Utah already allows needle exchange for addicts. Will it take the next step and allow safe injection sites?

(Scott Sommerdorf | Tribune file photo) "Jonathan" holds the syringe with a dose of black tar heroin as he prepares to inject himself on the median near the needle exchange tent on 500 West & 300 South, Thursday, August 3, 2017.

Three years after Utah lawmakers legalized syringe exchange programs to curtail the spread of disease, community groups have taken more than half-a-million dirty needles off the street and handed out about 834,000 clean ones.

Now, some local health advocates are pushing to take another — and more controversial — step toward mitigating the dangers of drug use, by creating safe havens where people can inject or consume substances under supervision.

Such centers, sometimes called supervised consumption sites or safe injection sites, are in operation in 12 countries, but attempts to open them in the United States have succumbed to political opposition and community pushback. While those battles have largely been waged in liberal-leaning states, Utah’s Legislature is poised to join the debate next year with a bill sponsored by Rep. Jen Dailey-Provost.

(Eric Risberg | AP file photo) In this photo taken Wednesday, Aug. 29, 2018, Marie Fauvel, left, and Pat Shea, right, talk at a reception desk at Safer Inside, a realistic model of a safe injection site in San Francisco. The model is an example of a supervised, indoor location where intravenous drug users can consume drugs in safer conditions and access treatment and recovery services.

“We don’t want people dying on our streets,” the Salt Lake City Democrat said. “It doesn’t matter that they break laws, that they’re using drugs. It doesn’t matter that they’re an addict. Everybody deserves an opportunity to get therapy, to get clean, to have a job and a life that’s meaningful for them.”

But for many people, even champions of the state’s needle exchange programs, the idea is too extreme and crosses a line into wholesale acceptance of illegal drug abuse.

Rep. Steve Eliason, who sponsored the 2016 legislation allowing syringe exchange in Utah, said he doesn’t generally take a position on bills before he’s read them, but he’s opposed to the concept of supervised consumption sites.

“We, as a society, don’t want to say this is OK," the Sandy Republican said, “and that we’re going to help facilitate it.”

Dailey-Provost’s bill is in the earliest stages of development, and she only has a general sense of how it would be written. However, she said it won’t call on the government to run any of these consumption sites and will simply let private organizations open them.

The Utah Harm Reduction Coalition would be first in line to establish a supervised consumption site, probably somewhere in Salt Lake City, said Mindy Vincent, the group's executive director.

The coalition is one of several organizations in Utah replacing dirty needles with clean ones, and Vincent said these programs and supervised consumption services shouldn’t be viewed as permission slips for drug use.

(Petros Giannakouris | AP file photo) In this 2013 photo, A drug user cleans his arm at a supervised injection site in central Athens. Drug experts and policy makers from around Europe gathered in Athens to urge their governments to exclude drug treatment from economic austerity programs, citing an alarming rise in HIV infections among drug users in Greece. The number of reported new infections among drug users in Greece shot up from 22 in 2010 to 245 in 2011, according to the European Centre for Disease Prevention and Control. Experts blame the rise on a number of factors, several related to Greece's major financial crisis.

“We already have consumption sites. They’re Maverik bathrooms, Burger King bathrooms, the port-a-potties down at Pioneer Park,” Vincent said. “People are consuming substances no matter what.”

The real question, she said, is whether it’s better to inject heroin while in a public bathroom or in a supervised center, where trained staff are on hand to stop an overdose.

Vincent said she’s visited these centers in Switzerland, where the first drug consumption room was opened in the 1980s. There, people arrive with their own drugs. After signing in, they wait until their number is called. At that point, they’re escorted into a clean room, where they’re allotted some time to inject or otherwise consume a substance, with medical staff watching through a window or over video surveillance in case of complications.

Legislation to permit these centers has been considered and rejected in New York, Massachusetts, Colorado and Missouri, among others. California lawmakers last year passed a bill on safe injection, but former Gov. Jerry Brown killed it with a veto.

(Eric Risberg | AP file photo) In this photo taken Wednesday, Aug. 29, 2018, Linda Montel shows off supplies on a check in desk at Safer Inside, a realistic model of a safe injection site in San Francisco. The model is an example of a supervised, indoor location where intravenous drug users can consume drugs in safer conditions and access treatment and recovery services.

The measure, which was reintroduced this year, is expected to clear the California Legislature again and get a warmer reception from sitting Gov. Gavin Newsom, says Lindsay LaSalle of the Drug Policy Alliance.

Some cities have chosen to forge ahead on supervised injection sites, even without permission from their state legislatures, LaSalle said. A nonprofit in Philadelphia has built local support to open a center but is pitted against the Justice Department, which has filed a lawsuit asserting the facility would violate federal law.

LaSalle said a state-authorized center would likely benefit from a higher degree of legal protection against federal enforcement.

The worry that these facilities will encourage drug abuse doesn’t bear up against the data, LaSalle said, with studies showing that the centers can reduce overdose deaths. The American Medical Association favors piloting supervised injection facilities, citing evidence that the centers could prevent the spread of disease and drug fatalities while encouraging people to begin treatment.

And, Vincent points out, people who visit the sites are exposed to resources, testing and treatment options. Building connections with people in drug addiction is part of drawing them toward recovery, she said.

“Because isolating them, pushing them away and saying, ‘I can only accept you this far,’ that’s what’s killing people. Our disapproval is not working,” she said.

As the state faces an opioid crisis, Utah has embraced the overdose-prevention drug naloxone and given pharmacies the go-ahead to dispense it without a prescription. Dailey-Provost says her bill flows out of the same premise — that the state should prioritize keeping people alive long enough to leave addiction behind.

Both she and Vincent are anticipating pushback to the legislation next year, but they predict that tolerance for supervised injection will grow over time, as it did for the once-controversial syringe program.