NEW YORK — In tears, Kailin See recounts a story that would not have been possible just weeks before.
A man addicted to heroin, who otherwise would have injected himself alone, visited one of the country’s first authorized locations to use drugs with supervision in early December. He had a job interview later that day, hoping to earn two paychecks by Christmas so he could afford gifts for his children, he told staffers at the Washington Heights site. But when he drew the drugs into his veins, he began to nod off and go pale, a sign of what could have been a lethal overdose. The trained workers sprang into action, giving him oxygen. He quickly came to, said See, one of the main organizers of the site.
In nondescript commercial buildings in Washington Heights and East Harlem, workers watch people use illegal drugs and step in when they overdose, a solution to the drug crisis once considered too fringe to operate in the open. Years of legal battles and debate delayed efforts by cities and states to supervised consumption sites, forcing the facilities to operate underground. These new locations, approved by the then-mayor of New York City, could spur a shift toward offering services nationwide, drug policy experts say. But these sites still present a tangled knot of concerns: The federal government has not approved overdose-prevention centers, still considered an untested concept, and neighbors worry about drawing crime to their area.
The Biden administration’s silence on the issue is not expected to halt potential sites supported by local officials. Now that New York City has claimed the title of first, more could be planned, experts say.
In a 12-month period that ended in April 2021, more than 100,000 Americans died of drug overdoses, an all-time high in a crisis exacerbated by the coronavirus pandemic, when many were isolated. The people who use the privately funded sites, operated by the nonprofit OnPoint NYC, say they otherwise would have used those drugs by themselves at a park, public restroom, subway station or at home, according to organizers’ review of intake paperwork.
Since the authorized service began operating Nov. 30, organizers say workers have reversed 76 overdoses, a small victory at a time when the nation is reporting a record number of fatal overdoses amid the coronavirus pandemic.
‘Cries for help’: Drug overdoses are soaring during the coronavirus pandemic
Sam Rivera, the nonprofit’s head, is often reminded of taking clean needles to what were called “shooting galleries” in the 1990s.
At that time, clean-needle programs were stigmatized, recalled the now 59-year-old New Jersey resident. Now they are endorsed by the federal government as safe.
“I saw an entire society change, an entire city change, when folks were given the opportunity to use clean syringes,” Rivera said.
For decades, Rivera has carried the overdose antidote naloxone with him, running from his office or jumping out of his car with a vial when he heard of an overdose, finding people at a point when oxygen was no longer reaching their brain, a critical stage.
Now, when he hears of an overdose at the nonprofit’s sites, Rivera watches as the staff helps the overdose victim. At the prevention centers, the overdose is reversed so quickly that many people are still conscious. The sites have called 911 for medical help once since their opening, at a time when the city estimates overdoses cost the health-care system $50 million annually for emergency medical service calls, emergency department visits and hospitalizations.
“To see it live is absolutely mind-blowing,” Rivera said, “especially the interaction with the participant who is thanking us in that moment.”
Those who oppose these facilities say they may actually lessen the incentive for participants to enter treatment and recovery.
People still use drugs outside of the centers, and there is little data about those people’s risk of fatally overdosing, said David Murray, a senior fellow at the Hudson Institute, a conservative think tank in Washington.
He argues that the resources would be better used for treatment programs.
“The goal to reduce overdose deaths is very laudable, but they seem to have problems demonstrating that that’s actually the outcome,” Murray said.
Keith Humphreys, an addiction researcher at Stanford University School of Medicine, questions the scalability of intervening when someone overdoses, when nearly 1 in 5 Americans used illicit drugs in 2018, according to the National Survey on Drug Use and Health.
“Will it be a game-changer?” Humphreys said. “Hell, no. It’s a pretty marginal effort.”
In New York City, the organizers of the sites hope that research conducted at the centers will change critics’ minds.
“If people aren’t alive, they can’t participate in treatment,” said Rivera, executive director of OnPoint NYC.
At the East Harlem site, all the accoutrements a drug user could need are neatly arranged in black trays on a folding table: needles of different sizes, cotton gauze, elastic tourniquets. Users need only bring their illegal drugs.
Although the site appears clinical, the staff tries to make the users comfortable, offering steaming towels when people come in from the waiting area — referred to as “the living room.” Above the defibrillator hanging on the back wall, a mural promises “THIS SITE SAVES LIVES.”
One of the interventionists on guard was Yucef Colley, who started working at the facility at a time when people used drugs unmonitored in the bathrooms. Colley said he would find some people “to the point they are so blue you’re thinking there’s no way they’re going to come back.”
Now each pod is equipped with mirrors for the interventionists to see if people overdose.
For 61-year-old Bronx resident Danny Micco, the site is a far better alternative to his usual spots, “streets, corners, wherever,” to use heroin and cocaine.
“I was going wherever I could, which is not good,” Micco said, outside the East Harlem facility.
“With this,” he said, motioning to the door outside, “you have a place to go, which makes all the difference in the world.”
Before the opening, See, the senior director of programs for OnPoint NYC, feared that people like Micco wouldn’t use the center.
Sitting in the nonprofit’s East Harlem office, See, a Canadian American dual citizen who worked for sites in Canada and unlawful locations in the United States, shared her worries: What if people who use drugs felt skeptical about the group’s intentions, fearing it was a poaching ground for police? Or rather, what if police were waiting at the door?
While unauthorized sites have operated underground in the United States, such a program has never been able to open legally. When an attempt was made to open one in Philadelphia, President Donald Trump’s Justice Department blocked the effort in court. The lawsuit is pending in U.S. District Court after the Supreme Court declined to review the case.
“This is such a historic moment for the U.S.” See said. “We couldn’t have known, because there’s really no example really to point to in the United States.”
Although the Justice Department under President Biden has stepped back from Trump’s aggressive legal challenges against sites opening, the administration has not taken a position on the issue and probably will not in the short term, said Lindsay LaSalle, a policy expert at the Drug Policy Alliance. LaSalle said she thinks that taking a position on supervised consumption sites is not “very high on the priority list for the administration,” which has faced a “wartime effort” against covid-19. She added that Biden’s history is another wrinkle. As a senator, he sponsored the “crack house” statute, which made it illegal for anyone to operate a facility for the purpose of using illegal drugs, a provision later used by Trump’s Justice Department to try to prevent supervised consumption sites from opening.
“I think that New York opening will put additional pressure on elected officials and government officials to take heed of what the advocates have been saying,” LaSalle said.
Approved drug-use sites have operated in other nations including Canada and Australia for years, with a spate of research showing that no one has died at such a facility and that the service enhances access to primary health care, limits the spread of diseases such as HIV and helps reduce the public nuisance of used needles discarded in neighborhoods. Scientists say no studies have found that these sites increase drug use or crime in the surrounding areas.
Still, American researchers won’t be able to learn more about the impact of these sites on their communities until more such facilities open.
Rhode Island legalized safe consumption facilities in July and is developing regulations for them, and similar legislation is under consideration in California. San Francisco Mayor London Breed (D), who this month declared a state of emergency in a neighborhood beset by drug use, has said a facility could be opened in her city as early as spring.
Alex Kral, an epidemiologist with RTI International who has researched one of the underground U.S. sites, cited benefits that authorized locations can offer. The East Harlem site has a doctor, social workers and holistic health workers, as well as a garden, showers, laundry machines and a meditation room.
Kral, who visited the New York locations before they opened, praised organizers’ efforts to inform not just participants but also others who tour the sites, possibly inspiring officials who see the sites’ success at reversing overdoses.
“People are trying to see if the sky has fallen or not,” Kral said three weeks after the sites opened. “Did the sky fall? No, it didn’t fall.”
Kral said the research conducted at authorized locations can offer more information about how much of a help these facilities are to their users. Organizers say they are collecting data that has not yet been reviewed by researchers.
More than 470 people have signed up as clients for the two sites, which have been used more than 3,300 times since the end of December, See said. Four of the city’s district attorneys praised the centers as “a model for other cities to follow” in a BuzzFeed News opinion piece, giving a green light for continued operations.
After decades of drug users’ hiding in isolation, fearing their illicit activities may stigmatize them, See and the other operators of the sites imagine a world where people who use drugs can gather, not just looking out for each other but also even helping one another through their drug use. People who use drugs have long learned misconceptions through word of mouth or online, further endangering themselves.
“I know this is going to sound controversial, and a little counterintuitive,” See said, “but we have to teach people to be the best drug users they can be while they’re using.”
At the heart of Canada’s fentanyl crisis, extreme efforts that U.S. cities may follow
Meanwhile, Rivera sees a future where sites like these will open across New York City, at least with a presence in every borough.
He said that could address the concerns of community organizers, such as the Greater Harlem Coalition, that oppose the sites in their own neighborhoods but might be assuaged by seeing others open throughout the city. The Greater Harlem Coalition lobbied against a site being opened in the predominantly Black neighborhood, which the coalition says is oversaturated with drug treatment clinics. Coalition leaders say they think the locations would become magnets for drug dealers soliciting customers.
Syderia Asberry-Chresfield, a co-founder of the Coalition, said data shows people who use these facilities come from elsewhere in the city.
Such criticism probably will be heard in other cities as local governments approve new sites.
Rivera argues that the staffers’ close connections with the participants allow them to gain trust to the point that when someone expresses an interest in treatment, they can encourage the person in that direction. Some of the staffers in the sites are in recovery themselves and have helped others find assistance, Rivera said.
“We can’t force people into treatment,” he said. “It doesn’t work. We know it doesn’t work. But when they’re ready, we’re ready.”
Weeks after recounting the tale of the job seeker, See was walking near her office and spotted him working at a street stall.
“The victories may be small, but they’re still victories,” she said, her eyes welling up as she recalled the man’s saying that his interview had gone well. “He survived, and he’s still trying.”