PHILADELPHIA>> Quetcy Lozada, a first-term City Council member, stood on a September evening near an elementary school just off Kensington Avenue, the epicenter of a sprawling fentanyl market in a city that saw a record 1,413 drug overdose deaths last year.

Just a block away, the street and sidewalks were dotted with used syringes and their discarded orange caps.

“Kids have to go through this every day,” Lozada said, her voice rising. Children “are so impacted that they don’t want to come to school.”

Public health experts have long endorsed a controversial strategy to blunt the opioid epidemic that has been sweeping cities such as Philadelphia: supervised drug consumption sites, in which people are allowed to take illicit drugs under professional supervision.

The sites employ medical and social workers who guard against overdoses by supplying oxygen and naloxone, the overdose-reversing drug, and by distributing clean needles and other resources to opioid users. New York City has two sites, the only ones operating openly in the nation.

Safe drug consumption facilities have reversed thousands of overdoses in the United States and abroad, helping people who use potent synthetic opioids such as fentanyl avoid the worst consequences of a volatile drug supply.

In the United States, the sites represent a novel form of “harm reduction,” which aims not to make drug users sober or abstinent but to prevent disease, overdose and death. President Joe Biden is the first president to endorse the idea.

But critics argue the sites encourage a culture of permissiveness around illegal drugs, formally sanctioning opioid use in neighborhoods struggling with high overdose rates. And they say that the groups working to open the sites, however well-intentioned, should not encroach on communities that might be hostile to the strategy.

Hours earlier Lozada had shepherded a measure through the City Council that restricted where drug consumption sites could operate in the city. The legislation, passed 13-1, survived a veto from Mayor Jim Kenney, who supports opening the facilities.

Lozada and her allies have cast their effort not as a rejection of drug consumption sites, per se, but as a way for Philadelphia residents to choose whether one may operate in their neighborhoods. Kensington Avenue, which sits in Lozada’s district, is seen as one of the most obvious locations for such a facility.

Lozada said her constituents did not want to accept living around open drug use, that it discouraged the use of local libraries and parks and drove away local businesses. “People in the political world just became afraid of: What do we do? How do we do it? Let’s not do anything,” she said of the state of her neighborhood.

Lozada has another idea: She supports involuntary roundups of opioid users, using the courts to route them to treatment facilities, a strategy that some public health experts have said is punitive and unproductive.

As much as any city, Philadelphia showcases the seesawing tensions and legal battles around supervised drug use. The city encapsulates a broader struggle among state and federal health officials searching for new methods to curtail the 110,000 annual fatal drug overdoses in the United States.

The sites operate in a legal gray area. A federal law passed in 1986 prohibits people from keeping property where controlled substances are ingested, a measure that defenders called the “crack house statute.”

Some cities and states have moved to open the facilities despite the risk of federal reprisals, as research has shown that supervised consumption sites in Canada, Australia and European countries have saved lives and led people to treatment.

Yet even liberal elected officials and communities, such as those in Philadelphia, question what they consider more lenient approaches to opioid use.

In May, Pennsylvania state senators passed legislation banning the sites. San Francisco is on track for a record number of overdose deaths this year, yet the city’s lone facility closed in December. Gov. Gavin Newsom of California, a prominent Democrat, has vetoed legislation that would have allowed some cities to open them.

This summer, the top federal prosecutor in Manhattan threatened the group operating the New York sites, saying they were running afoul of the law.

For groups with licenses to open sites, progress has been slow. After lawmakers in Rhode Island legalized drug consumption sites in 2021, the first state to do so, lease negotiations, construction delays and supply chain problems stalled the opening.

“There’s layers of bureaucracy,” said Colleen Daley Ndoye, executive director of Project Weber/RENEW, a group working to open the facility.

Fears have not been borne out by research: Supervised consumption sites have not led to upticks in neighborhood crime or community drug use, studies have found. And they can save lives.

In New York, the group operating the two sites said in August that workers had reversed 1,000 overdoses since opening. In San Francisco, medical workers reversed more than 300 overdoses in nearly a year at a drug consumption site in the city’s Tenderloin neighborhood.

Minnesota, the second state to legalize the sites, plans to spend about $26 million on harm-reduction services in the coming years, with some of the funds potentially going toward supervised consumption sites.

The state’s human services department is putting together potential plans to open the facilities, said Jeremy Drucker, Minnesota’s director of addiction and recovery. “People can’t recover if they’re dead,” he said.

In Philadelphia, the issue has captivated the city, pitting elected officials, residents and public health advocates against one another and exposing divisions in their approaches to the raging epidemic.

The same has been true of state and congressional leaders. Gov. Josh Shapiro of Pennsylvania, a rising Democratic star, has long opposed the drug consumption sites, while Sen. John Fetterman, a popular Democrat, has supported them.

But at the recent council meeting, there was just one vote against legislation restricting where the sites might be opened. “I know that this is a fight that I’m not going to win,” Kendra Brooks, a council member at large, said in an interview before the meeting.

“It can’t be a radical idea — providing folks who are in a medical crisis with the support they need to live,” she added.

Michael Driscoll, a City Council member who opposes the sites, said that even if a drug consumption facility were to offer people temporary protection against overdosing, “as they drift to other parts of their lives and stay dependent on these bad drugs, we’re going to lose that life as a productive citizen.”

Kenney, the Philadelphia mayor, watched the vote from his office below the council chambers in City Hall. “I was a little depressed,” he said after the meeting.

“It’s not just the people on Kensington Avenue. It’s people in every neighborhood, their sons and daughters in the basement or in the bathroom. If they’re by themselves, how do you get them better?”