Minneapolis considers supervised injection sites to address opioid crisis

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Minneapolis public-health officials are scrambling for answers to the city’s growing opioid crisis — an effort that’s gained urgency in the wake of people dealing drugs in clear sight of the Hiawatha homeless encampment along the busy Hwy. 55. At least one death there has been tied to drugs.

Social-service workers are fanning out each day to distribute clean needles and Narcan — a drug that can fight the effects of opioids — to people living in the tents, while researchers and elected officials discuss long-term solutions.

Among the possibilities: government-sanctioned facilities — known as supervised injection sites — where people would be able to use heroin or other drugs while health care workers make sure they stay alive. Though such programs operate in other cities around the world, none have been implemented in the U.S. — yet. Advocates in more than a dozen cities — including San Francisco, Seattle, Denver and Philadelphia — are looking to launch the first, even as federal authorities are promising swift legal action in response if any of those local governments move forward.

Minneapolis officials have studied those efforts and weighed the pros and cons of opening such sites locally as they try to combat the opiate crisis that extends well beyond the camp. More than 150 people died from opioid overdoses in Hennepin County in 2016, up almost 60 percent from the previous year. And the number of people receiving treatment for heroin addictions has reached an all-time high.

“What I like about this option [of a supervised injection site] is that it’s an option that — if done in conjunction with shelter or housing — could really help folks,” Council Member Jeremiah Ellison said at a City Council committee meeting last month. “I’m fearful now that we’ll get a lot of folks housed, or placed in an emergency sense, and then because of rules around chemical dependency, drug-use, we’re basically … setting them up to fail.”

The idea of a supervised injection site is far from final. The city’s first-ever “Multi-Jurisdictional Task Force on Opioids,” will look at various options over the next several months as it prepares to present official recommendations for tackling the crisis early next year.

The camp

For one woman at the Hiawatha camp, getting high was the only way to cope with the death of her infant son. “He was 8 months old, and that’s when I started ripping and running on the streets, using,” the woman, who identified herself as Sarina, 34, told City Council members. “I haven’t been able to get a job because I’m in and out of jail and just, basically, the deposit (for) rent — don’t have the money to pay and can’t get a job because of my background. It’s just hard, so I don’t want to do nothing but use. I start treatment today.” City Council chambers erupted with applause.

Sarina is among the hundreds of homeless people who have visited or set up tents at the camp near the Little Earth housing complex since the beginning of summer — finding relief in the location’s high visibility and amenities, such as washing stations and portable toilets. Most of the people at the encampment are Native American and represent a variety of tribes.

The extent of the drug problem at the camp is unknown, since users can retreat to their tents to discreetly use drugs or leave the site during the day. “Not everyone at the encampment is using drugs,” the city’s deputy commissioner of health, Gretchen Musicant, said in an interview. “Also, as we think about it, in Minnesota, the Native Americans are highly impacted by this drug-use epidemic, so we have to think about the underlying factors about the trauma that’s been caused to them over generations.”

Minneapolis Police Department’s homeless liaison, Sgt. Grant Snyder, witnesses the harmful effects of drugs at the site almost daily. He relayed the struggle of another female resident at the council committee meeting. “She’s had a number of experiences of overdosing, and she’s really wrestling with this process.”

Meanwhile, people like Angela Bowen are living in the tents to help their neighbors survive. “I take care of the Narcan people and I carry the needles and do the needle exchange. I have 20 years’ experience doing this. … I’ve saved 14 [people],” Bowen said in mid-September. “I’ve got it all, the needles, the [pamphlets] to teach people to get on the methadone program. I’ve been on the methadone program for six years.”

What officials are doing

Overall, the City Council agreed last week they need to move faster to help people at the encampment before temperatures get colder. Their focus is on demolishing a few buildings on Cedar Avenue to build a temporary center with indoor beds and services to treat problems — such as drug addictions — for the camp’s residents. That site will open as early as December, according to city staff.

But despite the attention from City Hall, some residents of the camp feel officials are not moving swiftly enough — especially considering three people with connections to the camp have died of various causes since the beginning of September.

Among the them was Pamela Rivera, 51. On Sept. 30, medics rushed her from the tents to Hennepin County Medical Center, where doctors declared her dead, according to the county’s medical examiner’s office. Officials believe she died of an apparent drug overdose, though the details surrounding her death remain under investigation.

“The latest mortality at the camp was associated with using a mixture of drugs, which is called pink,” Musicant said.

To avoid more fatalities while the city comes up with better solutions, social-service workers and volunteers — primarily with Natives Against Heroin — are going tent-to-tent to supervise drug users and gauge their thoughts on treatment, including a Rule 25 Assessment, which provides access to inpatient or outpatient addiction services, as well as extended care, for those who can’t afford it on their own.

“We’re certainly doing education on the ground. We’ve created signs that encourage people to use a buddy system, with an outreach organization, so people aren’t isolated and alone as a result of their drug use,” Musicant said.

The response has made officials think differently about how they offer programs for people to get sober. A number of drug users at the camp may be eligible for help but are not seeking available services because it doesn’t fit their needs, Musicant said. Parents don’t want to leave their children, for example, or some people are hesitant to abandon their families.

Supervised injection sites

Musicant, who’s served as the city’s deputy commissioner of health since 2005, told City Council members she has talked with her colleagues across the country who want to launch official supervised injection sites but “to date, they have not been able to move forward.”

Opponents of such sites argue they promote drug use, attract crime or create hubs for dealers to make big profits. Supporters, meanwhile, say they provide a place safer than streets or alleyways for addicts to get high, while connecting people to long-term medical help.

Those advocates hope acceptance grows for the sites as it did for needle exchanges — places where people can get clean hypodermic needles at little or no cost and dispose of dirty ones. The majority of states have legalized and opened such facilities over years.

So far, much of the world’s research on supervised injection sites comes from two places: Vancouver, British Columbia, and Sydney, Australia. Cities in Germany, Switzerland and the Netherlands have opened sites, too.

According to Mark Tyndall, who is executive director of the BC Centre for Disease Control, the numbers speak to the Canadian site’s success. An average of 415 people use the facilities across British Columbia to shoot up daily, and health officials there say they have stopped 6,400 overdoses since launching services in 2003.

“When you see them in action, the misconceptions are dispelled. They’re not a hub of people selling drugs,” Tyndall said. “The biggest opposition is that people shouldn’t be using drugs, but millions of people are using drugs and unfortunately tens of thousands of them are dying. We have to do something different.”

At least 13 U.S. cities have gone so far as writing proposals to establish official supervised injection site programs; the California Legislature even passed a bill to launch a pilot program, which Gov. Jerry Brown recently vetoed. Yet the U.S. Justice Department has issued stern statements against the efforts, citing federal law that prohibits the possession and consumption of illegal drugs.

A community group has been running a “clandestine” site in an “undisclosed location” since 2014, according to a summary of research for Minneapolis City Council members.

That document also says: “Because decisions related to official supervised injection sites in the U.S. remain pending, the issue of legality under federal law has not been tested in the courts. Before a court can weigh in, a site has to open.”

To council members, Musicant emphasized the research on supervised injection sites in Minneapolis as part of a bigger effort to study how laws allow physicians, or perhaps workers in the criminal justice system, to provide drugs to people who are severely addicted. 

“There’s a great more we can do with medically assisted treatment,” she said. “We have some issues that will require legislative change but maybe not insuperable, as it seems like the federal government prohibition is right now.”

Additional reporting for this story provided by MinnPost contributor Jim Walsh.