For nine years, I’ve worked with the population experiencing homelessness in Minneapolis — through drop-in centers, shelters, housing facilities and clinics. Every December, we remember people who died while experiencing homelessness. Since 2017, the No. 1 cause of death is overdose. If we don’t take decisive action, the number will keep going up.

Substance-use disorders are a chronic illness. One of the devastating progressions of this illness can be the injection of a substance. We must remember that these individuals are human beings first; they are still our family members and loved ones. Unintended consequences of this outcome are sharing of needles, buying substances that are mixed with fentanyl, and injecting in isolated and unsanitary environments. I do not believe we need to condemn people to possibly contract HIV or hepatitis or die from an overdose. There is another option.

Supervised injection sites, in other jurisdictions and nations, have proved to lower the number of drug injection and overdose-related deaths. There are approximately 100 supervised injection sites around the world; the first opened 36 years ago in Switzerland. At these sites, individuals bring their own substance. The sites provide individuals with clean injection supplies so they can inject under the supervision of medical staff in a clean and monitored environment. If needed, medical staff can administer naloxone, a drug that reverses an opioid overdose. As of the last survey in 2018, not a single person has died at one of these sites.

The Alternative to Public Injecting report released by the Harm Reduction Coalition, an American advocacy organization, addressed common concerns by communities located near proposed supervised injection sites. Their research shows that these sites do not encourage or increase drug use. In fact, they found that crime decreases in the neighborhoods around these sites. Public Safety Canada released a review of public safety research on supervised injection sites that also concluded that crime around supervised injection sites decreased after the site opened.

This is a time-sensitive matter. On Feb. 3, the Minnesota Department of Health released a health advisory on the 13 new cases of HIV diagnosed between December 2018 and January 2020. All of these cases were diagnosed in the metro area among people who inject drugs, many of whom are experiencing homelessness. This is a 116% increase in annual diagnoses.

Additional research shows that opening supervised injections sites in the Twin Cities would decrease the number of people injecting drugs in public spaces and subsequently would decrease the number of hazardous needles left out in public. Ambulance and police calls would be less frequent, saving taxpayer dollars. There would be fewer new cases and transmission of HIV and hepatitis. Furthermore, these sites offer additional services, such as recovery and treatment program assistance. They also provide access to medications like methadone and buprenorphine (also known as suboxone), which treat opioid addiction.

Let’s look at this in a historical context: Alcohol is a drug that when ingested in large doses can be deadly. During prohibition in the 1920s, speakeasies sold alcohol that was tainted with unsafe contaminants. Once alcohol consumption was regulated again, supervised use spaces, aka licensed bars, allowed people to consume alcohol in designated areas. Likewise, supervised injected sites have proved to have the same health and safety benefits for the entire community.

Substance use disorders are a chronic illness. To treat this illness, evidence behind supervised injection sites shows that there is greater access to treatment, recovery and safe health practices. Currently, the possession and consumption of illicit substances is illegal, therefore, creating a safe injection site is legally challenging. However, we have a positive example from Philadelphia, where federal judges have ruled that Safehouse, a supervised injection site nonprofit, does not violate federal law. The Twin Cities need to follow this example and make a change in how we approach mitigating the public health risks involved in unsupervised drug injection.


Sarah Stackley is an administrative worker for a program serving people experiencing homelessness.