D.C. to open sobering centers as fatal overdoses remain at record highs

August 12, 2024

Under pressure to enhance the city’s response to an escalating opioid crisis, the administration of Mayor Muriel E. Bowser is preparing to open the first of two sobering centers designed to divert drug users from emergency rooms and jail cells.

The facilities — in place for years in cities such as Baltimore — would be the first of their kind in the District, which is suffering the second-highest rate of fatal opioid overdoses in the nation with an annual death toll more than twice that of homicides.

City officials see the centers as another tool in the District’s response kit — places where people can rest, shower, put on clean clothes and begin treatment if desired in a respectful setting where clinical staff are trained to administer the overdose antidote naloxone.

But harm reduction advocates and several D.C. Council members question why the centers are not accessible to residents east of the Anacostia River. They are pressing city officials to be bolder in their efforts to reduce the death rate, especially with millions in opioid settlement dollars available to spend soon.

City data shows the NoMa commercial strip slated to house the District’s first sobering center is in a Ward 6 Zip code hit hard by deadly overdoses last year, but most of the 461 who died in 2022 lived in wards 5, 7 and 8.

“There seems to be a missed opportunity here,” said council member Zachary Parker (D-Ward 5). “We need to act more urgently and treat this as the public safety and public health crisis that it is.”

Some experts and reform-minded policymakers contend that to truly save lives, the city should go a step further and develop a facility where people can use illegal drugs under the watch of staff trained to reverse overdoses — a full embrace of society’s shift away from criminalizing addiction. Only New York is home to these centers in the United States and, while a pilot program is planned for Rhode Island, similar proposals hit roadblocks recently in other major U.S. cities gripped by drug deaths. And D.C. has an additional barrier: congressional approval.

“It’s a political issue. The science is very clear that they save lives and are also very instrumental in getting people into treatment,” said Edwin Chapman, a physician who treats people who use opioids and is an outspoken advocate for harm reduction.

Chapman watched firsthand as the introduction of fentanyl and its analogues devastated the population of D.C. drug users, with 98 percent of fatal overdoses involving fentanyl in 2022, nearly doubling from early 2016, data shows. The vast majority of victims, 85 percent, were Black.

Advocates say the rapid escalation in overdoses and overdose deaths warrants a closer look at supervised places where people can use illegal drugs, which a Bowser working group in 2019 recommended for wards 5, 6, 7 and 8. Council member Janeese Lewis George (D-Ward 4) requested $15 million last year for two such centers after visiting a site in New York.

The Bowser administration is seeking to keep the focus on the sobering centers as part of the District’s overall strategy to combat opioid use, including the distribution of naloxone and fentanyl test strips, which are available in free vending machines. The first center is scheduled to open at 35 K St. NE in late September or early October.

The Department of Behavioral Health, the city’s lead opioid response agency, has so far been noncommittal on city-operated spaces where people can use illegal drugs.

“Quite frankly, you know, I don’t know enough about it and am currently in the process of gathering information, so that I would be able to then be in a better position to address that,” said DBH Director Barbara J. Bazron, who was appointed by Bowser (D) in 2019.

Even advocates for the option, often termed an overdose prevention center but sometimes called safe or supervised injection sites, acknowledge the approach is likely to draw negative attention from congressional Republicans, who have sought to block District policies they view as too liberal.

Congress intervened in the District’s harm reduction plans until 2007, when it lifted a ban on the use of federal funds for needle exchange programs — now ubiquitous across the country and a key part of the Bowser administration’s opioid abatement strategy.

Republicans in Congress have also blocked laws from an overhaul of the District criminal code to restricting how D.C. spends local funds on subsidized abortion or the development of a legal recreational marijuana industry, providing a clue as to how they’d regard overdose prevention centers. There are more than 200 safe injection centers operating in 14 countries, including Canada, Australia and Portugal, according to the Drug Policy Alliance.

“We have Congress down the road. They would love nothing more than to disrupt in the same manner they have in the past,” said council member Christina Henderson (I-At Large), chairwoman of the health committee. (Bazron, Henderson, Parker and others are scheduled to visit OnPoint, which runs two overdose prevention centers, in New York later this month, the council offices said.)

Ambrose Lane, founder of the Health Alliance Network, which advocates for better outcomes for communities of color, said that at first he, too, feared overdose prevention centers would promote use over treatment.

But, he said: “The injection sites are already there. The question is whether we make them harm reduction. … I’d rather you be alive and treated then out on your own and dead.”

With the District focused on sobering centers, Shane Sullivan, a community outreach specialist at the harm reduction agency HIPS, and other advocates involved in a grass-roots response to the crisis say they have questions — both about the location and the city’s choice to partner with an out-of-state operator.

“Anywhere east of the river we know people are just dying en masse there and bearing the brunt of this,” Sullivan said.

Bazron, the city behavioral health director, said the agency used D.C. Fire and EMS Department data on nonfatal overdose calls to decide where to place the centers. Procurement paperwork for the centers using 2019 data shows that the agency transported about 25 people a day who were under the influence but not sick enough to occupy a hospital bed.

“As we look forward, we hope there will be other locations that will be possible in which we can build other stabilization and sobering centers,” Bazron said. “But this is the first one … and we have a second one. And both of those are in government-operated facilities.”

The District already runs a mental health clinic at the Northeast D.C. location on K Street, which will have operations costs of about $2.9 million in the first year and $2.4 million next year, Bazron said. Building out the second site, in a historic firehouse at 1338 Park Rd. in Columbia Heights, will be more costly, with $9.5 million in capital expenses alone.

She said the city had to put out requests for proposals several times before Community Bridges, an Arizona-based company, was chosen in a process she said is controlled by the city office of contracts and procurement. A spokesman for the firm, which operates mobile crisis teams, inpatient psychiatric care and supportive housing, referred questions to the District.

Bazron, who was deputy health secretary in Maryland when the Baltimore sobering center opened, said she visited a site it operates in Arizona and was impressed with an environment she characterized as welcoming. The center she saw provided a range of supports that will be offered in D.C. Clinical staff as well as peers who have experienced addiction and mental illness will also be on-site, she said. Because workers will be doing crisis services, Bazron said they can bill Medicaid for some of their work.

Walk-ins will be welcome, but officials expect the D.C. fire department and police will drop off many people under the influence of a range of substances, including alcohol. The intake process should be quick, no more than 10 minutes, according to the request for proposals. The center will operate 24/7 with 10 beds in the first year, increasing to 16 beds the following year to admit about 3,500 people for as long as three days, the document says.

Although drug use will not be allowed in the centers, Bazron said, people can safely store their belongings in lockers, shower and get clean clothes and food, and connect to treatment if they so choose.

“We are really trying to saturate the District in terms of looking at harm reduction,” Bazron said. “We need to make sure we keep people alive. We need to make sure that people feel it’s okay to get treatment and we destigmatize that. We’ve got to get it out of the closet.”

With $80 million in opioid settlement dollars projected to trickle into District coffers by 2040, city leaders will soon have fresh choices.

Jennifer Loken, a psychotherapist and the manager of substance use treatment services at Whitman-Walker Health who helped write the 2019 report on the feasibility of overdose prevention centers, encouraged them to make the most of the opportunity.

“This sort of effort to incarcerate, adjudicate drug use, it’s not working, it hasn’t worked and it doesn’t matter how much we want it to. You can keep putting money there, but it’s not solving the problem,” she said.

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