NEW YORK — As the death toll from opioids skyrockets in New York, the role of supervised drug injection centers in reducing fatalities has been a key focus of attention.
The center on 126th Street in East Harlem opened in November 2021 as the nation’s first, along with another OnPoint NYC location in Washington Heights. Their purpose was to curb deaths. At the center, users bring their own drugs for use under the supervision of staff, and advocates say it’s a lifesaving model that should be replicated across the country.
But resistance — both on the local and national level — has been strong.
In East Harlem, neighbors say it’s become a magnet for drug dealers and users that’s created more drug use, violence and trash on the streets.
“It’s sad,” said Ashley Valle, a Harlem resident and mom of a 5- and 3-year-old as she stopped on her way home. “It’s basically saying drugs are OK, just don’t overdose. ... I’m scared to come out with my kids sometimes, I don’t want them to see that.”
Beyond East Harlem, lawmakers across the country are citing concerns that the centers — illegal under federal law — could worsen the opioid crisis by giving users the go-ahead to do drugs and burden neighborhoods by concentrating the fallout of the opioid crisis in already-vulnerable areas.
Gov. Kathy Hochul has jumped into the issue, saying New York’s cut of the settlement dollars from the opioid lawsuits should not be used to fund the facilities, also known as overdose prevention centers. In California, Gov. Gavin Newsom vetoed a bill that would have paved the way for more.
The debate has taken on a new urgency as New York confronts an overwhelming opioid crisis.
A combinations of fentanyl’s infiltration of the drug market and COVID-19 mental health struggles has pushed drug overdose deaths to record levels in New York City. In 2021, there were 2,668 overdose deaths — the most since the city started tracking them, according to a recent report. Numbers for 2022 are likely just as dismal.
East Harlem has the highest number of overdose deaths in Manhattan. The contention and tough questions there over how to solve the problem mirrors the complexity of the debate nationwide.
Too many problems
Rafi Alammari has lived in New York City for the past 37 years. East Harlem isn’t what it used to be, he said. The opioid crisis has spilled further into the street in the past few years.
“I can tell you, it’s not good to me. It’s too much crimes, too much problems. The whole area is in trouble,” said Alammari, 46, who works at a deli right next door to OnPoint.
“It’s like walking zombies, all the time,” he said.
At a day care across the street and a school just a couple of blocks away, parents pick their kids up and walk to the train, sometimes glancing uneasily at groups standing on the curb outside the center.
“It is undeniable that it’s having a negative impact on our community,” said Xavier Santiago, chairman of Community Board 11.
Santiago says the area around the center has deteriorated since the center’s opening.
“Custodians are constantly bleaching and cleaning the sidewalk from human excrement, urination and vomit, and not to mention needles,” Santiago said, adding that he’s seen the area increasingly become a hotspot for dealers and users.
Shawn Hill, a community activist and co-founder of The Greater Harlem Coalition, said the center acts as a magnet to users and dealers, damaging the neighborhood.
“We don’t want people commuting into East Harlem in order to buy and get high,” Hill said. “ ... People come to this neighborhood because they are attracted by the drugs and illegal drug sales that go on. They’re attracted now to the fact that they can come to attend one of the many addiction programs that are packed into this neighborhood.
“By placing only two OPCs in communities of color and not locating them in white neighborhoods or in more affluent neighborhoods, they are increasing the stigma associated with OPCs. They are concentrating the problems associated with OPCs in some of the most vulnerable neighborhoods in the city,” Hill added.
The NYPD says they are aware of the neighborhood’s concerns and are “working to address them.”
Saving lives
On the other side of the debate, advocates for the centers say that the centers save lives. Since opening, OnPoint’s two locations together have reversed more than 700 overdoses to date, according to the organization.
The centers don’t just keep people alive, but also lower health care costs, cut down on public drug use and provide access to drug treatment, Sam Rivera, executive director of OnPoint, said.
“There’s no war on drugs in this country. There’s a war on drug users. And that’s not what works,” Rivera said, emphasizing a harm-reduction approach that aims to tackle the opioid crisis by reducing risks associated with drug use.
Some studies have shown that safe injection sites were not found to increase drug use, drug trafficking or crime in the areas surrounding them, and are an effective way to mitigate the opioid crisis and cut down on unnecessary hospitalizations.
“They’re going to use, right? So having them have a space to use safely and stay alive is important,” Rivera said.
There have been more than 55,000 visits and about 2,300 individual participants at OnPoint.
“We have to use every tool we know is available right now to address the current crisis,” Toni Smith-Thompson, director of the Drug Policy Alliance’s New York office, said. “We are not yet ahead of the crisis. The crisis has gotten worse. The New York City numbers are absolutely devastating.
“Having overdose prevention centers in place years ago could have been saving lives, and so we want them to exist now, so that we can begin to turn the tide. People don’t need to die,” she added.
Proponents of the centers believe much of the resistance to them is stigma.
“Instead of pushing people into the shadows and stigmatizing their health problem, we’re bringing them in and providing them a safe and respectful place to speak with health care professionals, peers and really meet them where they are and say, ‘What do you need?’ That’s a very different frame to dealing with the problem,” said Brandon Marshall, a professor of epidemiology at the Brown University School of Public Health.
Broader debate
The same concerns now playing out in East Harlem are echoed in state legislatures and federal courts across the nation.
Last month, the Hochul administration rejected the use of opioid settlement funds to fund overdose prevention centers, on the grounds that they violate state and federal laws prohibiting the operation of facilities dedicated to the consumption of illegal drugs.
Outside of New York, legislation to create similar safe injection sites have been shut down or stalled in Illinois, Massachusetts, New Mexico and California.
California Gov. Gavin Newsom vetoed a bill that would have created safe injection sites in three cities last year, and more recently a highly publicized center in San Francisco operating as a safe injection site was closed.
“It is possible that these sites would help improve the safety and health of our urban areas, but if done without a strong plan, they could work against this purpose,” Newsom said at the time. “These unintended consequences in cities like Los Angeles, San Francisco and Oakland cannot be taken lightly. Worsening drug consumption challenges in these areas is not a risk we can take.”
President Joe Biden’s stance on the centers hasn’t been clear, and a U.S. Justice Department decision over the legality of a supervised injection site proposed in Philadelphia has been pending for four years.
Earlier this month, OnPoint itself faced almost shuttering as the private funds it relies on to operate the overdose prevention work ran low.
“We were in a very crucial place, and we’re no longer there,” Rivera said. “People really stepped up and went the extra mile to make sure we stayed open and can keep folks alive, and it shows. I think what the biggest difference is it shows the care and concern that folks out there have for the beautiful people we serve.”
It’s clear that overdose deaths will continue, and Rivera and others hope to open more centers across the city and country.
“It’s not a silver bullet, but it is an important and effective intervention for people who are at a particularly high risk of overdose death, notably in this era of fentanyl,” Marshall said.
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