $ 2255. Cases requesting review ofa decision of the Secretary of Health and Human Services denying plaintiff Social Security Benefits. (b) Social Security (c) Arbitration - Cases required to be designated for arbitration under Local Civil Rule 53.2. (d) Asbestos - Cases involving claims for personal injury or property damage from exposure to asbestos. - Cases that do not fall into tracks (a) through (d) that are commonly referred to as complex and that need special or intense management by the court. (See reverse side ofthis form for a detailed explanation ofspecial management cases.) () () () (e) Special Management (f) Standard Management February 5,2019 Date 215-861-&521 lelephone (( ir. 660) l0/02 - Cases that do not fall into any one of the other tracks. Gregory B. David, AUSA Attorney-atJaw (215) 861-8618 FAX Number United States of America Attorney for gregory.david@usdoj. gov E-Mail Address () (4 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 1 of Page 24 Asked Frequently Case Questions I Safehouse 1of24 FREQUENTLY ASKED QUESTIONS "studies from other countries have shown that [overdose prevention services] reduce the number of overdose deaths, reduce transmission rates of infectious disease, and increase the number of individuals initiating treatment for substance use disorders without increasing drug trafficking or crime in the areas where the facilities are located."tll -American Medical Association https ://www. safehousephil ly.org/about/faqs 21412019 Page 2 of 24 FrequentlyCase Asked Questions I Safehouse 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 2 of 24 "We cannot just watch as our children, our parents, our brothers, and our sisters die of drug overdose ... We have to use every proven toolwe can to save their lives until they recover from the grip of sd6li6fisn."tzl -Dr. Thomas Farley, Philadelphia Health Commissioner FREQUENTLY ASKED QUESTIONS: . What are overdose prevention services? . Why do we need overdose prevention services? . What are the benefits of overdose prevention services? . . What is Safehouse? . What will be the rules of conduct for Safehouse participants? . Who will work at Safehouse? . Do other jurisdictions offer supervised consumption rooms as part of What can participants expect when they come to Safehouse? overdose prevention services? . . Does supervised consumption save lives? Do people who use supervised consumption sites seek treatment? . Do supervised . consumption sites encourage drug use? Do supervised consumption sites increase neighborhood crime? https ://www. safehousephil ly.org/about/faqs 21412019 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 3 of Page 24 3 of 24 Asked Frequently Case Questions I Safehouse . What are the benefits to the community? . Does the law allow overdose prevention services like those provided by Safehouse? . Will Safehouse seek a partnership with law enforcement? . Willdata be collected at Safehouse? . How can I financially support the efforts of Safehouse? WHAT ARE OVERDOSE PREVENTION SERVICES? Overdose prevention services are part of a broader harm-reduction strategy. Harm reduction in substance use treatment is aimed at decreasing the negative consequences of substance use, and it includes elements of safer use, managed use, and medication-supported treatment plans. Harm reduction is designed to address the circumstances of the addiction in addition to the addiction itself, striving to minimize the harmful effects of addiction while recognizing that drug addiction cannot be completely eliminated. current leading scholarship establishes that a demonstrably effective approach to combating substance use disorder is to encourage treatment while providing harm reduction.t3l Overdose prevention services are designed to reduce harms associated with drug use by carrying out the following activities: . Assessment of participant's physical and behavioral . health status Provision of sterile consumption equipment. . Provision of drug testing, such as fentanyl https ://www. safehousephilly. orglabouVfaqs test strips. 214/2019 Page 4 of 24 Asked FrequentlyCase 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 4 of 24 Questions I Safehouse . Medically supervised safe consumption and post-consumption observation. . Overdose reversal. . Wound care, other basic medical services, and referral for more complex medical care. . On-site education and counseling about substance use treatment. . On-site initiation of medication assisted treatment (MAT) and recovery counseling. . Access to a resource specialist for referrals to supporting services including housing opportunities, public benefits, and legal services. . Safe disposal of consumption equipment. . Distribution of naloxone and other opioid overdose antidotes approved by the U.S. Food and Drug Administration. WHY DO WE NEED OVERDOSE PREVENTION SERVICES? Philadelphia is experiencing an overdose crisis of unprecedented proportion. ln 2015, the city's rate of 46.8 drug overdose deaths per 100,000 residents dramatically outpaced those of Chicago (11.8) and New York 2017, the 1,217 overdose deaths in Philadelphia t6l (13.7).141, tsl In represented a 34 percent increase from 907 in 2016.t71 Since 2009, overdose deaths in the city have risen by nearly 200 percent.lsl Philadelphia has not had a public health crisis of this magnitude in more than 100 years.tsl Across all racial and ethnic groups, more people have died from drug overdose than from homicide.llol, [1 1] https ://www. safehousephi I ly.org/about/faqs 21412019 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 5 of 24 Page 5 of 24 Asked FrequentlyCase Questions I Safehouse This crisis led the Mayor's Task Force to Combat the Opioid Epidemic in Philadelphia to recommend that the city further explore implementing overdose prevention services and expand treatment access and capacity. Overdose prevention services have a long record of success in reducing harms of injecting heroin and other opioids.ttzl WHAT ARE THE BENEFITS OF OVERDOSE PREVENTION SERVICES? Overdose prevention services are part of a multifaceted public health approach to combating the opioid crisis. Extensive research has demonstrated the benefits of overdose prevention services for people who use drugs and the communities where drug use Overdose prevention services . occurs.tl3l'1141'1151'1161 : Save lives by reducing the number of fatal drug overdoses through education on safer use practices, overdose prevention, and intervention. . Reduce the spread of infectious diseases such as HIV and hepatitis C among people who use drugs by providing sterile consumption supplies. . Connect people who use drugs with other health, treatment, and social services. . Create a safer community by reducing drug use in public spaces and publicly discarded paraphernalia. https ://www. safehousephilly. org/about/faqs 21412019 Page 6 of24 Asked FrequentlyCase 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 6 of 24 Questions I Safehouse WHAT IS SAFEHOUSE? Safehouse is a privately funded Pennsylvania nonprofit corporation whose mission is to save lives by providing a range of overdose prevention se rvtces The leaders and organizers of Safehouse are motivated by the JudeoChristian beliefs ingrained in us from our religious schooling, our devout families and our practices of worship. At the core of our faith is the principle that preservation of human life overrides any other considerations. Safehouse is working with community partners to find a suitable location(s) to deliver those services. Safehouse's Board of Directors: President and Treasurer Jose A. Benitez, MSW Executive Director, Prevention Point Philadelphia (http://ppponline.org/) Vice President and Secretary Ronda B. Goldfein, Esq. Executive Director, AIDS Law Project of Pennsylvania (http ://www. aidslawpa. org/) Board member Edward G. Rendell, Esq. former Governor of Pennsylvania, former Mayor and District Attorney of P h i I a de I ph i a ( http //www. edwa rd re n d el l. co m/) : https ://www. safehousephilly.org/about/faqs 2/4t20t9 of24 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 7 of PageT 24 Asked FrequentlyCase Questions I Safehouse Safehouse will receive guidance from an Advisory Committee of community leaders and health experts, including: Ana V. Diez Roux, M.D., Ph.D., M.P.H. Dean, Drexel University Dornsife School of Public Health (https://d rexel. ed u/dornsife/) Thomas Farley, M.D., M.P.H. Commissioner, Department of Public Health, City of Philadelphia (https://www. ph ila. gov/departments/department-of-pu bl ic-health/) Perry Halkitis, Ph.D. Dean, School of Public Health, Rutgers University-New Brunswick (https://sph. rutgers. ed u/) David T. Jones, M.S. Commissioner, Department of Behavioral Health and lntellectual disAbility Services, City of Philadelphia (https://dbhids.org/) Larry R. Kaiser, M.D., FAGS President and CEO Temple University Health System (https ://www.tem plehealth. org/contenUdefau lt. htm ) Sister Mary Scullion, R.S.M. president and Executive Director, Project HOME (https://projecthome.org/) WHAT CAN PARTICIPANTS EXPECT WHEN THEY COME TO SAFEHOUSE? https ://www. safehousephilly.org/abouVfaqs 2t412019 Page 8 of24 Asked FrequentlyCase 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 8 of 24 Questions I Safehouse All participants must register and provide basic demographic information upon entry to the Safehouse facilities. A physical and mental health assessment will be conducted and a range of overdose prevention services offered. Participants seeking supervised consumption will be directed to the medically supervised consumption room and provided sterile consumption equipment and fentanyl test strips. Participants will safely dispose of used consumption equipment before leaving the supervised consumption area. Under no circumstances will Safehouse make available any narcotic or opioid, other than those that are FDA-approved for treating opioid addiction. From the consumption area, participants will be directed to the medically supervised observation room and offered on-site initiation of Medication Assisted Treatment (MAT), wound care, and referrals to primary care, social services, and housing opportunities. Participants may choose to go directly to the observation room to access MAT and other services. Medically trained professionals will provide overdose reversal and other emergency care. Safehouse personnel will be available to advise on sterile injection technique in order to reduce the risks of skin infections, but will not place needles or administer any narcotic or opioid, nor encourage the use of any drug. https ://www. safehousephi I ly. org/abouVfaqs 21412019 Page9 of24 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 9 of 24 Asked FrequentlyCase Questions I Safehouse Certified peer specialists, recovery specialists, social workers, and case managers will encourage treatment readiness and facilitate access to medical and social services. As participants leave, additional data will be collected, medical and social services will be offered again, and naloxone will be distributed. Registratlon Ass$3ment of physical and behavioral health Offer of services Medically supervised consumption room Medical services observataon Wound care Fentanyl test strips Overdose reversal and emerEency care Wraparound social services r@m Overdose reversal and emergency @re Sterile equipment Safe disposal Medically supervised On-site initiation of MAT Referrals to primary care Referrals to social services, legal services, and housing opportunities Certified peer specialists Offer of services of eouioment Chcd out Addftional &ta colHion, offer of sctvices, and naloxone dastributaon https://www. safehousephilly.org/abouVfaqs 2t4/2019 Frequently Asked Questions I Safehouse Case 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 10 ofPage 24 l0 of24 WHAT WILL BE THE RULES OF CONDUCT FOR SAFEHOUSE PARTIC!PANTS? All participants will be expected to comply with rules to ensure the safety of participants, employees, volunteers, and the public. Safehouse will develop detailed policies and procedures, which it will post in a conspicuous place on location and on its website. Safehouse's rules of use include: . No one under age 18 may use the services. Appropriate referrals will be provided to minors. . No drug dealing. . No drug sharing. . No exchange of currency. . No sharing of consumption equipment. . No participant may help another consume . No staff person may help a participant . drugs. consume drugs. Staff will not handle controlled substances. . All participants must properly dispose of consumption equipment before leaving the premises. WHO WILL WORK AT SAFEHOUSE? Safehouse staff will include medically trained professionals, social workers, case managers, and certified peer specialists and/or recovery specialists. All staff will be trained in CPR and naloxone administration. https ://www. safehousephilly. org/about/faqs 214120t9 ll Page 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 11 of 24 Asked FrequentlyCase Questions I Safehouse of24 DO OTHER JURISDICTIONS OFFER SUPERVISED CONSUMPTION ROOMS AS PART OF OVERDOSE PREVENTION SERVICES? The first government-authorized supervised consumption room opened more than 30 years ago in Switzerland. Today, more than 120 supervised consumption sites are operating in Europe, Australia, and Canada. The availability of supervised consumption services is increasing as research confirms the effectiveness and the advantages to the broader community. DOES SUPERVISED CONSUMPTION SAVE LIVES? Yes. No overdose deaths have been reported at any ofthe more than 120 supervised consumption sites worldwids.ltzl'tt8l ln Canada, the fatal overdose rate in the Downtown Eastside neighborhood of Vancouver, British Columbia, decreased by 35 percent after the city opened North America's first supervised consumptien si[s.ttsl Germany also experienced declines in overdose- and drug-related deaths in the years following the opening of a su pervised consumption site-t201 DO PEOPLE WHO USE SUPERVISED CONSUMPTION SITES SEEK TREATMENT? Yes. Following the opening of lnsite, a supervised consumption site in Vancouver, the use of detoxification services in the area increased by 30 percent.t2ll More than half (57 percent) of people in a cohort of more than 900 long-term injection drug users sought addiction treatment within 24 months of enrollment.l22I https ://www. safehousephilly. orglabout/faqs 21412019 Asked Frequently Case 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 12 ofPage 24 12 of 24 Questions I Safehouse DO SUPERVISED CONSUMPTION SITES ENCOURAGE DRUG USE? No. Research shows that when managed in cooperation with local authorities and police, supervised consumption sites do not increase public disorder problems by attracting additional users and dealers to a nei g h borhoo d.t231,t24) N o cred i ble evidence sug gests that su pervised consumption sites encourage increased drug use or initiate new users. DO SUPERVISED CONSUMPTION SITES INCREASE NEIGHBORHOOD CRIME? No. Considerable research on neighborhoods around safe consumption sites has shown no increase in crime.t2sl ln fact, a decrease in drug-related crime has been reported.t26l't271 Safehouse believes in a partnership with law enforcement and supports appropriate law enforcement measures to address public safety issues resulting from the opioid epidemic. Safehouse will actively discourage loitering. WHAT ARE THE BENEFITS TO THE COMMUNITY? Overdose prevention services will reduce fatal opioid overdoses. As Safehouse will provide immediate reversal in the event of overdoses, the strain on emergency medical services and health systems will be decreased. By reducing ambulance rides, emergency room trips, and hospital visits, overdose prevention services are expected to save Philadelphia at least $2 million a year in health care costs. t28l https ://www.safehousephilly. org/about/faqs 21412019 Page 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 13 of 24 13 of 24 Asked FrequentlyCase Questions I Safehouse ln addition, by providing a supervised place to consume drugs, fewer people will be using drugs on the streets. Less drug paraphernalia will be publicly discarded. DOES THE LAW ALLOW OVERDOSE PREVENTION SERVICES LIKE THOSE PROVIDED BY SAFEHOUSE? We believe it does. Safehouse's overdose prevention services are designed to save lives, which is consistent with the intent of federal drug laws. We believe that 21 U.S. Code $ 856 ("Section 856") was never intended to apply, and does not apply, to a nonprofit providing a good faith, public health approach to overdose prevention services, including a supervised consumption room. The purpose of a supervised consumption room is to carry out legitimate medical and public health initiatives that offer scientifically proven interventions effective for encouraging treatment and rehabilitation of individuals addicted to opioids. Section 856 prohibits maintaining any place "for the purpose of . . . using any controlled substance." The purpose of a supervised consumption room is to save lives by preventing fatal overdoses and encouraging participants to enter into treatment. lt is intended solely as a place to address the public health crisis of opioid addiction by providing harm reduction and emergency response in the event of an overdose or other medical emergency, in https ://www. safehousephil ly. org/about/faqs 21412019 Asked Frequently Questions I Safehouse Case 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 14 ofPage 24 14 of 24 addition to providing counseling about safer injection practices and referrals to other social and health services including referrals to addiction treatment, medical care, housing, and other related comprehensive social services. The express statutory restrictions set forth under Section 856 are not clearly applicable to a supervised consumption room that will be utilized as part of Safehouse's holistic approach to saving lives and providing overdose prevention services. Philadelphia has a history of creative public health initiatives and prosecutorial discretion. ln 1992, then-Mayor Rendell and the Board of Health authorized by executive order Prevention Point Philadelphia's syringe exchange program to protect public health by preventing the transmission of HlV. Syringe exchange in Philadelphia has been found to be an effective harm reduction method. lndeed, syringe exchange has reduced new HIV cases in injection drug users in Philadelphia by more than 95 percent, from 819 cases in 1992 when Prevention Point opened to just 27 cases in 2016.t2st Effective syringe exchange programs also increase the number of injection drug users referred to and retained in substance use treatment. ln addition, they increase referral and entry opportunities for social services such as housing, case management, and medical 62rs.laol Studies also have found that syringe exchange programs do not increase injection drug use.tarJ WILL SAFEHOUSE SEEK A PARTNERSHIP WITH https ://www. safehousephilly. org/about/faqs 2t4120t9 Page 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 15 of 24 l5 of24 Asked FrequentlyCase Questions I Safehouse LAW ENFORCEMENT? Yes. Safehouse hopes to have a mutually beneficial, productive partnership with law enforcement, as we have a shared goal of making the community safer. ln Vancouver, police leaders strongly support overdose prevention services. I33l Bill Spearn, a longtime inspector with the Vancouver Police Department, formerly a staunch opponent of the sites, now admits that he was wrong. ln May 2018, he said: 'lf you want to keep these people alive long enough to get them into treatment, you have to give them a space to use." ln reflecting on the benefit of Vancouver's overdose prevention services, Spearn said "it made sense to me that the reason that the number of overdoses that I was attending, or my members were aftending, had dropped significantly, was because of lnsite."tsal WILL DATA BE COLLECTED AT SAFEHOUSE? Yes. Data will be collected on a range of information points, including: client demographics, needs assessments, utilization, and referrals for treatment. An evaluation of the impact of the services on overdose fatalities and use of drug treatment will be conducted. Data collection and analysis will be conducted in a manner that respects and preserves client privacy and confidentiality. https ://www. safehousephilly.org/about/faqs 2t4t20r9 Asked Frequently Questions I Safehouse Case 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 16 ofPage 24 16 of 24 HOW CAN I FINANCIALLY SUPPORT THE EFFORTS OF SAFEHOUSE? lf you'd like to support Safehouse, please send donations to: Safehouse PO Box 36788 Philadelphia, PA 19107 Or click here to donate via PayPal (https://www.paypal.com/cgi-bin/webscr? cmd=_s-xcl ick&hosted_button_id=2D9UWP35AH DMW). At this time, contributions to Safehouse are not tax-deductible for federal income tax purposes. REFERENCES: . American MedicalAssociation (2017, June 12) AMA Wants New Approaches to Combat Synthetic and lnjectable Drugs [Press release]. Retrieved Sept. 1 2, 201 8, from https://www.ama-assn.org/ama-wantsnew-approaches-combat-synthetic-a nd-i njectable-d rugs (https://www. ama-assn. org/a ma-wants-new-approaches-com batsynthetic-and-i njectable-d ru gs) back to footnote 1 source . City of Philadelphia, Department of Public Health, Department of Behavioral Health and lntellectual disAbility Services, Office of the Mayor (2018, Jan. 23). City Announces Progress on Opioid Task Force https ://www. safehousephi I ly. org/about/faqs 2t4t2019 PagelT of24 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 17 of 24 Asked FrequentlyCase Questions I Safehouse Recommendations [Press release]. Retrieved Sept. 9, 2018, from https://www. phila. gov/201 8-01 -23-city-announces-progress-on-opioid- task-force-recommendations/ (https://www. phila. gov/201 8-01 -23-cityan nou nces-prog ress-on-opioid-task-force-recommendations/). back to footnote 2 source . Logan, D.E. & Marlatt, G.A., Harm Reduction Therapy: A PracticeFriendly Review of Research, NCBI (Feb. 2010), available at https://www. ncbi. nlm. nih. gov/pmc/articles/PMC3928290/ (https://www. ncbi. nlm. nih. gov/pmc/articles/PMC3928290/) ("As described, harm reduction interventions are demonstrably effective for alcohol and substance abuse in many settings and with many populations. They are also effective in recruiting a larger proportion of afflicted clients and in reaching several populations (e.9., worksite, homeless) that conventional treatment programs rarely reach'"). back to footnote 3 source . Division of Health Data and Policy, lllinois Department of Public Health, State of lllinois Comprehensive Opioid Datq Report, Dec. 4 2017 ,lrom http://dph.illinois.gov/sites/defaulufiles/publications/publicationsdoilopioid-data-repo rt. Pdf (http://dph. illinois. gov/sites/defaulufiles/publications/pu blicationsdoil- opioid-data-report.pdf); Paone, D. Tuazon, E., Nolan, M., & Mantha, S.' "Unintentional Drug Poisoning (Overdose) Deaths lnvolving Heroin and/or Fentanyl in New York City, 2000-2015," New York City Department of Health and Mental Hygiene: Epi Data Brief August 2016 (74), from https ://www.safehousephilly.org/about/faqs 2t4120t9 Asked Frequently Questions I Safehouse Case 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 18 ofPage 24 https://www1 . nyc. gov/assets/doh/downloads/pdf/epi/databrief/4. l8 of24 pdf (https://wwwl .nyc.gov/assets/doh/downloads/pdf/epi/databriel/4.pdf). back to footnote 4 source . The Mayor's Task Force to Combat the Opioid Epidemic in Philadelphia, Final Report and Recommendations. 2017 : Philadelphia, PA. from https://dbhids.org/wpcontenUuploa dsl2017 lO4lOTF_Report. pdf. (https://dbhids.org/wpcontenUu ploa dsl20 17 I 041 OTF_Report, pdf. ) back to footnote 5 source . City of Philadelphia, Department of Public Health (2018, April). Fatal Drug Overdoses in Philadelphia, 2017.from https://www. phila. gov/health/pdfs/charto/o20v3e1 .pdf (https://www. ph ila. gov/health/pdfs/chart%20v3e 1 . pdf) back to footnote 6 source . tbid. back to footnote 7 source . Office of the Medical Examiner, Philadelphia Department of Public Heafth. (2018). Unintentional Drug Related Deaths by Year 2003-2017. Retrieved on Oct 1, 2018 from https://public.tableau.com/profile/pdph#llvizhomelUnintentionalDrugRelate (https://public.tableau.com/profile/pdph#!/vizhome/UnintentionalDrugRelatt back to footnote 8 source . Combating the opioid epidemic I Department of Behavioral Health and lntellectual disAbility Services (n.d. ). Retrieved Sept. 1 4, 201 8, from https://www. ph i la. gov/prog rams/com bati ngthe-opioid-epidemic/ https ://www. safehousephilly. org/abouVfaqs 2/412019 Page 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 19 of 24 19 of 24 Asked FrequentlyCase Questions I Safehouse (https://www. ph i la. gov/prog rams/combati n g-the-opioid-epidemic/) back to footnote 9 source . tbid. back to footnote 10 source . Mayor's Task Force to Combat the Opioid Epidemic (2017), supra note 5. back to footnote 11 source . tbid. back to footnote 12 source . Wood, E. (2004). Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users Canadian Medical Association Journal, 171(7), 731-734. doi: 1 0. 1 503/cmai.1 04077 4 back to footnote 13 source . Wood, E., Tyndall, M. W., Lai, C., Montaner, J. S., & Kerr, T. (2006). lmpact of a medically supervised safer injecting facility on drug dealing and other drug-related crime [Abstract]. Substance Abuse Treatment, Prevention, and Policy,l (13), 14. doi:1 0.1 18611747 -597X-1- 1 3; Supervised lnjection Services. (2018, August 20). Retrieved Sept. 13, 201 8, from https://www.toronto.calcommunity-people/health-wellness- care/health-programs-advice/su pervised-injection-services/ (https://www.toronto.calcommunity-people/health-wellness-care/healthprograms-advice/su pervised-injection-services/) back to footnote 14 source https ://www. safehousephilly. org/about/faqs 2/4/2019 Asked Frequently Case 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 20 ofPage 24 20 of 24 Questions I Safehouse . Kerr, T., PhD, Tyndall, M. W., MD, Zhang, R., MSc, Lai, C., MMath, Montaner, J. S., MD, & Wood, E., PhD. (2007). Circumstances of First lnjection Among lllicit Drug Users Accessing a Medically Supervised Safer lnjecting Facility. American Journalof Public Health,97(7), 1281 30. doi:10.21 05/AJPH.2006.086256. back to footnote 15 source . Wood, E., Tyndall, M. W., Zhang, R., Montaner, J. S., & Kerr, T. (2007). Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction,102(6), 916-919. doi: 1 0. 1 1 1 1 lj.1 360-0443.2007 .01 81 8.x back to footnote 16 source . Alternatives To Public lnjection, Harm Reduction Coalition (2016) from https://harmreduction.org/wp-contenUuploads/2016/05/Alternatives-to- Pu... (https://harmreduction.org/wpcontenUu ploa dsl201 6 I 05 I Alternatives-to-P u bl ic-l njection-report. pdf) back to footnote 17 source . Kerr, T., Tyndall, M. W., Lai, C., Montaner, J. S., & Wood, E. (2006). Drug-related overdoses within a medically supervised safer injection facility. lnternational Journal of Drug Policy,17(5), 436441. doi:'t 0. 1 01 6/j.dru9po.2006.05.008 back to footnote 18 source . Marshall, B. D., Milloy, M., Wood, E., Montaner, J. S., & Kerr, T. (2O11). Reduction in overdose mortality after the opening of North Americas first medically supervised safer injecting facility. A retrospective popu lation-based study. Th e La n cet, 37 7 (977 5), https ://www. safehousephilly.orglabout/faqs 1 429-1 437 . 214/2019 Page 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 21 of 24 2l of 24 Asked FrequentlyCase Questions I Safehouse doi: 1 0. 1 01 6/s01 40-6736(1 0)62353-7 back to footnote 19 source . Degkwitz, P., Haasen, C., Verthein, U., and Zurhold, H. (2003). Drug Consumption Rooms in Hamburg, Germany: Evaluation of the Effects on Harm Reduction and the Reduction of Public Nuisance. Joumal of Drug /ssues, 33, 663-688. back to footnote 20 source . Wood, et al. (2007), suPra note 16. back to footnote 21 source . DeBeck K., KerrT., Bird L., et al.'lnjection Drug Use Cessation and Use of North America's First Medically Supervised Safer lnjecting Facility." Drug Alcohol Depend. 2011 Jan.15; 113(2-3): 172-176. doi: 1 0. 1 01 6/j.drugalcdep.201 0 .07 .023. back to footnote 22 source . Vancouver's INSITE Service and Other Supervised lnjection Sites: What Has Been Learned from Research? - Final Report of the Expert Advisory Commiftee on Supervised lnjection Site Research (2008, April 3). Health Canada. Retrieved Sept. 13, 2018, from https://www. canada. calen/health-canada/corporate/about-health- canada/reports-publications/vancouver-insite-service-other-supervisedinjection-sites-what-been-learned-research. htm l#pu b (https://www. canada. calen/health-canada/corporate/about-hea lth- canada/reports-publications/vancouver-insite-service-other-supervisedinjection-sites-what-been-learned-research. html#pub). back to footnote 23 source https ://www. safehousephilly.org/about/faqs 2t4/2019 Asked Frequently Case 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 22 ofPage 24 22 of24 Questions I Safehouse . Kerr, T., et al. (2007), supra note 15. back to footnote 24 source . Wood, E., et al. (2006), supra note 14. back to footnote 25 source . Wood, E. (2004), supra note 13. back to footnote 26 source . Supervised lnjection Services. (2018, Aug. 20), supra note 14. back to footnote 27 source . Larson, S., Padron, N., Mason, J. & Bogaczyk(2017) Superuised Consumption Facilities - Review of the Evidence. Retreived from https://healthdocbox. com/Su bstance_Abuse/72880022-Supervisedconsu mption-faci ities-review-of-the-evidence-sharon-larson-phdI norma-padron-phd-jen n ifer-mason-tyler-bogaczyk. htm I (https ://healthdocbox. com/S u bstance_Abuse/72880022-S upervised- consumption-faci lities-review-of-the-evidence-sharon-larson-phdnorma-pad ron-phd-jenn ifer-mason-tyler-bogaczyk. html ) back to footnote 28 source . Philadelphia Department of Public Health,AlDS Activities Coordinating Office Surveillance Report, 2016. Philadelphia, PA: City of Philadelphia; September 2017. back to footnote 29 source . Des Jarlain, D., & Braine, N., Assessrng syringe exchange programs (2004). Addiction, 99(9), 1081-1 082. doi:10.1 1111j.136o0443.2004.00800.x back to footnote 30 source https ://www. safehousephil ly.org/about/faqs 21412019 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 23 of 24 23 of 24 Page Asked FrequentlyCase Questions I Safehouse . Frakt, A., Ph.D. (2016, Sept. 2). Effectiveness and cost-effectiveness of syringe exchange programs [Web log post]. AcademyHealth.org, Retrieved Sept. 24, 2018, from https://www. academyhealth. orgl nodel221 1 (https://www. academyheallh. org I nodel221 I ) back to footnote 31 source . Whelan, A., A Vancouver cop tells Philadelphia why he changed his mind on safe injection slfes, Philly.com (https://Philly.com), Apr. 3 2018, http://www2.philly.com/philly/health/addiction/safe-injection-sitesopioids-philadelphia-vancouver-temple-university-201 80403. html (http://www2.philly.com/philly/health/addiction/safe-injection-sitesopioids-philadelphia-vancouver-temple-university-201 80403. html) back to footnote 32 source . Mannarino, D., lnside supervised iniection sifes: How they work in the fight against opioid crisis, WP X11 NY, May 8 2018, https://pixl 1 .coml201 8l 05/08/inside-supervised-injection-sites-howthey-work-i n-the-fig ht-aga i nst-opioid-crisis/ (https://pixl 1.coml2018lO5/08/inside-supervised-injection-sites-howthey-work-i n-the-fi g ht-against-opioid-crisis/) back to footnote 33 source . Gordon, Elana, Lessons from Vancouver: U.S. clties consider superuised injection facilities, WHYY, July 5, 2018' https://whyy.org/segments/lessons-from-vancouver-u-s-cities-consider- supervised-injection-facilities/ (https://whyy.org/segments/lessons-from- https ://www. safehousephilly.org/about/faqs 21412019 of24 Asked Frequently Case 2:19-cv-00519-GAM Document 1-2 Filed 02/05/19 Page 24 ofPage24 24 Questions I Safehouse va ncouver-u-s-cities-consider-su pervised-i njection-faci ities/) I back to footnote 34 source ABOUT Articles of lncorporation (/abouUarticles-incorporation) Frequently Asked Questions (/abouUfaqs) Log in (/user/login) https ://www. safehousephi lly.org/about/faqs 21412019 Case 2:19-cv-00519-GAM Document 1-3 Filed 02/05/19 Page 1 of 2 U.S. Depertment of Justice United States Anorney Eastern Disnict of Peansl trillian ll. llcslr",in United Sto,/ss 61 5 .lttom4' Chetdu, grea Snre 1250 Philadel?hio. P.nn$Iwnia I9I lwnia N-1176 ot5) 86t-t200 November 9, 2018 Via Certified Mail (Return Receipt Requested) and First Class Mail Jose A. Benitez, M.S.W, President Ronda B. Goldfein, Esquire Vice President Safehouse c/o Prevention Point Philadelphia 291 3- 15 Kensington Avenue Philadelphia, PA 19134 Re: Safehouse/ProposedlnjectionSite Dear Mr. Benitez and Ms. Goldfein: Earlier this month, Safehouse announced its formation as a nonprofit and intention to facility in Philadelphia where, among other things, "participants" could inject controlled substances such as heroin and fentanyl in a 'tonsumption room" under medical supervision. It also plans to offer onsite medical care and referral services such as wound care, onsite initiation ofmedication-assisted treatment for substance abuse, and referrals to primary care. In addition, it will offer a series of "wrap-around social services" such as referrals to social services, legal sen ices, and housing opportunities. open at least one While the U.S. Attomey's Office supports many of the services that Safehouse proposes to offer, including the medical and social referral services, Safehouse's proposed 'tonsumption room" for injection of illicit drugs would violate federal law. Specifically, Title 21, United States Code, Section 856 provides in relevant part that "it shall be unlawful to": (a)(l) knowingly open or maintain any place for the purpose of manufacruring, distributing, or using any controlled substance; (a[2) manage or control any place whether permanently or temporarily, either as an owner, lessee, agent, employee, occupant, or mortgagee, and knowingly and intentionally r€nt, lease, profit from, or make available for use, rvith or without Case 2:19-cv-00519-GAM Document 1-3 Filed 02/05/19 Page 2 of 2 Safehouse c/o Prevention Point Philadelphia November 9, 201 8 Page Two compensation, the place for the purpose of unlawfully manufacturing, storing, distributing, or using a controlled substanceSection 856(a)(2), in particular, encompasses a broad range of rclationships and conduct. It reaches a person or enlity who has management or control over a place made available for the unlawful use ofcontrolled substances, whether "permanently'' or 'temporarily." lt covers not only landlords, but also lessees, agents, employees, occupants, and even mortgagees (i'e', lending institutions). lr applies whether the place is made available "with or without compensation," explicitly encompassing a situation such as this one where Safehouse does not plan to profit from the use of the property. Morcover, the statute makes no exception for Lntities, such as Safehouse, who claim a benevolent purpose or purpose other than the use of conrolled substances. See, e.g., Ilnited States v. Tamez'941F -2d 770,774 (fth Cir' l99l)' Please ensure that your organization, board members, and employees comply will federal law. The Department of Justice to ensure your organization's compliance. with pursue appropriate legal remedies should you fail The Department of Justice is committed to ending the opioid epidemic through prcvention, enforcement, and treatment efforts. We recognize rhat Safehouse and its proponents thare our goal of combatting the scourge of opioid abuse. I appreciated the rccent opponunity to tour Prevention Point with Mr. Benitez and I thank Ms. Goldfein for prcractively contacting my olfice lo keep us apprised of Safehouse's intentions. Many of the services Safehouse intends to provide appear worthwhile and commendable. While we do not and cannot approve of Safehouse's 'tonsumption room," we invile a continuing dialogue with you to hear more about your proposal and to discuss how we can work together to fight this epidemic within existing federal law. Very truly yours, D1fu..ay *0---- WILLIAM M. MCSWAIN United States Attomey Case 2:19-cv-00519-GAM Document 1-4 Filed 02/05/19 Page 1 of 2 Safehouse A public health approach to overdose prevention in philadetphia November 26, 2018 tilt\ [rr 30 p: 0't William M. McSwain U.S. Department of Justice U.S. Attomey Eastem District of Pennsylvania 615 Chestnut Street Suite 1250 Philadelphia, P A 19106-447 6 Dear U.S. Attomey McSwain: Thank you for letter ofNovember 9 and the invitation to continue the dialogue about our efforts to provide overdose prevention services. We are grateful for a Department ofJustice that embraces the need to combat the scourge ofopioid abuse. To ensure candor in our ongoing dialogue, we would like to share our thoughts about this initiative. We respectfully disagree with the conclusion that Safehouse's proposed consumption room would violate federal law. The legislative intent of Title 21, United States Code, Section 856 is to prohibit individuals from knowingly allowing their property ro be used for the purpose ofdistributing or using drugs for profit. We believe that a proper and constitutional application of Section 856 does not prohibit our primary purpose of preventing fatal overdoses. Overdose prevention is part ofa multifaceted public health approach to combating the opioid crisis. Extensive research has demonstrated the benefits ofoverdose prevention services for people who use drugs and the communities where drug use occurs. For more on the services to be offered, please see safehousephilly.org. Moreover, the leaders and organizers of Safehouse are motivated by the Judeo-Christian beliefs ingrained in us from our religious schooling, our devout families and our practices of worship. At the core ofour faith is the principle that preservation of human life overrides any other considerations. As witnesses to great losses of life in our community, we are compelled by our religious beliefs to take action to save lives. Finally, we hope that the U.S. Attomey's otlice will exercise prosecutorial discretion in assessing our proposed overdose prevention services. This is not a request that your oflice approve or ignore Safehouse's proposed consumption room, but rather that the P. O. Box 36788, Philadelphia, PA 19107 satehousephilly.org Case 2:19-cv-00519-GAM Document 1-4 Filed 02/05/19 Page 2 of 2 same discretion in prosecution, that is shown in a range ofactivities that may be considered unlawful, be exercised here. We welcome the opportunity to meet and discuss our shared goals offighting this epidemic. Respectfully a Jose A. Benitez, M.S. L-