Containers for used needles and drug use information are provided at each of the injecting cubicles at Sydney's Medically Supervised Injecting Centre in Sydney, Australia. Credit: Rick Rycroft | AP

Cities seeking to open sites where illegal drug users are monitored to prevent overdoses responded defiantly Tuesday to a Justice Department threat to take “swift and aggressive action” against that approach to the nationwide opioid epidemic.

Plans for those “supervised injection sites” — under consideration in San Francisco, Philadelphia, New York City, Seattle and elsewhere — collided with a stern Justice Department warning issued last week, threatening to create a standoff between federal and local authorities like the confrontation over “sanctuary cities.”

As they have before, some liberal-leaning cities trying to cope with conditions on their streets find themselves at odds with more-restrictive Trump-era policy and enforcement.

“Just as local governments had to lead during the HIV epidemic, cities like ours will be on the forefront of saving lives in the opioid crisis,” James Garrow, a spokesman for Philadelphia’s Department of Public Health, said in a statement Tuesday. “The federal government should focus its enforcement on the pill mills and illegal drug traffickers who supply the poison that is killing our residents, not on preventing public health officials from acting to keep Philadelphians from dying.”

On the other side of the country, California state legislators and San Francisco Mayor London Breed, D, who lost a sister to a drug overdose, vowed at a news conference Tuesday to open a supervised injection site soon. State Sen. Scott Wiener, D, said the city would act “even if the federal government threatens us with criminal prosecution.”

A bill to authorize San Francisco’s plans passed the California legislature last week and is sitting on Gov. Jerry Brown’s desk. The officials urged Brown, D, to sign it.

At supervised drug consumption sites, users are monitored by staffers equipped with the opioid antidote naloxone and with oxygen for quick response in the event of an overdose. The sites — some operate in Canada, some European countries and Australia — also may provide clean syringes, matches, cooking tins and other equipment that facilitates drug use. But they do not offer drugs or help users inject or smoke them.

Advocates contend that such sites have saved the lives of countless thousands addicted to drugs who would have used them anyway under less safe and sanitary conditions, although the most recent research has reopened the debate. They say the facilities also curb the spread of HIV and hepatitis C by limiting needle sharing. Researchers report that no one has ever died in a supervised drug consumption facility in the nearly 20 years that they have existed.

But in the United States, the facilities appear to violate a 1986 federal law aimed at crack houses. The law criminalized opening or running places where illegal drugs are knowingly used. That is the position that Deputy Attorney General Rod Rosenstein took in an interview with the Philadelphia radio station WHYY last Wednesday and in an opinion column in the New York Times the following day.

“Because federal law clearly prohibits injection sites,” he wrote, “cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action.”

Rosenstein did not spell out what that action would be, but he noted that violators face as much as 20 years in prison, large fines and forfeiture of property. The government also could seek a court injunction, he wrote.

A spokesman for the Department of Justice declined to comment Tuesday.

There are no official supervised injection sites in this country, though researchers have reported on a clandestine site that has been operating for about four years.

Public health advocates say the federal law was not intended to bar government or medical authorities from responding to emergencies — in this case, the worst drug epidemic in U.S. history. More than 72,000 people died of drug overdoses in 2017, led by more than 49,000 deaths from opioids, according to preliminary statistics released last month by the Centers for Disease Control and Prevention.

Leo Beletsky, an associate professor of law and health sciences at Northeastern University, said California’s law would put the effort on “much more solid footing” legally. Action by the federal government against a site could set up a court test of whether cities and states have the right to control what is happening on their streets.

In April, a federal appeals court in Chicago ruled that the Trump administration could not withhold federal funds from cities, many led by Democrats, that decline to help the federal government apprehend illegal immigrants. In July, a federal judge in California largely rejected the Justice Department’s effort to block California’s “sanctuary state” laws.

Cities and states have also won battles against federal authorities in the past for the authority to distribute clean needles to drug users and to open medical marijuana dispensaries.

Advocates of supervised injection said the country is at a similar crossroads in the opioid crisis, a point where previously rejected ideas need to be considered.

“Many of us are hoping that the federal government, at some point, allows states and communities to try approaches they think will work locally with the population that’s affected,” said Jessie Gaeta, chief medical officer of Boston Health Care for the Homeless, which allows people who have used drugs off-site to come inside for medical monitoring. “In this case, with an unprecedented public health crisis on our hands, I think this is a case that warrants that kind of response from the federal government. If you think this could save lives, let’s try it.”

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