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NYC opening supervised illegal drug injection sites. Good idea?

It certainly makes sense to treat drug abuse as a public health crisis. Decriminalizing cannabis use at the Federal level is a good place to start. Whether cities want to provide supervision for taking illegal substances and take on legal responsibility if things go awry?

Nation’s First Supervised Drug-Injection Sites Open in New York

During the first official day in operation at the two Manhattan facilities, trained staff reversed two overdoses, officials said.

People can use drugs in what is called a narcotic consumption booth inside the injection sites.

By Jeffery C. Mays and Andy Newman

Nov. 30, 2021

In an attempt to curb a surge in overdose deaths caused by increasingly potent street drugs, New York City authorized two supervised injection sites in Manhattan that began operating on Tuesday.

Trained staff at two sites — in the neighborhoods of East Harlem and Washington Heights — provided clean needles, administered naloxone to reverse overdoses and provided users with options for addiction treatment. Users brought their own drugs to the sites.

New York, the country’s most populous city, became the first U.S. city to open officially authorized injection sites — facilities that opponents view as magnets for drug abuse but proponents praise as providing a less punitive and more effective approach to addressing addiction.

Other cities including Philadelphia, San Francisco, Boston and Seattle have taken steps toward supervised injection but have yet to open sites amid debate over the legal and moral implications of sanctioning illegal drug use.

The two Manhattan sites were already operating as needle exchange programs, and some residents in the communities have previously raised concerns about the decision to place the sites in less affluent areas of the borough.

In an interview, Dr. Dave A. Chokshi, the city’s health commissioner, said the city was moving forward to address a public health crisis.

“Every four hours, someone dies of a drug overdose in New York City,” he said. “We feel a deep conviction and also sense of urgency in opening overdose prevention centers.”

Mayor Bill de Blasio began championing safe injection sites in 2018, citing their use and success in European and Canadian cities. The decision to officially allow the sites to open comes during the mayor’s last few weeks in office and as he considers a run for governor. He said in a statement that the decision will show other cities that “after decades of failure, a smarter approach is possible.”

The mayor also sent a letter to the providers promising “not to take enforcement action” against their operations. Four of the city’s five district attorneys — excluding only the Staten Island district attorney, Michael McMahon — support supervised drug sites.

Eric Adams, the mayor-elect, has expressed support for overdose prevention centers, as has the incoming Manhattan district attorney, Alvin Bragg.

Nationally, overdose deaths rose to more than 100,000 in the 12-month period that ended in April, according to the National Center for Health Statistics, up nearly 30 percent from the previous 12 months.

More than 2,000 people died of a drug overdose in New York City in 2020, the highest total since the city began keeping track of overdose deaths in 2000. During the first three months of 2021, there were close to 600 overdose deaths, according to preliminary data. New York also saw an increase in overdose deaths related to fentanyl and other synthetic drugs.

The city provides funding to the two nonprofits that run the needle exchange programs — New York Harm Reduction Educators and Washington Heights Corner Project, which are merging to form OnPoint NYC.

“I know deep in my soul that we are doing the right thing,” said Sam Rivera, the executive director of OnPoint, adding, “The data doesn’t lie.”

Both sites began offering injection services on Tuesday. Inside the East Harlem site, a dozen people sat on chairs in a waiting area. Some were eating lunch, some were seeking refuge from the raw weather and some were dozing, quietly affected by whatever narcotic they had just taken in the “overdose prevention center,” an inner room with eight booths equipped with “crash carts” stocked with naloxone and other lifesaving tools.

In the day room, Kailin See, OnPoint’s senior director of programs, interrupted a tour she was giving reporters when she spotted a bearded man in one of the chairs with his head all the way down on his chest. She noticed that his nod seemed “heavy.”

She walked over and rubbed his sternum and quietly told him “I need two more hours from you” before she would feel comfortable with him leaving. The man sat up.

About 40 people had come in to use as of 2 p.m. at the East Harlem location on the first official day of operation, while 32 people had used drugs under supervision at the Washington Heights site, Ms. See said.

Staff had reversed two overdoses, she said.

“That means the world,” Mr. Rivera said, pausing to collect himself. “Two people are alive because we’re here.”

Federal law, however, still describes the activities at OnPoint’s two facilities as unlawful. A federal law often referred to as the “crack house statute” makes it illegal to operate, own or rent a location for the purpose of using illegal substances. The Justice Department, under the Trump administration, sued in 2019 to stop a supervised injection facility in Philadelphia from opening.

The Biden administration has embraced harm reduction methods but has not explicitly endorsed supervised injection sites. Dr. Chokshi said the city has had “productive conversations” with federal and state health officials, and said he believed the facilities would be allowed to operate because of “a shared sense of urgency” about addressing the overdose crisis.

Officials from the Justice Department declined to comment Tuesday on whether they would intervene.

Michael Botticelli, the former director of the White House Office of National Drug Control Policy under President Barack Obama, said the Department of Justice did not prosecute states when recreational marijuana use began to be legalized around the country.

“Many cities have been waiting for someone to go first, particularly to see what the federal Department of Justice reaction is going to be,” Mr. Botticelli said.

On the state level, Gov. Kathy Hochul wants to “explore the efficacy” of supervised injection sites and “how it impacts our communities,” said her spokeswoman. The incoming state health commissioner, Dr. Mary Bassett, served as New York City’s health commissioner when the pilot for supervised injection sites was announced in 2018 and has voiced support for the facilities.

In East Harlem, already home to a heavy concentration of methadone clinics and other drug treatment centers, Eva Chan, a member of Community Board 11, has been bracing for the opening of the injection site and lamented that it would just further cement the neighborhood’s status as a place where drug use and sales are tolerated.

“If every district in New York City has one site and it’s not right next to my home, I’m not against it,” Ms. Chan said. “But the root cause of high drug use in East Harlem is the over-concentration of drug treatment facilities, and this does not address that.”

Syderia Asberry-Chresfield, a co-founder of the Greater Harlem Coalition, a neighborhood improvement group, has held protests to demand a reduction in the number and density of substance abuse treatment facilities in Harlem.

“Not only can I buy my drugs here but I can safely shoot them up in a comfortable atmosphere where people are watching over me?” Ms. Asberry-Chresfield said. “And then they go outside and they wreak havoc in the neighborhood. We can’t live like this.”

Health officials will identify additional needle exchange programs that can expand their services to include supervised injections and overdose prevention by looking at where those facilities are and where there are clusters of people who are overdosing.

Alyssa Aguilera, co-executive director of VOCAL-NY, a group that advocates for low-income New Yorkers affected by drug use and H.I.V. and AIDS, said that her organization hoped to open an overdose prevention center in Brooklyn.

Proponents of supervised injection sites argue that the facilities will not only prevent overdose deaths but can actually stem the problem of public drug use that often leaves a trail of used syringes on the street and in parks.

In 2020, a study in the New England Journal of Medicine found that there had been no overdose deaths at an unsanctioned supervised injection site from 2014 to 2019. There had been more than 10,000 injections that resulted in 33 opioid-involved overdoses, which the staff reversed using naloxone.

A systematic review of 22 studies of overdose prevention sites, most focused on a supervised injection facility in Vancouver, found that overdose deaths were reduced while there was not an increase in crime or nuisance activities in the surrounding neighborhoods.

Councilwoman Diana Ayala, who represents East Harlem and the South Bronx, said that the problem of drug sales and use exploded in the pandemic. She now finds so many syringes encircling her vehicle when it’s parked near her East Harlem office that she keeps a box in the trunk to safely collect them.

“We need to stop pretending and have the difficult conversation,” Ms. Ayala said.

She received a call on Tuesday morning from Councilman Robert F. Holden, a conservative Democrat who represents Queens and remains unconvinced that the sites won’t disrupt stable neighborhoods.

Mr. Holden said he wanted to learn more but he already knows that his constituents will object, even though many families have loved ones who are struggling with addiction.

“It’s going to be hard to sell in any middle- or working-class community,” he said.

That sentiment played out Tuesday afternoon in East Harlem, where the supervised injection site is across the street from the Graham School, an early-childhood program run by the Association to Benefit Children.

Juan Carlos Feliz, a technician picking up his children age 2 and 3 years old, was surprised to learn of the safe injection site across the street.

“That’s not cool at all,” said Mr. Feliz, 28. “Why would they have a place like that near a school?”

Inside the site, Chynna Rodriguez, 36, a crack user, said she was grateful the facility was in operation.

“We’re here, the police are not bothering us, we’re not out in the park dying, and we’re not out in front of kids,” she said.

Jeffery C. Mays is a reporter on the Metro desk who covers politics with a focus on New York City Hall. A native of Brooklyn, he is a graduate of Columbia University. @JeffCMays

Andy Newman writes about social services and poverty in New York City and its environs. He has covered the New York metropolitan area for The Times for 25 years and written nearly 4,000 stories and blog posts. @andylocal

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