Safe Injection Sites for Drug Users Are a Tough Sell to Foundations

José Benitez believes so strongly that his public-health nonprofit has an effective approach to helping people who use drugs that his organization has taken the U.S. Justice Department to court. He is asking the federal government to reverse decades of federal drug enforcement by allowing his nonprofit to open a center where people can use drugs relatively safely without fear of arrest. If he wins, not only will his group get to expand its mission but the ruling could lead other philanthropies to help nonprofits nationwide copy the approach.

Benitez, chief executive officer of Prevention Point Philadelphia, a public-health nonprofit, envisions opening a center called Safehouse. Drug users would be off the streets and alleys, out of public bathroom stalls and parks. And they would be under the supervision of medical professionals who could keep watch and administer medicine to reverse overdoses if needed. By reducing the stigma surrounding drugs, Benitez says, it could be easier to provide other services, like help with housing and food, and ,ultimately, treatment when the drug users determine they are ready.

“Because there’s additional safety and comfort, it also affords us to have different kinds of conversations about how to support them,” Benitez says of the safe injection sites. “And that is the beginning of establishing a relationship.”

If the Justice Department changes its policy, philanthropy — which in large part has avoided supporting safe injection sites — might be willing to put more money behind the idea. Philadelphia could follow New York, where in November, two safe injection sites opened with the approval of the city government. A year ago, lawmakers in Rhode Island cleared the way for a two-year test of safe sites.

The effort to open Benitez’s Safehouse in Philadelphia has been sustained by about $1 million grants from the Scattergood Foundation, the Vital Projects Fund, and a foundation that has a policy of making all of its grants anonymously, as well as gifts from individuals.

Related Content

1. Drug Use

   Ban on Government Funds Puts Pressure on Nonprofit Drug Injection Sites in R.I.

Those grant makers are among the few that have made grants to nonprofits working to open safe injection sites. Another is the Comer Family Foundation, which provided a $25,000 grant for a site in New York run by the nonprofit OnPoint.

Open Society Foundations, founded by George Soros, has been a major force behind building safe injection sites. Over the past 30 years, the grant maker has spent in excess of $300 million internationally, pushed for a range of drug-policy changes, and helped establish overdose-prevention centers in 14 countries.

Providing a place for drug users to take illegal substances in relative safety may have seemed too risky for many grant makers. The idea has sparked opposition from residents of neighborhoods where the safe injection sites are planned and from some in law enforcement. But the pending Department of Justice decision may clear the way for additional foundation grants.

Historically, philanthropy has mainly supported other approaches such as educating people about the dangers of drug use, financing rehabilitation centers, and advocating for tougher penalties to punish people who use or sell drugs.

After decades of those efforts, people are dying from drugs at record numbers. In the 12 months that ended in November, the United States had a record 107,000 overdose deaths — an increase of about 16 percent over the previous year, according to figures compiled by the U.S. Centers for Disease Control.

With little to show for the war on drugs policies that began in earnest in the 1980s, proponents of what is called harm reduction began to take a different approach, starting with needle exchanges set up by city and nonprofit leaders in San Francisco during the AIDS crisis. Rather than focus on deterring people from using drugs, harm reduction seeks to reduce the number of overdoses and to minimize the dangers of using illegal substances.

Harm reduction tries to make using drugs as safe as possible by providing clean syringes, testing kits to determine if a drug contains fentanyl, which can be extremely hazardous, and naloxone, a drug that can reverse an overdose if administered in time. Safe injection sites go one step further by providing users with a physical place to use drugs without fear of being turned into the police.

Research shows that the safe sites can cut costs and save lives. For instance, the Institute for Clinical and Economic Review showed that operating a single site could result in a reduction of $2 million in hospital costs, nearly 800 fewer ambulance rides, and anywhere from 3 to 15 fewer overdose deaths each year. The study used data gathered from a safe site in Vancouver and projected those results in several U.S. cities.

The fact that sites in several jurisdictions have gotten the go-ahead has given advocates hope that more foundation money will follow. Benitez says the possibility of getting Justice Department approval for his planned center may make it easier to raise money to open and run Safehouse than when the safe site was the focus of a legal challenge.

The tangles with the Justice Department, he says, “sort of put a speed bump on how much foundation support we could get.”

Bastiaan Slabbers, NurPhoto, Getty Images

From Radical Idea to Accepted Policy

Harm reduction grew from being viewed as a radical approach nearly four decades ago to an accepted tenet of federal drug policy under President Biden. Many foundations have provided grants to support the approach but often have balked at supporting safe injection sites.

Open Society Foundations, which has led the way internationally, put more than $13 million toward changing drug policy in North America in 2019 and 2020 combined. The philanthropy has supported nonprofits that have specifically advocated for the creation of safe injection sites in New York, San Francisco, and Seattle. Safe injection site legislation is pending in San Francisco. An effort to open a site in Seattle has stalled.

Other grant makers have supported harm reduction more broadly but have stopped short of providing grants to safe injection site efforts.

The Pew Charitable Trusts, a large public-policy philanthropy with a long history of grant making in Philadelphia, supports a long-running program called the Substance Use Prevention and Treatment Initiative. The effort works to expand access to drug-treatment programs and provide medications such as methadone for substance-use disorder. Sheri Doyle, the program’s manager, declined to say why the philanthropy had not made grants in support of safe sites.

“Our primary goal is increasing access to treatment,” she says."We see that as the best way to reduce overdose deaths in this country.”

Other large philanthropies, including Arnold Ventures and the Robert Wood Johnson Foundation, have provided researchers with grant dollars to study safe injection sites, but they have done little else to advance such efforts. An Arnold Ventures spokesman declined to comment on why it has taken this limited approach.

Robert Wood Johnson, the nation’s largest health-care grant maker, has a decades-long history of supporting research on drug-use prevention and treatment. The foundation has viewed drug and alcohol addiction as treatable chronic health conditions. It provided about $52,000 for research that estimated the safe injection sites could improve health and reduce medical costs in Philadelphia, but it has not followed up with related grants.

Donald Schwarz, Philadelphia’s former health commissioner and now a senior vice president at the foundation, says Robert Wood Johnson has made an effort to build a “culture of health” where all Americans have the opportunity to improve their well-being.

Schwarz declined to provide an opinion on whether the safe sites would be a plus for public health and referred questions about the study it funded to the researchers.

“We’re not going to build a culture of health alone,” he said. “So we talk very intentionally about working with others to build a culture of health. And what that means, in this case, is there are parts of the work toward building a culture of health that we do and there are things that we don’t do.”

The fact that Robert Wood Johnson has not followed its support of research with grants to fund the sites themselves disappoints Kima Taylor, founder of the Substance Use Funders Group, a network of foundation staff and leaders who want to emphasize treating drug addiction rather than punishing addicts.

“The thing that makes me mad about them is they did foundational work on substance use,” she says. “And now they’re not in this space at all.”

Harm-reduction programs, including safe injection sites, were slow to catch on because drug users are treated as pariahs by society at large, said Taylor, a pediatrician who used to oversee grant making on harm reduction at Open Society Foundations.

During the war on drugs, policymakers preferred a punitive approach. The basis for that, Taylor said, is a racist mind-set that dehumanized Black drug users and scapegoated them as the cause of the rise in overdoses.

To win people over, Taylor believes public-health leaders will have to provide hard evidence that the safe sites don’t lower the quality of life in the neighborhoods where they are set up but that they lower hospital and ambulance costs, reduce transmission of hepatitis and HIV, and, most important, are leading to a drop in fatal overdoses.

Taylor is creating a community advisory board for her group to engage with people in neighborhoods with planned centers who can feel blindsided by the decision to place a site nearby. But to gain even deeper support, Taylor said, it will take personal testimonials, especially from white people.

“It’s going to require people who use the service and are now in recovery to say how it saved their lives,” she said. “There have to be people of different colors and, ideally, a really wealthy white person that used it and now has recovered.”

Matt Rourke, AP

Not Heavy-Handed

As nonprofit leaders in Philadelphia await the Department of Justice’s decision on Safehouse, the federal government has already embraced harm reduction more broadly. In December the Substance Abuse and Mental Health Services Administration made $30 million in grants available to groups providing a range of services, including counseling and the provision of fentanyl test kits. Those grants, part of a larger federal overdose-prevention strategy, are complemented by philanthropic efforts, including a $120 million commitment Bloomberg Philanthropies made in November to support harm-reduction efforts in seven states.

The Bloomberg grants will go toward providing naloxone, building better drug-use tracking data systems, and harm-reduction advocacy efforts at the state and federal levels. Bloomberg declined to comment on whether safe injection sites are a viable approach to reducing the overdose epidemic.

But Vital Strategies, a Bloomberg grantee that is directing much of the foundation’s cash to harm-reduction programs at the state and local levels, seems to be embracing the safe sites as an option. In February, Vital Strategies spent $500,000 of the money from Bloomberg on a media campaign, including full-page advertisements in the New York Times and commercials on several cable channels. The campaign, which promoted the distribution of naloxone to families of drug users, was intended to build awareness of safe injection sites as a viable approach, according to Vital Strategies. The nonprofit plans to spend $100,000 on a similar campaign at the state level.

Daliah Heller, director of Vital Strategies’ drug-use programs, says the sites can be a crucial part of a broader harm-reduction strategy.

But the nonprofit has not directly worked to open a safe injection site. Before a site is opened, people who live nearby need to learn more about it and support the approach, Heller says.

“We follow the lead of what’s happening on the ground in the states where we work,” Heller says. “We’re not trying to go in to make things happen that are not being driven locally. Otherwise, we’d be heavy-handed.”

Seeing Is Believing

Legislation is now pending in five states that would legalize safe injection sites, according to the Drug Policy Alliance, which favors their use. But they remain controversial: Bills in six states have failed. The idea that solving the nation’s overdose crisis involves setting up places where people can use drugs can seem counterintuitive, making it a tough sell as a policy, say proponents of the sites.

If the negotiations between Safehouse and the Department of Justice result in federal approval of a safe injection site, foundations may get a clear green light to support safe sites across the country, observers say. But the approach faces a wall of opposition from police departments and from neighborhood activists who don’t want the centers on their streets.

The International Association of Police Chiefs posted a resolution on its website that declares the group “has serious concerns that [safe injection facilities] will increase drug trafficking and entice more crime as addicts pursue cash to finance their habits, and this will result in compromised public safety while requiring additional law-enforcement resources.”

The association, which lists support from Arnold Ventures, Bloomberg Philanthropies, and the Joyce, MacArthur, and Target foundations, did not respond to requests for comment.

Personal testimony from people who have used safe injection sites is key to generating support, says Sarah Evans, division director for drug policy at the Open Society Foundations, who managed a safe injection site in Vancouver.

“With issues like this, you need to see it to believe it,” she said. “People need to see that it’s possible that all the terrible things that they predicted aren’t going to happen.

That approach backfired when Joe Pyle, president of the Scattergood Foundation, took Philadelphia city leaders on a visit to sites in Toronto. Pyle came back full of hope after seeing clean, calm centers surrounded by nice neighborhoods, where, he says, housing prices were on the rise. But some elected officials didn’t feel the same way. Some city council members came back determined to block a site in their wards.

Pyle says he and other nonprofit leaders didn’t follow the site visit with meetings with councilmembers and their constituents, which might have changed their minds.

“We had a great idea, and we failed to execute,” Pyle said.

As Safehouse shifted from planning its center to waging a legal battle, Scattergood also switched its approach. Instead of doing things to educate people about the site, it made grants to pay lawyers fees.

Bigger checks from national foundations would have helped, says Ronda Goldfein, executive director of the AIDS Law Project of Pennsylvania, who established Safehouse as a free-standing nonprofit with Benitez. But the money hasn’t materialized. The biggest sticking point, she says, was the uncertainty surrounding the legality of the sites.

The uncertainty stems from the 1986 federal drug law commonly known as the crackhouse statute that targets landlords of properties maintained for drug use. The law has scared away some foundation trustees and leaders who fear any grants made to a safe site could trigger big fines or jail time.

But going after foundation officers would contradict the federal stamp of approval that the Internal Revenue Service has already given to Safehouse, Goldfein argues. That came, she says, when the IRS recognized its mission to improve people’s lives and approved the group’s status as a nonprofit organization dedicated to opening a safe injection site.

That argument hasn’t unlocked a lot of cash from major donors.

“We’ve had conversations with big funders, but it was clear that it was never going anywhere and they were just kind of humoring us,” she said. “But that’s a big ask of a foundation to say, ‘Not only do we want you to support us for an activity for which we’ve been sued but where the criminal liability could possibly extend to you.’”

Reporting for this article was underwritten by a Lilly Endowment grant to enhance public understanding of philanthropy. See more about the grant and our gift-acceptance policy.