For Sam Rivera, the last few years have shown encouraging indications that a novel method to stemming the rising tide of drug overdose deaths in the United States is gaining momentum.
“We are beginning to see a shift,” says Rivera, executive director of OnPoint NYC, a nonprofit organization that administers the nation’s first and only “safe consumption” venues for illicit drug users. “You must love those who are struggling, love those who are in the depths of drug abuse, and offer them opportunities and humanize a dehumanized process.”
Also known as supervised consumption sites, safe injection sites, or overdose prevention centers, the concept of providing a place where people can use drugs obtained elsewhere while being monitored to prevent fatalities has existed outside the United States for years, with approximately 200 sites operating in more than 50 countries, according to the Drug Policy Alliance.
Late in 2021, two OnPoint NYC locations debuted in Manhattan: one in East Harlem and the other in Washington Heights. According to the organization’s website, more than 2,300 individuals have accessed the services of the overdose prevention centers approximately 55,000 times since then. There have been over 700 overdose interventions with no fatalities in the facilities.
“That’s 55,000 drug use incidents that did not occur on the street,” Rivera explains. They did not take place in a playground or park.
Today, after more than a year of operation, Rivera is aware that the success or failure of his program has broader ramifications since a number of U.S. locales are considering the potentially effective but controversial strategy for combating the ongoing opioid epidemic.
Rivera states, “We have served as a national model.” Efforts to establish supervised consumption facilities in other areas have been greeted with hostility from nearby people and public officials who say that such sites encourage drug use and increase other illicit activity.
In a 2018 New York Times opinion piece, then-Deputy Attorney General Rod Rosenstein argued against supervised consumption facilities by stating, “When drug users go to a site, drug dealers follow, bringing with them violence and despair, posing a hazard to neighbors and law-abiding visitors.”
Notably, according to a paper published by the Institute for Clinical and Economic Review in 2020, there is no evidence that supervised consumption locations affect crime rates. And proponents are confident that the country may be inching closer to having more of them due to recent actions taken by a number of counties.
Dr. Miriam Komaromy, medical director of the Grayken Center for Addiction at Boston Medical Center, opines that the site’s successful launch in New York has inspired efforts in other cities. Along with the ever-increasing mortality toll from overdoses, this has heightened the pressure to deploy every resource available.
Prior to the COVID-19 crisis, the death toll of what has been termed a “epidemic within the pandemic” continued to rise, with the number of drug overdose deaths in the United States surpassing 100,000 for the first time in 2021. Despite recent preliminary data from the Centers for Disease Control and Prevention indicating that the crisis may have peaked, it is anticipated that more than 107,000 deaths from drug overdoses will have occurred over the 12-month period ending in August 2022.
OnPoint NYC’s array of supportive services, which include access to addiction treatment, primary and mental health care, social service case management, and job training, as well as acupuncture, massage, and amenities such as meals, showers, and laundry, according to Rivera, is a major component of its program. Rivera states that around 87% of the program’s active drug users have also utilized other programs.
“If you can get 40 to 50 percent of active drug users to use alternative services, you’ve achieved great success,” he says. In an effort to allay fears and clarify misconceptions about the program, OnPoint NYC has conducted around 400 tours of its safe consumption sites over the last year.
Katjana Ballantyne, the mayor of Somerville, Massachusetts — a suburb of Boston – visited the East Harlem location roughly two months ago to have a better idea of what goes on within such a facility.
According to the most recent data from the Massachusetts Department of Public Health, at least 17 residents of Somerville died of an opioid-related overdose in 2021. Ballantyne, an ardent proponent of safe consumption sites, says the visit has helped inform efforts to move forward with a similar model for Somerville. More than 2,200 citizens of the state died of an opioid-related overdose that year.
Ballantyne says of the OnPoint NYC program, “What we realized was that it was incredibly person-centered.” It was respectful and respectful. Plans for a facility in Somerville, according to Ballantyne, have moved past the feasibility study phase and are now focusing on logistics such as program design, land acquisition, and input from community stakeholders.
“If we are deliberate in our data collection and dissemination, it will encourage others to take a chance and help us better comprehend how to prevent these fatalities and strengthen our community,” adds Ballantyne. Across the country, San Francisco Mayor London Breed recently launched an effort to pave the way for a sanctioned safe consumption site – a scheme that would mirror New York City’s by allowing a nonprofit organization to build a facility.
Breed’s office informs U.S. News, “Currently, there are legal impediments to launching safe consumption locations, but we continue to plan to open a facility as we await federal instructions.” As part of the city’s comprehensive overdose prevention plan, we will continue to advance creative methods to aid addicts and lower the number of deadly overdoses.
The campaign for safe consumption venues is not new to San Francisco or the rest of California. In 2017, for instance, California Governor Gavin Newsom vetoed a bill that would have permitted Los Angeles, San Francisco, and Oakland to host pilot sites. Newsom expressed fear that the bill may lead to “a world of unforeseen consequences” because it enabled a “unlimited” number of locations.
Newsom stated, “It is feasible that these sites may assist improve the safety and health of our metropolitan neighborhoods, but if implemented without a solid plan, they could work against this goal.” We cannot risk a deterioration of the drug consumption problems in these regions. In addition to controversies regarding their efficacy, federal law, and finance are also obstacles to the establishment of consumption places.
According to the federal law often known as the “crack house” statute, it is prohibited to “manage or control any facility” and make it “available for use, with or without compensation… for the criminal manufacture, storage, distribution, or use of a restricted substance.” In Philadelphia, the Trump administration’s Department of Justice filed a lawsuit to prohibit the nonprofit organization Safehouse from opening a supervised consumption location.
In 2021, a federal appeals court sided with the Justice Department, but according to an Associated Press report from February 2022, the DOJ under the Biden administration suggested that it may take a different posture. As part of its broader approach to harm reduction and public safety, the FDA stated that it was “considering supervised consumption locations, including discussions with state and local authorities regarding acceptable safeguards for such sites.”
The Justice Department did not answer to U.S. News’ requests for comment on its current position, but it is apparently in mediation with Safehouse. Ronda Goldfein, vice president of Safehouse, tells U.S. News that the company is having fruitful discussions with the Department of Justice. We’ve been following up on the talk about the appropriate boundaries and what it would take to establish a compromise that addresses everyone’s concerns.
Although OnPoint NYC has aroused the ire of certain members of Congress, federal law enforcement has not posed a challenge. Funding has, however: Rivera explains that his organization receives public funding for activities such as medical treatment and needle exchange but not for the safe consumption locations themselves. According to him, the nonprofit has had to rely on private donations and foundation funding to pay the center’s $120,000 monthly expenses.
“We were in a position where we hoped to close by February,” Rivera explains. There have been a few people who have stood up and committed to assisting us, but as an organization, we are in a very precarious position.
Legal settlements are a potential source of money for safe consumption venues in the United States. The administration of New York Governor Kathy Hochul rejected in December, citing restrictions in state and federal law, a recommendation from the state’s Opioid Settlement Fund Advisory Board to use money from settlements with opioid manufacturers to support activities related to the development of overdose prevention centers. The state of New York has received almost $2 billion in settlement agreements connected to the opioid epidemic.
Advocates continue to hold out hope that an eventual settlement in the Safehouse case and potential support for safe consumption sites from the Biden administration – which emphasized harm reduction in its national drug control strategy released last year – will prompt officials to invest settlement funds in sites. Rhode Island became the first U.S. state to legalize supervised consumption locations in 2021, and its Opioid Settlement Advisory Committee allocated $2 million for a supervised consumption center.
Dr. Brian Hurley, president-elect of the American Society of Addiction Medicine Board of Directors, describes opioid settlements as “a very potential source of money if there are no constraints imposed by the state or other regulators on the use of the funding.”
Certainly, not everyone is confident that increasing the number of supervised consumption places would reduce overdose mortality in the United States. The medical director of the Opioid Policy Research Collaborative at Brandeis University, Dr. Andrew Kolodny, contends that such facilities are more suited for metropolitan as opposed to rural regions.
As per US News, increasing access to addiction treatment for individuals in need would have a more immediate effect, he believes.
“If you know you’re going to get very unwell if you don’t use anything immediately and you know where you can get something for a few dollars, but treatment is expensive and complicated, you’re going to continue using,” says Kolodny. If we turned it so that therapy was practically free, I believe we would begin to see a decline in mortality.
