Does Minneapolis need a place where users can inject drugs while supervised? One neighborhood is studying the idea.

Where Stephen Gregg lives, near 26th Street and Bloomington Avenue in the working-class south Minneapolis neighborhood of East Phillips, used needles litter the sidewalks. In summer, large groups congregate against the storefronts and use drugs openly to the distress of neighbors, who occasionally find bodies in their yards, Gregg said.

Gregg approached the East Phillips Improvement Coalition neighborhood association to explore the possibility of creating an overdose prevention site, also known as a supervised drug consumption site.

"This is the most diverse neighborhood in the city. It's one of the poorest. We've had all these environmental harms. It's just a dumping ground for the city, and this is also where these issues happen," said Gregg. "We have a homelessness epidemic and an opioid epidemic, and it shouldn't be the neighbors who have to battle that."

He wrote a column for the neighborhood newspaper, the Alley, asking residents to acknowledge the reality of drugs in East Phillips. Gregg also asked them to consider creating a facility where staff trained to administer naloxone, also known as Narcan, can provide sterile needles, prevent overdoses and refer treatment.

Southside Harm Reduction Services, which runs a needle exchange and contracts with the city Health Department to provide Narcan training, has been hosting educational presentations on overdose prevention sites the past few months. They and East Phillips neighbors plan to survey the appetite of the neighborhood through a mix of door-knocking and outreach to people who use drugs.

The concept is far from implementation. There is no specific location under discussion, nor any established operator.

"It would be a great idea because we have people using and the reality is they're not going to stop unless they really want to," said East Phillips Improvement Coalition Secretary Cassandra Holmes. "Instead of losing our relatives, we should be able to provide a space where they can use safely and we won't have needles laying about for kids or animals or other people to be harmed."

Minneapolis is in the midst of an HIV outbreak with rates unseen since the beginning of the HIV crisis in the 1980s, said Noya Woodrich, the city's Deputy Health Commissioner, who ties the outbreak to encampments and intravenous drug use. The Minnesota Department of Health's latest stats also show there were 27% more overdose deaths in 2020 than 2019.

At 26th and Bloomington, people come to buy drugs and go; others stay on in tents through the harsh winter. When the city disbands one homeless encampment, the camp's residents gather their remaining belongings and set up again nearby. They say they use in order to survive.

"And what we're doing right now in Minnesota just isn't meeting people where they're at, it's not meeting people who need support," said Southside Harm Reduction Executive Director Jack Martin. "We need to explore new avenues and adjust how we are looking out for for each other in Minnesota, and one idea is safe consumption sites."

There are more than a 100 supervised injection sites operating in Europe, Australia and Canada. They vary greatly in feel and services provided. Some are furnished like lounges with comfy chairs, private ventilated rooms, showers, computers and newspapers. Others are austere rooms with a spread of clean supplies on flimsy tables, where people are not encouraged to linger. Some sites have nursing staff to treat wounds.

The United States' first two legally sanctioned supervised injection sites opened in November in New York City. Others exist but operate only underground because the federal government considers these sites illegal under the Controlled Substances Act, which prohibits managing any "place … for the purpose of using a controlled substance," even if the drugs are not manufactured or sold on the premises.

When the Philadelphia harm reduction nonprofit Safehouse attempted to open a drug consumption site in 2019, it was sued by the U.S. Attorney for the Eastern District of Pennsylvania and ultimately lost on appeal. United States v. Safehouse offers a window into the forces that could assemble on both sides of a pitched battle over these sites.

Those in favor of Safehouse included medical associations, homelessness organizations and nine states in want of local power to try different public health approaches.

The American Medical Association supports the development of supervised injection pilot facilities because studies from other countries show such sites reduce fatal overdoses and infectious disease transmission while increasing the numbers of people seeking addiction treatment. Minnesota Attorney General Keith Ellison co-signed a brief backing Safehouse, arguing that the Controlled Substances Act was passed to shut down "crack houses, not community health clinics."

Opponents included 20 neighborhood associations and the police union.

The objectors argued that supervised drug consumption sites would attract predatory drug dealers and create "criminal economic zones" in which police would not be able to fight trafficking because the success of harm reduction sites depend on people being able to come and go "free from any interference by law enforcement." They also cited an economic review by the Canadian province of Alberta's government showing that cleanup crews continued to find hundreds of discarded needles per day near the sites and that local businesses complained of drug dealing and theft.

"There's different problems, pros and cons, and I just want them to be aware," said East Phillips resident Schuyler Sellars, who believes medical institutions should also be at the table throughout planning. "Maybe the site itself [might] be safe, but the surrounding area might not be."

With the U.S. Department of Justice under a new administration, officials are evaluating supervised drug consumption sites for possible pilots as part of an overall approach to harm reduction strategies, the agency told the Associated Press earlier this month.

"We have pretty conclusive evidence from international models, and the results are very compelling," said Dr. Gavin Bart, director of Addiction Medicine at Hennepin Healthcare. Studies show they do bring reductions in overdose deaths, ambulance trips and complaints of discarded needles without increasing crime or 911 calls, while a quarter to one-third of individuals who frequent the sites are interested in accessing some form of treatment, he said.

"If [East Phillips] were successfully able to set up a facility like that, we need to be realistic. It's not going to solve the drug problems in Minneapolis, but it could likely help in a sort of four-block radius of where the location is in terms of reducing overdose deaths, ambulance calls for overdoses, drug paraphernalia," he said. "One could expect to improve."