Last month, Gov. Dan McKee signed legislation making the Ocean State the first to legalize safe injection sites, dubbed “overdose prevention sites” by harm-reduction advocates. Hopefully, Rhode Island won’t run into the same federal buzzsaw that Philadelphia encountered when a privately funded group of citizens received the city’s permission to establish Safehouse.

Claiming safe injection sites violate the 1986 “Crack House Statute” making it a felony to “knowingly open, lease, rent, use, or maintain any place for the purpose of manufacturing, distributing, or using any controlled substance,” the Justice Department took Safehouse to court. Its future is now in legal limbo. Federal prosecutors say safe injection sites don’t work. Yet, despite federal proscription, safe injection sites have been working quite well — albeit illegally — under the radar in the U.S. for years.

In a 2017 American Journal of Preventive Medicine article, University of California San Diego researchers shared data from a clandestine safe injection site opened in 2014 by a social service agency in an undisclosed urban area. The researchers maintained the site’s secrecy. The site has one large room dedicated to safe injection with an adjoining room for post-injection monitoring and supervision. (Safe injection sites always provide “chill” rooms in which clients stabilize before leaving.) The site was open four to six hours a day, five days a week. During its first two years in operation, two overdoses were reversed with naloxone and there were no overdose deaths. The site averted 2,300 instances of public injection during that time frame. All syringes used were safely disposed of by the facility, averting an estimated 1,725 public disposals.

A follow-up study in 2019 by nonprofit research institute RTI International revealed that the site expanded its operation to eight to 10 hours per day, five to six days a week, but to maintain secrecy was “invitation only.” Over the period of the study, 540 clients injected 9,000 times. Twenty-six overdoses were reversed and there were no deaths. Nearly 8,400 public injections were averted. The facility was well accepted by the community.

Last August, those same researchers delivered updated data through 2019 in the New England Journal of Medicine. The secret safe injection site had, by then, reversed 33 overdoses. There were still no deaths. There were also no instances involving emergency services since the site’s inception. Of note, the proportion of injections involving combinations of stimulants like cocaine or meth with opioids increased from 5% to 60% over the period.

In March of this year, the researchers reported crime data. The site had no effect on crime in the area, which continued declining at a similar rate from 2014–2020. There was also no increase in interpersonal crime in the surrounding area over that period.

Several other sites operate on the down-low. In the Pacific Northwest, the People’s Harm Reduction Alliance reported on “dozens” of underground safe injection sites in the Seattle area. Some are run by volunteers in rented houses. Others are run in apartments and are reminiscent of Prohibition-era “speakeasies.” Some operate beneath small storefronts in darkly lit areas with tables and chairs. Many are staffed by volunteer health professionals.

Safe injection sites have been around since the 1970s. The first government-sanctioned facility was established in Bern, Switzerland, in 1986. Germany sanctioned “drug consumption rooms” (DCRs) in 1994. A 2011 German retrospective analysis concluded DCRs “make a decisive contribution for survival assistance and risk minimization when consuming illegalized drugs,” and “DCRs significantly contribute to limiting the spread of infectious diseases such as hepatitis and HIV in addition to individual health protection.”

There are now over 120 safe injection sites in more than 66 cities in Europe, Australia and Canada. In 2003, Insite in Vancouver, B.C., became the first one in North America.

Congress and the Biden administration have both shown a renewed appreciation for harm-reduction strategies to confront the overdose crisis. The Biden administration should urge its Justice Department to exercise prosecutorial discretion so safe injection sites can get under way in Rhode Island and proceed in Philadelphia without fear of federal intervention. Congress should repeal the Crack House Statute, which was passed at a time when few were aware of safe injection sites, and blocking them was never the legislators’ intent.

Rhode Islanders should respond to critics by pointing out not only the successes of legal sites throughout the developed world, but of illegal sites here at home.