How to Respond to the Opioid Crisis: Re-conceptualizing Shooting Galleries

“It’s a way we all look out for each other, like, to make sure you got your clean cooker, your clean water, and alcohol.” It was 2007 and Charles (a pseudonym) and I were sitting in the back of Prevention Point Philadelphia’s mobile syringe exchange, a retrofitted RV containing safer injection supplies and a private room for HIV testing. Charles, a middle-aged African American man who had been injecting heroin since the early 1970s, was telling me about the shooting gallery that he ran in an abandoned row house in North Central Philadelphia.
As a harm reduction and HIV counselor at Prevention Point, I was learning from Charles about how people who use drugs have long taken measures to protect themselves – and their families, friends, and communities – from risks associated with drug injection and syringe sharing, including HIV and Hepatitis C transmission and fatal overdose. Over the next three years, I spent up to twenty hours per week doing ethnographic fieldwork: hanging out in informal settings with homeless and transiently-housed people who inject drugs to learn how they cope with the myriad dangers and stresses of being marginalized, poor, criminalized, and sick.
As the opioid crisis generates media, public health, and government attention, Philadelphia became the first U.S. city to legalize “supervised injection facilities” (SIFs) – and Seattle, San Francisco, Denver, and New York are not far behind. SIFs are legal facilities where people who use drugs can inject (pre-obtained) drugs under medical supervision. SIFs have been lauded for reducing overdose deaths, connecting people to medical care, housing, and drug treatment, and reducing public drug injection. SIFs have also been shown to have no effect on neighborhood “crime,” although ending the war on drugs and decriminalizing drugs (and poverty) would be the most meaningful way to reduce drug crime.
Meanwhile, shooting galleries – private spaces, overseen by a manager, where people use drugs – have been represented in public imagination and public health literature as high-risk places that facilitate syringe sharing, drug trafficking, and neighborhood decay. But what if shooting galleries function like underground SIFs? During the course of my research, I learned that shooting galleries can act as distribution centers for sterile injection equipment and harm reduction knowledge. Moreover, shooting galleries don’t necessarily increase public drug nuisances – like discarded syringes and public drug use – in the neighborhoods where they’re located.
Charles’s shooting gallery, located on a narrow street connecting the neighborhood thoroughfare on one end with the public housing complex on the other, was outfitted with an illegal electric hookup, kerosene space heaters, couches, and a complete array of injection supplies courtesy of Prevention Point Philadelphia, including sterile syringes, distilled water, cotton filters, alcohol pads, antibiotic ointment, Band-Aids, and a “sharps” container for disposing used syringes. Charles – and Lady, June, Martin, Linda, and the other shooting gallery managers and patrons that I knew – saw distributing sterile injection equipment as an extension of their responsibility to their black, working-class community.
Although shooting galleries nominally charge an entrance-and-sterile-syringe fee – $2 during the course of my research – this fee was routinely waived when the patron lacked funds and the alternative was sharing syringes or leaving to inject somewhere else. As Charles explained, “All we got out here is each other, and we’ve gotta look out for each other because there ain’t no one else doing it for us.” Tonya, a young black woman who had come to Philadelphia leaving an abusive relationship, said that in Charles’s shooting gallery she found a sense of safety: “Charles is the first person to really look out for me since I came to Philadelphia and not want anything back from me. […] Since I’m staying here I know that I’ll be safer.”
Our society stigmatizes people who use drugs, representing them as though they’re untrustworthy, dangerous, and reckless. We also often represent them as though they exist outside the social fabric: without families, communities, or a sense of social responsibility. The people I met in North Philadelphia shooting galleries belied those stereotypes, enacting deep commitments not only to other people who inject drugs, but to their neighbors. For example, shooting gallery managers like Charles, June, and Lady – in an effort to keep drug use away from youth – restricted access to their galleries to adults. They encouraged their patrons to leave the neighborhood quiet and free of drug paraphernalia. In Charles’s words, “We look out for the old people, keep the crime down and the drugs off the street.” Jumping in, Lady clarified that she always closed her shooting gallery by midnight: “There are kids on the block and they have to go to school in the morning, so […] after a certain time, it’s over.”
For the most part, neighborhood residents treated the people who used drugs in shooting galleries as part of the community’s fabric, hiring Charles and others to do odd jobs in their homes and businesses, and sometimes reaching out during times of financial hardship. Martin – an acute observer of the violence wrought by racism, classism, and criminalization – recognized his circumstances as a person who injects drugs to be bound up with the issues facing his community more broadly. As he said to me after passing a young boy a couple dollars one summer afternoon while we sat in the vacant lot next to Charles’s, taking in the sun and watching a game of pinochle, “I know what it was like to grow up with nothing. It isn’t those kids’ fault that their moms are poor.”
Over and again, what I learned in shooting galleries conflicted with the public health narrative holding that people who share resources and inject together are at increased risk of HIV infection. Because people who inject drugs often learn how to inject from people who already do so, being part of social networks of people who inject drugs is protective when these networks share harm reduction information and materials. People like Charles, who began injecting heroin before the AIDS epidemic and had remained seronegative, told me that that the AIDS crisis had provoked a collective response. Outside formal public health campaigns, people came together to regulate injection practices to avoid transmitting the virus. As a middle-aged white man explained to me, “I heard about it on the street in New York. They were selling the works [syringes], ‘Buy works so you don’t get the AIDS.'” Sally, a long-time heroin user and part-time dealer, echoed: “I’d always give [syringes] away. As long as I’ve sold dope, I’ve given out works. I don’t like people to reuse.” And, in a different conversation, a young white woman newly arrived to Philadelphia from the suburbs, told me “I learned [you shouldn’t share works] from the old heads. They say don’t share, you’ll catch AIDS. They’re older than me … [they] know what [they’re] talking about”.
In general, it is not lack of knowledge about safer injection but lack of resources that constrain people’s capacities to inject drugs safely. People who inject drugs want to avoid risky injection practices and want to make sure that people they care about also avoid unnecessary risks – like injecting in public places and sharing or reusing syringes. However, criminalization, homelessness, poverty, and lack of access to sterile syringes make consistently practicing safe injection difficult.
In addition to spending time in shooting galleries, I interviewed people who didn’t go to shooting galleries but didn’t have a private place to use. Many of these people used heroin in Kensington, a white and Latino working-class neighborhood in North Philadelphia known for its open-air drug market and abandoned factories, vacant lots, and railroad tracks where people inject heroin. Because of the visibility of drugs in Kensington, it’s often the first place that Philadelphians think of during conversations about drugs, although it’s far from the only neighborhood where people get high.
In conversations with people who didn’t go to shooting galleries, interviewees communicated desires for “a safe place to get high,” a “safe injection space,” or a legal “room for taking a hit.” The consensus was that such a location would significantly decrease potentially-risky injection practices. This is because syringe sharing was most prevalent in contexts in which environmental dangers were high and the goal was to inject as quickly as possible. As Phil, a young white man, explained, “you don’t want to walk around with the drugs. I’m already absconded right now [i.e., has an open warrant]. It’s only a matter of time before I’m locked up again.” Even though it was legal under Pennsylvania law for registered participants of the syringe exchange to carry syringes, interviewees reported that they were frequently stopped by police, who issued citations for carrying “drug paraphernalia” and confiscated or damaged sterile syringes. This policing climate made people less likely to carry syringes, especially extra sets. In attempting to evade police both by injecting quickly after procuring drugs and by not carrying syringes, people were forced into injection practices that they knew were dangerous: “I don’t share, but I’ve picked up a needle [off the ground]. I’ll pick it up and shoot, but flush it [with bleach and water] three times first. It’s embarrassing.”
Qualitatively, I observed during the course of my research that people who injected drugs in sheltered places like private homes and shooting galleries had fewer complications than people who injected in public places. People who injected on the street and in vacant lots reported higher rates of syringe re-use and sharing than people who got high in shooting galleries, who generally reported that they hadn’t shared a syringe since “back in the day,” before the 1980s. However, even under conditions not conducive to harm reduction, people who inject drugs do their best to inject safely and provide support to others to inject safely. For example, many youth I spoke to about their experiences with public injection told me that they would give sterile syringes to strangers who were otherwise going to pick up a used syringe off the ground. Even the unregulated abandoned buildings in Kensington – which aren’t quite shooting galleries in the formal sense, because they lack managers who oversee comings and goings and distribute injection equipment – might have served to reduce harms associated with injection drug use. After several of these locations were razed in May 2017, people predictably continued to use drugs in Kensington, but outdoors, in conditions that make injection riskier.
Although it might be tempting to explain differences in injection practices as resulting from demographic differences – older cohorts who survived the initial HIV crisis being more concerned with “risk” than younger cohorts, for example – infrastructure is a crucial determinant of risk behavior. Intermittently, one or another shooting gallery would temporarily shutter or move, due to policing and arrests, illnesses, or the city’s demolition of these informally-occupied houses. When shooting galleries closed, people who were used to injecting drugs in relative safety were forced into injection conditions that were less safe. As Pops told me during one of these periods, “Out here, I’m rushing to get a hit. Looking over my shoulder for the cops, I’m missing the shot” – missing his vein while injecting, causing abscesses and skin infections.
In the spring of 2010, Charles was arrested for a probation violation and sent to serve a six-month sentence at an upstate prison. While he was incarcerated, the city razed the building where he had lived and run his shooting gallery for five years. For a while, people from Charles’s stayed around the neighborhood, sleeping in the cemetery and keeping it moving during the day to avoid arrest. But as the months wore on and the city began to redevelop the blocks, the community that had been grounded in the shooting galleries’ relative stability broke apart. Demolishing shooting galleries in the name of neighborhood “cleanup” puts homeless people who use drugs at profound risk of overdose, illness, hunger, and exposure by undermining their access to community, resources, and shelter. It’s like Charles said, a mere six months before his house was torn down:

“They’d rather have people thinking that these abandos and everyone who live up in here is a criminal, that way they can sell the land when they think they can make money off it. […] Why don’t they give us the abandos? Give us the electric hook up and the water, and let us take care of the buildings, put them back together, make them better. […] Ain’t no way none of us, doin’ what we do, ever gonna get any housing beyond what we make for ourselves.”

Gentrification has specific effects on homeless people who inject drugs – effects which go unrecognized because of how shooting galleries and the people associated with them are represented as disposable, undesirable, and criminal. This misrepresentation occludes our ability to see that shooting galleries have been a vital, if informal, infrastructure of safer injection.
Supervised Injection Facilities can help marginalized people negotiate risky and hostile urban environments. Beyond offering material resources for safer injection, SIFs function as sheltered spaces in which people who use drugs relax, share food and clothing, and connect with their friends. Yet, shooting galleries have long been doing what legal SIFs will accomplish – but without material, institutional, or legal support, in “abandoned” buildings always-at-risk of collapse or demolishment. Perhaps we should re-conceptualize shooting galleries as “underground safer injection facilities” in order to recognize the central role that they have played in harm reduction and preventing fatal overdoses. As ever, people who inject drugs are at the forefront of interventions – like syringe exchange programs – that save their lives. We should listen to them when they tell us what they need.
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