An overview of the first official safe injection sites in the United States

NEW YORK (AP) — Jose Collado sat down at a clean white table in a sunny room, sang a few bars and injected himself with heroin.

After years of being shot in the streets and on rooftops, he was in one of the first two establishments in the country where local authorities allow the use of illegal drugs to make it less lethal.

Equipped and staffed to reverse overdoses, New York’s new private “overdose prevention centers” are a bold and contested response to a wave of opioid overdose deaths across the country.

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Supporters say the sites – also known as safe injection sites or supervised consumption spaces – are humane and realistic responses to the deadliest drug crisis in US history. Critics see them as illegal and defeatist responses to the harm drugs cause to users and communities.

For Collado, 53, the room he uses regularly is simply “a blessing”.

“They always worry about you and they always take care of you,” he said.

“They make sure you don’t die,” adds his friend Steve Baez. At 45, he has approached it several times.

In their first three months, the sites in the East Harlem and Washington Heights neighborhoods of upper Manhattan stopped more than 150 overdoses in about 9,500 visits — many of which repeat visits from some 800 people at the total. The sites plan to expand their 24-hour service later this year.

“It’s a loving environment where people can safely use and stay alive,” says Sam Rivera, executive director of OnPoint NYC, a nonprofit that operates the centers. “We show up for people that too many people consider disposable.”

Supervised drug consumption sites date back decades in Europe, Australia and Canada. Several U.S. cities and the state of Rhode Island approved the concept, but no licensed site was actually operating until New York City opened in November (researchers documented an underground site at an undisclosed U.S. location for several years ). The New York announcement came six weeks after the U.S. Supreme Court issued a lower court ruling that a planned site in Philadelphia was illegal under a 1986 federal law against waste management. a place of illicit drug use.

Despite winning the Philadelphia case, the US Department of Justice indicated last month that it may stop fighting such sites, saying it was evaluating them and discussing “appropriate safeguards”.

New York’s only Republican in Congress, Rep. Nicole Malliotakis, has urged the Justice Department to shut down what she sees as “heroin shooting galleries that only encourage drug use and deteriorate our quality of life”.
She offered to withdraw federal money from any private group, state or local government that “operates or controls” a safe injection site. (His efforts prompted a protest in lower Manhattan on Wednesday by VOCAL-NY, a social services group interested in possibly opening a consumer site.)

Another New Yorker in Congress, Democratic Representative Carolyn Maloney, is a leading sponsor of a drug addiction proposal that could make money available for such facilities. Organizers say the New York sites currently operate through private donations, though their parent group receives money from the city and state for needle exchanges, counseling and many other services offered. parallel to the consumption rooms.

Several state and city officials have adopted them. But they also fueled a protest in December that drew more than 100 people, including U.S. Representative Adriano Espaillat, a New York Democrat, to complain that drug programs in general are unfairly concentrated in neighborhoods of injection sites and kept away from whiter, richer areas.

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“The Safe Consumption Site is doing God’s work, but they’re doing it in the wrong place,” says Shawn Hill, who co-founded a neighborhood group called the Greater Harlem Coalition.

People bring their own drugs – of whatever type – into consumption rooms, but they’re filled with syringes, alcohol wipes, sniffing straws, other paraphernalia and, most importantly, oxygen and naloxone, a drug that reverses opioid overdoses.

Staff members, some of whom have used illegal drugs themselves, watch for signals of overuse or other needs, from advice on injection technique to more complicated help.

Leaning a supportive hand on the shoulder of a crestfallen and dispirited man, Adrian Feliciano encouraged him to speak with a mental health counselor – and brought one in – one recent afternoon.

“For many of our people, just providing a safe space is an introduction to services,” Feliciano, director of clinical and holistic care at the center, said afterwards.

For all the services it offers and the overdoses it has achieved, OnPoint has also met its limits. During a 10-day period in February, two regulars died and a third was in a coma for some time after apparent overdoses elsewhere when venues were closed at night, according to senior program director Kailin See, who think longer hours would have saved those who died (third person recovered).

There have been no deaths recorded at supervised injection sites in countries that allow them, and there is evidence linking them to fewer overdose deaths and ambulance calls in their neighborhoods, according to a report of 2021 which compiled existing studies.

The report, from the Boston-based Institute for Clinical and Economic Review, found no link between safe injection sites and rates of various crimes, although public drug use has declined in some places.

“If you believe in harm reduction, here’s harm reduction that will save you money” in ambulance racing, said Dr David Rind, the think tank’s chief medical officer.

But for Jim Crotty, a former Drug Enforcement Administration official during the Obama and Trump administrations, the sites’ goal of saving lives comes at a high social cost.

“The goal can’t just be to keep people alive,” said Crotty, who argues that policymakers should instead focus on expanding drug treatment. “If you believe, as I do, that drug use is very destructive, then the goal must be to stop using drugs.”

Rivera, for his part, emphasizes the need to stem the flow of drugs into the United States, rather than what he sees as blaming people in poor communities “for using the drugs that were let in.” OnPoint says staff members regularly encourage, but don’t force, conversations about treatment, which many clients have already tried.

“You must be alive to try again,” See said.

Collado tried to quit drugs, sometimes quitting over his four decades of use, he said. Like many people who use consumption rooms, he lives on the streets.

He and Baez watch out for each other. They helped each other solve problems, split money when one was broke, and tried to make sure neither would overdose and die alone. The bedroom, and everything that comes with it, fulfills that last role now, and more.

“This is my home here,” Collado said. “It is my family.”

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