According to the Centers for Disease Control and Prevention, overdoses on opioids – which encompass heroin, synthetic opioids like fentanyl, and commonly prescribed pain relievers such as OxyContin and Vicodin – caused 115 deaths per day in 2016. That’s a staggering 42,249 deaths in that year alone, an increase of 141 percent from just ten years earlier. (This graph from Vox includes data from 1999 to 2017).

In addition to the pain and suffering experienced by these individuals and their families, the sheer volume and rapid growth of opioid overdoses are causing severe public health and economic crises. In fact, it’s estimated that “the total economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.”

One possible intervention is gaining more attention recently – offering safe, medically-supervised sites where patients can inject opioids. In addition to clean needles and access to overdose-reversal medications, services offered may also include counseling and/or referral to social services and drug abuse treatment. It’s worth noting that drugs are not provided, handled, or injected by medical professionals at these sites.

Referred to by a number of names – including supervised consumption services, overdose prevention centers, and safe injection sites – the Drug Policy Alliance cites a range of benefits provided by these facilities, which are indicated by evidence-based, peer review studies. Among these are reducing the risk of HIV and Hepatitis C transmission, reducing public safety concerns like disorderly conduct and public injecting, and managing on-site overdoses.

Although the United States does not yet have any safe injection sites, other countries have had encouraging results. About 100 safe injection sites exist globally – 66 cities in nine countries – one of which was opened in Sydney, Australia over 15 years ago. According to data from Uniting, the facility’s operator, overdose deaths have been prevented in more than 8,000 cases since its opening, and workers have made more than 13,000 referrals to drug treatment programs. Insite, North America’s first legal safe injection site, opened in Vancouver, Canada in 2003 in response to the city’s own opioid epidemic. It’s resulted in the prevention of more than 6,000 overdose deaths and hundreds of referrals to the adjoining detox treatment facility.

In the U.S., critics of safe injection sites argue that the facilities could undermine drug enforcement and discourage people from seeking drug addiction treatment. A 2018 study led by researchers at Johns Hopkins Bloomberg School of Public Health is “the first to poll a large, nationwide, representative sample of Americans for their views on safe [injection sites],” and found that out of 1,004 respondents, only 29 percent supported the facilities. Perhaps more notable is the stance of the federal government, which is decidedly against the introduction of safe injection sites. U.S. Deputy Attorney General Rod Rosenstein criticized the idea, telling NPR, “I’m not aware of any valid basis for the argument that you can engage in criminal activity as long as you do it in the presence of someone with a medical license.”

Despite opposition at the federal level, some cities are moving ahead with plans to open safe injection sites, including San Francisco, Seattle, and Philadelphia. Philadelphia, which has one of the highest opioid death rates in the U.S., is the closest to making safe injection sites a reality. But it won’t come without a fight – the U.S. Department of Justice has filed a lawsuit arguing that the site would violate the Controlled Substances Act by facilitating illegal drug use. In response, the non-profit organization intending to operate the site issued a statement, saying, “Safehouse believes that supervised consumption sites are legal and save lives. We welcome the opportunity to present to the court the credible evidence and research that has informed our belief.”

While Americans disagree about setting up safe injection sites, there is shared concern that opioid addiction is clearly on the rise. A survey conducted by The Associated Press-NORC Center for Public Affairs Research shows that 43 percent of Americans “say the use of prescription pain drugs is a serious problem in their community,” up 33 percent from two years ago.