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Feds' Response to Denver's Safe-Use Site Plan: Weak, Toothless, Mega-Stupid

Injection booths at Insite, a supervised injection site in Vancouver visited by a delegation from Denver in January.
Injection booths at Insite, a supervised injection site in Vancouver visited by a delegation from Denver in January.
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A joint statement released on December 4 by the U.S. Attorney's Office for the District of Colorado and the Drug Enforcement Administration regarding what's described as "Denver’s Proposal to Create Supervised Locations to Inject Heroin and Other Illegal Drugs" was clearly meant to undermine the project. Instead, the momentum for a safe-use site in the Mile High City is likely to increase, thanks to a document that's more political than legal and uses the same tired assertions that have made the War on Drugs a losing battle for decades.

After the release was made public, Westword reached out several times to Jeff Dorschner, spokesman for recently named U.S. Attorney Jason Dunn, a former member of Denver's powerful Brownstein Hyatt law firm, but we have not yet received a reply. So we'll let the text of the feds' statement about the Denver proposition (which needs approval from the Colorado Legislature before it can take effect) speak for itself — and then take on the points one by one.

The Introduction: The Denver City Council recently passed an ordinance that proposes establishing supervised use sites, where drug users would be allowed to lawfully inject heroin and other illegal drugs in a facility operated by a governmental organization or a nonprofit. This proposal still has a number of steps to go before it becomes a reality. In the meantime, there are a few things Coloradans should know.

Our take: Nothing inherently false yet. But get ready.

Attack one: Foremost, the operation of such sites is illegal under federal law. 21 U.S.C. Sec. 856 prohibits the maintaining of any premises for the purpose of using any controlled substance. Potential penalties include forfeiture of the property, criminal fines, civil monetary penalties up to $250,000, and imprisonment up to 20 years in jail for anyone that knowingly opens, leases, rents, maintains, or anyone that manages or controls and knowingly and intentionally makes available such premises for use (whether compensated or otherwise). Other federal laws likely apply as well.

Our take: You know what else is against federal law? The possession, use and sale of marijuana. And unless we're very much mistaken, all of those things are happening in Colorado and a slew of other states across the country right now, despite nearly identical warnings from various law enforcers in the administration of President Donald Trump. As for the use of the word "likely" in the last sentence: Don't you guys know for sure? Couldn't you have had an intern look it up for you?

U.S. Attorney Jason Dunn, during his days at Denver's Brownstein Hyatt law firm.
U.S. Attorney Jason Dunn, during his days at Denver's Brownstein Hyatt law firm.

Attack two: Second, there is no evidence that such sites actually reduce the number of drug-related deaths or make it more likely that users will seek help for their addiction or mental health issues. Indeed, a recent review of one facility in Vancouver found that the overdose death rate in the immediate vicinity of the facility was actually the highest in the city. This may be due in part to the fact that while these facilities are touted as being “safe” because of the availability of opioid antagonists (e.g., Naloxone or Narcan), these facilities are not actually limited to opioid users. Those injecting methamphetamine, cocaine, or other drugs for which there is no counteragent are also welcome to use the facility. The Denver facility likewise would welcome users of any drug, not just opioids.

Our take: There are so many whoppers in this paragraph that Burger King should sue for copyright infringement. As National Public Radio acknowledged in a September analysis, proof that safe-use sites work isn't overwhelming, in part because of the difficulties inherent in studying this particular population. But to say there's no evidence at all is a flat-out falsehood. For starters, scope this snippet from a report by the Journal of the American Medical Association, complete with original links:

Dozens of cities around the world host SIFs [Safe Injection Facilities], and 2 are planned in Seattle. A SIF that opened Vancouver, Canada, in September 2003, has been extensively researched. Studies have found the Vancouver SIF and its use were associated with safer injection techniques and practices, reduced syringe reuse and sharing, fewer injections in public and publicly discarded syringes, increased entry into drug detoxification programs, no overdose deaths, and no evidence of increases in drug-related crime.

Not enough for you? Eyeball this summary of findings in a study by the College of Family Physicians of Canada, helpfully labeled "evidence:"

• One high-quality cohort study examined overdose mortality before and after an SIS opened in Vancouver, BC.

— Of persons living within 500 m of the SIS (70% of SIS users), overdose deaths decreased from 253 to 165 per 100 000 PYs and the absolute risk difference was 88 deaths per 100 000 PYs; 1 overdose death was prevented annually for every 1137 users.

— There was no change in mortality in the rest of city.

• Before the SIS opened, 35% of 598 intravenous drug users were admitted to hospital in a 3-year period, 15% for skin infections.

— After the SIS opened, of 1083 SIS users over 4 years, 3 9% were admitted with cutaneous injection-related infections (including osteomyelitis and endocarditis).

— While SIS nurse "referral" to hospital increased the likelihood of admission, the average length of stay decreased by 8 days (from 12 to 4).

— Indirect comparison of different cohorts is a limitation.

• Near one SIS, average monthly ambulance calls with naloxone treatment for suspected opioid overdose decreased from 27 to 9 (relative risk reduction of 67%).

• About 6 to 57 HIV infections per year are prevented by the SIS according to mathematical modeling.

— Limitations include assumptions made about drug use and injecting practices, and might include benefit from needle exchange programs.

Against this, the U.S. Attorney's Office and the DEA offer an unspecified "review" and a single vague negative reference. That's really going the extra mile.

Denver City Council member Albus Brooks embraces Harm Reduction Action Center executive director Lisa Raville after the pilot program was approved.
Denver City Council member Albus Brooks embraces Harm Reduction Action Center executive director Lisa Raville after the pilot program was approved.

Attack three: Third, these facilities actually increase public safety risks. Just like so-called crack houses, these facilities will attract drug dealers, sexual predators, and other criminals, ultimately destroying the surrounding community. More importantly, the government-sanctioned operation of these facilities serves only to normalize serious drug usage — teaching adults and children alike that so-called “safe” drug usage is somehow appropriate or can actually be done 'safely.' The type of drug use contemplated here is always life-threatening behavior.

Our take: Speaking of evidence, not even the flimsiest sort is mentioned here. Instead, the authors fall back on fear-mongering tropes intended to reinforce dubious stereotypes rather than debunking them. Come on, guys! Try a little harder!

Attack four: Finally, we note that nothing in this statement should be read as casting aspersions on the laudable motives of those seeking to improve our communities and free Coloradans from the scourge of drug addiction. The U.S. Attorney’s Office and the Denver Field Office of the Drug Enforcement Administration support all methods of legal intervention to address the opioid and methamphetamine crisis in Colorado, and in fact work hard to facilitate them every day.

Our take: The feds believe that the opioid crisis is a bad thing — but they want to tie the hands of local authorities interested in addressing it in new and innovative ways. That'll fix it!

The coda: But these efforts must comply with federal law. Efforts that do not comply with federal law risk action by the U.S. Attorney’s Office using any and all federal remedies available.

Our take: This falls well short of a crackdown promise; it's more of a flimsy threat of the sort for which Denver officials have long been prepared. When we spoke to Denver City Council member Albus Brooks about his advocacy of supervised-use sites back in October, we pointed out that Trump administration officials had previously warned other cities about possible legal action should they open such facilities.

His response? "As you know, Colorado was the first state in the country to legalize [recreational] marijuana, which the federal government did not condone. There are many instances in our policies where we have had a different perspective than the federal government. So that's not a concern."

Brooks's reply to the feds' finger-wagging seems similarly unbothered; we've reproduced it below in its entirety. And Mayor Michael Hancock, who waited until Denver City Council had passed the safe-use bill to confirm that he plans to sign it, wasted no time standing up for the concept, as seen in this interview clip tweeted by Fox31 reporter Joe St. George:

Granted, such sites are controversial, as witnessed by the varied reactions to the measure's passage from Westword readers. But both Brooks and Hancock will only enhance their reputations by standing up to the feds on this issue — and the tepid push-back from Trump's minions has made doing so a snap.

Here's the aforementioned statement from Brooks:

Assorted supplies available to participants at the Harm Reduction Action Center.
Assorted supplies available to participants at the Harm Reduction Action Center.
Photo by Michael Roberts

Ordinance 1292 to Create Supervised Use Sites will Help Prevent Overdose Deaths

The United States Attorney's Office for the District of Colorado and the Denver Field Office of the Drug Enforcement Administration issued a joint statement in response to the passage of ordinance 1292, sponsored by Councilman Albus Brooks. This ordinance creates a supervised use site pilot program in Denver. Supervised use sites provide a safe space for injection that is monitored by trained staff, helping prevent overdose deaths and the transfer of preventable diseases. These sites also help connect drug users with treatment and healthcare support.

Councilman Brooks provided the following response to the joint statement:

"Last year, more than 1,000 of our neighbors in Colorado died of an overdose. As the U.S. Department of Health and Human Services has continued to affirm, we are facing a national public health emergency, and cities are on the front lines. While we recognize the role of the federal government, we cannot wait for federal action while the death toll rises. These people are not simply addicts. They are our neighbors, friends, and family members who are experiencing addiction. As a designated local public health department, the city through the Denver Department of Public Health and Environment has the authority under law to address and regulate this type of emergency. Extensive research and global precedent demonstrate that supervised use sites save lives. Choosing not to save the lives of our neighbors is an injustice that threatens to destabilize the very foundation of our society. This is a piece of a larger plan to address this epidemic, and as leaders we know that saving lives takes precedent over politics. Now is the time to act."

Cities across the nation are considering opening supervised use sites to combat the growing overdose epidemic. It is estimated that emergency services in the city are responding to almost three overdoses per day. Studies have shown that supervised use sites not only save lives, they do not increase crime in the areas where they are located, and save money by reducing the number of 911 calls, ambulance responses, hospital stays, and treatment for transferable diseases.

The ordinance designates one pilot supervised use site in the city that would be monitored for two years. In order to implement the supervised use site pilot program, a bill will also have to pass through the state legislature in the 2019 session.

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