Quetcy M. Lozada, a first-term Philadelphia City Council member, stood on a September evening near an elementary school just off Kensington Avenue, the epicenter of a sprawling fentanyl market in a city that saw a record 1,413 drug overdose deaths last year.
Just a block away, the street and sidewalks were dotted with used syringes and their discarded orange caps.
“Kids have to go through this every day,” Ms. Lozada said, her voice rising. Children “are so impacted that they don’t want to come to school.”
Public health experts have long endorsed a controversial strategy to blunt the opioid epidemic that has been sweeping cities like Philadelphia: supervised drug consumption sites, in which people are allowed to take illicit drugs under professional supervision.
The sites employ medical and social workers who guard against overdoses by supplying oxygen and naloxone, the overdose-reversing drug, and by distributing clean needles and other resources to opioid users. New York City has two sites, the only ones operating openly in the nation.
Safe drug consumption facilities have reversed thousands of overdoses in the United States and abroad, helping people who use potent synthetic opioids like fentanyl avoid the worst consequences of a volatile drug supply.
In the United States, the sites represent a novel form of “harm reduction,” which aims not to make drug users sober or abstinent but to prevent disease, overdose and death. President Biden is the first president to endorse the idea.
But critics argue that the sites encourage a culture of permissiveness around illegal drugs, formally sanctioning opioid use in neighborhoods already struggling with high overdose rates. And they say that the groups working to open the sites, however well intentioned, should not encroach on communities that might be hostile to the strategy.
Hours earlier, Ms. Lozada had shepherded a measure through City Council that restricted where drug consumption sites could operate in the city. The legislation, which passed 13-1, survived a veto from Mayor Jim Kenney, who supports opening the facilities.
Ms. Lozada and her allies have cast their effort not as a rejection of drug consumption sites per se, but as a way for Philadelphia residents to choose whether one may operate in their neighborhoods. Kensington Avenue, which sits in Ms. Lozada’s district, is seen as one of the most obvious locations for such a facility.
Ms. Lozada said that her constituents did not want to accept living around open drug use, that it discouraged the use of local libraries and parks and drove away local businesses. “People in the political world just became afraid of: What do we do? How do we do it? Let’s not do anything,” she said of the state of her neighborhood.
Ms. Lozada has another idea: She supports involuntary roundups of opioid users, using the courts to route them to treatment facilities, a strategy that some public health experts have said is punitive and unproductive.
As much as any city, Philadelphia showcases the seesawing tensions and legal battles around supervised drug use. The city encapsulates a broader struggle among state and federal health officials searching for new methods to curtail the roughly 110,000 annual fatal drug overdoses in the United States.
The sites operate in a legal gray area. A federal law passed in 1986 prohibits people from keeping property where controlled substances are ingested, a measure that defenders called the “crack house statute.”
Some cities and states have moved to open the facilities despite the risk of federal reprisals, as research has shown that supervised consumption sites in Canada, Australia and European countries have saved lives and led people to treatment.
Yet even liberal elected officials and communities, like those in Philadelphia, continue to question what they consider more lenient approaches to opioid use.
In May, Pennsylvania state senators passed legislation banning the sites. San Francisco is on track for a record number of overdose deaths this year, yet the city’s lone facility closed last December. Gov. Gavin Newsom of California, a prominent Democrat, has vetoed legislation that would have allowed some cities in the state to open them.
This summer the top federal prosecutor in Manhattan threatened the group operating the New York sites, saying they were running afoul of the law.
And in Washington, the Biden administration has taken steps to limit their use even after key officials signaled openness to the strategy. The Justice Department asked a judge in Philadelphia this summer to dismiss a lawsuit brought by Safehouse, a nonprofit group working to open a supervised drug use site in the city.
The Trump administration sued the organization in 2019, halting its plans. The Biden administration and Safehouse have yet to agree on a settlement. Ronda Goldfein, the group’s vice president, said a decision from a federal judge could come any day.
For groups with licenses to open sites, progress has been slow. After lawmakers in Rhode Island legalized drug consumption sites in 2021, the first state to do so, lease negotiations, construction delays and supply chain problems stalled the opening.
“There’s layers of bureaucracy,” said Colleen Daley Ndoye, executive director of Project Weber/RENEW, a group working to open the facility.
The state’s human services department is putting together potential plans to open the facilities, Jeremy Drucker, Minnesota’s director of addiction and recovery, said.
“People can’t recover if they’re dead,” he said.
In Philadelphia, the issue has captivated the city, pitting elected officials, residents and public health advocates against one another and exposing divisions in their approaches to the raging epidemic.
The same has been true of state and congressional leaders. Gov. Josh Shapiro of Pennsylvania, a rising Democratic star, has long opposed the drug consumption sites, while Senator John Fetterman, a popular Democrat, has supported them.
But at the recent City Council meeting, there was just one vote against legislation restricting where the sites might be opened. “I know that this is a fight that I’m not going to win,” Kendra Brooks, a council member at large, said in an interview before the meeting.
“It can’t be a radical idea — providing folks who are in a medical crisis with the support they need to live,” she added.
Michael Driscoll, a City Council member who opposes the sites, said that even if drug consumption facility were to offer people temporary protection against overdosing, “as they drift to other parts of their lives and stay dependent on these bad drugs, we’re going to lose that life as a productive citizen.”
Mr. Kenney, the Philadelphia mayor, watched the vote from his office below the Council chambers in City Hall. “I was a little depressed,” he said in an interview after the meeting concluded.
“It’s not just the people on Kensington Avenue. It’s people in every neighborhood, their sons and daughters in the basement or in the bathroom. If they’re by themselves, how do you get them better?”
Mr. Kenney said that a site in Kensington would draw people from the street who have nowhere else to go, reducing drug-related litter and offering services far beyond the supervision of drug use.
He criticized City Council members for deferring to constituents who balked at the idea.
“If we put that standard on every public issue, our schools would still be segregated because people in the community, back in the day when we were desegregating schools, said no, and a court had to tell them to do it,” he said.
Treatment alone is not always the answer, some public health experts say. Some substance users are unwilling to take medication, or cycle in and out of treatment programs.
“If people aren’t ready, they aren’t ready,” said Susan Sherman, a drug policy expert at the Johns Hopkins Bloomberg School of Public Health who has studied supervised drug consumption.
There are also major obstacles for anyone seeking treatment, including the resources available. One effective opioid addiction medication, methadone, is heavily regulated and often difficult to obtain. Another effective treatment, buprenorphine, is underprescribed.
A site in Philadelphia would likely offer services far beyond medical supervision of drug use. Workers could distribute fentanyl test strips and clean needles, direct drug users to treatment once they are willing, and help them find housing or food. And staff could provide wound care, a vital service in a city besieged by xylazine, an addictive animal tranquilizer that causes horrific lesions.
“We walk around all day looking at folks who are in the street, who need services, who are overdosing, who are losing their kids,” Moses Santana, a supporter of supervised consumption sites, told Council members at City Hall.
“We have to look at these folks as if we’re looking at ourselves.”
