New York City opened the nation's first overdose prevention center Tuesday, which harm-reduction advocates are calling a big step in a country that has suffered countless deaths due to drug overdoses as it continued to battle an opioid epidemic.
Cities and states across the country have pushed to open similar sites in recent years as the opioid epidemic continued to get worse. Advocates have long said the sites would reduce opioid deaths, destigmatize drug misuse and help connect people with substance use disorders to addiction services. Critics said the sites would create spaces that accommodate and magnify drug use.
"If you think about a public health response to a crisis and you want to triage people to stop it, this is one intervention most likely to do that," said Caleb Banta-Green, the principal research scientist at the University of Washington Addictions, Drug and Alcohol Institute. "They're doing it in much of the world, so we're really kind of late to the game."
Overdose prevention sites provide supervised settings for people who use drugs to be in a monitored space with nurses, clinical staff or peers to ensure the person does not overdose. Observers are there to reverse overdoses with naloxone, a medication that works as an antidote to opioid overdoses, and prevent death.
Banta-Green said a key benefit of these sites is that they stop people from using substances alone, which he said greatly increases the risk of a fatal overdose.
“These facilities create a way for a person to use around other people, but in almost an anonymous way,” he said. “You don’t need to go find a friend or some random person to bring over to your apartment to use. You can use with other people and get the safety of that and not have to create a new social life or a new identity.”
The two sites in New York City will open in Manhattan, in the East Harlem and Washington Heights neighborhoods, where people will bring and use their drugs and be observed by trained staff members who will provide clean needles, prevent overdoses and connect people who are willing to addiction services.
Advocacy and addiction service groups New York Harm Reduction Educators and Washington Heights Corner Project will merge to form OnPoint NYC to staff the centers, which are expected to open Tuesday.
The opening in New York City comes after the Centers for Disease Control and Prevention reported more than 90,000 overdose deaths in the U.S. in 2020. Over 2,000 occurred in New York City alone. The city reported there were nearly 600 deaths between January and March 2021, the greatest number of overdose deaths in a single quarter since reporting began in 2000.
“The national overdose epidemic is a five-alarm fire in public health, and we have to tackle this crisis concurrently with our COVID fight,” New York City Health Commissioner Dr. Dave Chokshi said in a statement. “Giving people a safe, supportive space will save lives and bring people in from the streets, improving life for everyone involved. Overdose prevention centers are a key part of broader harm reduction.”
City health officials and Mayor Bill de Blasio believe sites such as these will turn the tide. A study conducted by the city concluded these two spaces could save the lives of more than 130 people per year.
“After exhaustive study, we know the right path forward to protect the most vulnerable people in our city. And we will not hesitate to take it,” de Blasio said in a statement. “Overdose Prevention Centers are a safe and effective way to address the opioid crisis. I’m proud to show cities in this country that after decades of failure, a smarter approach is possible.”
The city’s analysis of safe drug sites cited the success of similar programs in Europe, Canada and Australia. Community impact studies showed that Vancouver, Canada, saw a 35 percent reduction in fatal overdoses in communities after a safe injection facility opened, and Sydney reported an up to 80 percent reduction in overdose-related emergency medical service calls in areas that had similar centers.
De Blasio reportedly told providers he had assurances from law enforcement agencies that they would not take action against any of the sites or the people who took advantage of them. The city did not respond to a request for comment, however, when asked to provide further details about those assurances.
Of the city’s five district attorneys, all but the one who represents Staten Island have stated their support for supervised drug sites. Richmond County District Attorney Michael McMahon, whose office represents previously noted a troubling rise in overdose deaths on Staten Island, has not shared in that approval and did not respond to a request for comment.
It is also unclear what state and federal oversights these programs will have to contend with. New York Gov. Kathy Hochul signed a legislation package last month aimed at harm reduction and combating the ongoing opioid epidemic, but she has not provided a full-throated endorsement of safe injection sites despite pressure from advocates.
Former Gov. Andrew Cuomo had previously signaled his support for overdose prevention centers proposed by New York City officials but never followed through on that support after the Trump administration sued an organization trying to open a similar site in Philadelphia in 2019.
The administration cited a federal law, often called "the crack house statute," that prohibits the renting or ownership of a property for the use of illegal drugs.
"It's one of a number of punitive policies that were enshrined in our nation's war on drugs, which was unfortunately driven by racism and led to tremendous harm," said Dr. Sarah Wakeman, medical director at the Massachusetts General Hospital Substance Use Disorders Initiative who has studied the use of safe drug use sites internationally. "It's served as a real barrier to implementing some strategies that have been done successfully internationally."
There is hope that the Biden administration will be more friendly, though the appointment of Rahul Gupta, a former West Virginia health official, to head the Office of National Drug Control Policy and direct the nation’s response to the opioid epidemic received some pushback from harm reduction advocates after his office supported the closure of a safe needle exchange program in 2018 amid an HIV outbreak.
States and cities such as Colorado, Maryland, Maine, Massachusetts, New York City, Philadelphia, San Francisco and Seattle have attempted to study, legislate and create policies that would open similar facilities, but the federal government remained the greatest roadblock.
"I think it is an important tipping point," Wakeman said of New York City's announcement to open the two overdose prevention centers. "A lot of the fears around these sites are rooted in sort of stereotype and stigma about drug use, but a lot of those fears are disproven once these are actually up in operation. Soon people realize that this is an important health intervention that engages people and improve their lives and the health of communities around them."