United States vs Safehouse: The implications of the Philadelphia supervised consumption facility ruling for law and social stigma.

In October 2019, a federal judge ruled that a Philadelphia nonprofit (Safehouse) group's plan to open the first site in the U.S. where people can use illegal opioids under medical supervision does not violate federal Controlled Substances Act, delivering a major setback to Justice Department lawyers who launched a legal challenge to block the facility. The Judge wrote that "the ultimate goal of Safehouse's proposed operation is to reduce drug use, not facilitate it," which represents the first legal decision about whether supervised injection sites can be legally permissible under U.S. law. Although supervised consumption facilities ("SCFs") remain controversial, they already exist in many countries in Europe as well as Canada, Australia, and Mexico, and evaluations of their public health impact have demonstrated the value of this practice. The decision is hailed as a public health victory and could shape the legal debate in other U.S. cities. Challenges remain as stigmatizing attitudes regarding substance use are widely accepted, culturally endorsed, and enshrined in policy. The Safehouse case shows that SCFs might be able to survive under current federal drug laws, but public understanding and support of these facilities will also be crucial for cities and states to open them.

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Declaration of competing interest All authors have no financial conflicts of interest.