Representative Stephen M. Casey is an unlikely crusader for supervised drug injection sites. 

A Democrat from Woonsocket, R.I., he’s also a Catholic and self-described conservative. He’s against abortion rights. And he supports the Second Amendment right to own a gun. 

So my first reaction was like no way,’’ Casey said. “As a rescue guy I’m like, we can’t give ‘em a shoot up center.”

Casey is also a firefighter and licensed emergency medical technician in Woonsocket. Last year, his city had the highest per capita rate of 911 calls for suspected overdoses in the state.  

“Guy comes home from work…and goes into the bathroom,’’ Casey said. “His wife doesn't even know he's doing it, and he OD's in the bathroom.”

EMTs try to revive people with naloxone, a medication that reverses an opioid overdose. But sometimes they don’t get there in time. Last year, 430 people in Rhode Island died of drug overdoses, the highest on record. 

Rhode Island is the first in the nation to legalize supervised injection sites. The two-year pilot program approved last June calls for creating safe places where people can consume heroin and other illicit drugs.

Studies of supervised injection sites in Canada and Australia show they reduced fatal overdoses and lowered the number of overdose-related 911 emergency calls.

The sites also were associated with less use of drugs in public outdoor spaces. And there was no apparent increase in crime.

Representative John G. Edwards, a Democrat from Tiverton, R.I., sponsored the bill to create the new harm reduction centers. “We're gonna let them come in and use their own drugs because that's when they have overdoses,’’ he said,  “and we want to be there to save them.”

Clients would bring their own drugs, and be given clean needles and a safe space to use them. Clients also would be allowed to smoke their drugs. Staff would be trained to administer naloxone when someone overdoses. 

Rep. Casey said staff also would offer clients information about drug treatment and other health services.

“I felt that, you know, this is something that…just might work,’’ he said. “And if it wasn't going to cost the state any money, we'd be crazy not to try it.”

At least 100 supervised injection sites operate around the world, mainly in Canada, Europe and Australia. Last November, New York City opened the nation’s first supervised injection site. Similar sites have been proposed in cities including San Francisco, Denver, Seattle and Philadelphia and nearby Somerville, Massachusetts. A plan to open a site in Philadelphia is currently blocked in court, and the Biden Administration hasn’t taken a position on it yet. 

Scott Burris of the Center for Public Health Law Research at Temple University says that while supporters of supervised injection sites are keeping their eye on what happens in Philadelphia, Rhode Island has a distinct advantage. Supervised injection sites are already legal in the state. “So the way looks pretty clear for Rhode Island at the moment,’’ Burris said.

But even with the state’s blessing, it’s expected to be months before Rhode Island’s first supervised injection site opens. The next hurdle: finding a place to open the sites. The law requires anyone who wants to open a supervised injection site to first get approval from the local city or town council.  The City Council in Woonsocket, where Casey is an EMT, recently proposed a resolution to prohibit the sites in their city. (The resolution was tabled March 21.) 

Even some elected officials who support the program are reluctant to say so publicly, said Lisa Peterson, chief operating officer at VICTA, a private substance abuse and mental health treatment program in Providence. That’s because for much of the public “this does seem really radical,’’ she said. “And an elected official who supports it, in theory, might worry about what their constituents think.”

Peterson said that VICTA  is looking to partner with other groups - including CODAC Behavioral Healthcare and Project Weber/Renew – to open a supervised injection site in Providence.

Rep. Edwards recently introduced a bill  to extend the deadline for the pilot program for another two years, to March 1, 2026. 

So while Rhode Island was the first state to legalize supervised injection sites, it’s going to take work to persuade public officials to allow a site in their backyard.

Health reporter Lynn Arditi can be reached at Follow her on Twitter @LynnArditi