By Steven Ross Johnson

Feb. 2, 2023

For Sam Rivera, the past few years have offered hopeful signs that a different approach to curbing the continual onslaught of drug overdose deaths in America is gaining steam.

“We are starting to see a shift,” says Rivera, executive director of OnPoint NYC, a nonprofit that operates the nation’s first and only officially authorized “safe consumption” sites for illicit drug users. “You have to love on people who are struggling, love on people who are in the depths of drug use and offer them opportunities, and humanize a process that has been dehumanized.”

Also known as supervised consumption sites, safe injection sites or overdose prevention centers, the concept of offering a place where people can use drugs obtained elsewhere while being monitored to prevent a fatality has been around for years outside the U.S., with approximately 200 sites operating in more than a dozen countries, according to advocacy group the Drug Policy Alliance.

The two sites under OnPoint NYC’s banner opened in Manhattan in late 2021: one in East Harlem and another in Washington Heights. More than 2,300 participants have utilized the overdose prevention centers' services approximately 55,000 times since then, according to the group’s website. There have been more than 700 overdose interventions and zero deaths at the facilities.

“That is 55,000 drug-using activities that didn’t happen in the street,” Rivera says. “They didn’t happen in a schoolyard or in a park.”

Today, after more than a year in operation, Rivera knows the success or failure of his program has broader implications, with a number of places around the U.S. contemplating the potentially useful yet controversial method of addressing the ongoing opioid epidemic.

“We’ve been a model across the country,” Rivera says.

Making the Case

Efforts to launch supervised consumption sites elsewhere have been met with opposition from neighboring residents and public officials who have argued such sites sanction drug use and lead to an increase in other illegal activity.

“When drug users flock to a site, drug dealers follow, bringing with them violence and despair, posing a danger to neighbors and law-abiding visitors,” then-Deputy Attorney General Rod Rosenstein wrote in a 2018 New York Times opinion piece arguing against supervised consumption sites.

Notably, a 2020 report by the Institute for Clinical and Economic Review said evidence suggests supervised consumption sites do not lead to a change in crime. And recent moves by some jurisdictions have advocates optimistic the country might be inching closer to seeing more of them.

“I think the impact of the site successfully opening in New York has been one of encouragement for efforts elsewhere,” says Dr. Miriam Komaromy, medical director of the Grayken Center for Addiction at Boston Medical Center. “It has increased the urgency, along with ever-increasing rates of overdose deaths, as another real fuel to … to deploy everything that we can get our hands on.”

Predating the COVID-19 crisis, the toll of what’s been called an “epidemic within the pandemic” continued to accelerate in recent years, with year-end drug overdose deaths topping 100,000 in the U.S. for the first time in 2021. Though recent preliminary figures from the Centers for Disease Control and Prevention point to the crisis potentially peaking, more than 107,000 deaths from drug overdose still are predicted to have occurred during the 12-month period ending in August 2022.

Rivera says a major part of OnPoint NYC’s program is the array of supportive services it provides, 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 like meals, showers and laundry. Approximately 87% of the program’s active drug users have used other services as well, Rivera says.

“If you get 40% to 50% of active drug users to use other services, that’s really successful,” he says.

Over the past year, OnPoint NYC also has held around 400 tours of its safe consumption sites in an effort to assuage concerns and dispel misconceptions about the program.

Getting a better understanding of what goes on inside such a site was what prompted Katjana Ballantyne, mayor of Somerville, Massachusetts – located just outside of Boston – to visit the East Harlem location about two months ago.

Ballantyne, a strong proponent of safe consumption sites, says the visit has helped inform efforts to move forward on a similar model for Somerville, which saw at least 17 residents die of an opioid-related overdose in 2021, according to the most recent data from the Massachusetts Department of Public Health. Across the state, more than 2,200 residents died of an opioid-related overdose that year.

“What we learned was that it was extremely person-centered,” Ballantyne says of the OnPoint NYC program. “It was respectful and dignified.”

Ballantyne says plans for a site in Somerville are past the feasibility-study phase and are now focused on logistics like program design, procuring a location and getting input from community stakeholders.

“If we’re intentional, collecting data and sharing back that data, it informs other people to take a chance, and to better understand how we can stop these deaths and improve our community,” Ballantyne says.

Meanwhile, across the country, San Francisco Mayor London Breed recently announced an attempt to clear the way for a sanctioned safe consumption site – one that would echo New York City’s strategy by allowing a nonprofit organization to open a facility.

“Currently there are legal barriers to opening safe consumption sites, but we continue to prepare to open a site as we wait for federal guidelines,” Breed’s office tells U.S. News in a statement. “While we do that work, we will continue to push forward innovative solutions to help people struggling with addiction and further reduce the number of fatal overdoses as part of the City’s comprehensive overdose prevention plan.”

The push for safe consumption sites isn’t new in San Francisco or the broader Golden State: Last year, for example, California Gov. Gavin Newsom vetoed legislation that would have allowed Los Angeles, San Francisco and Oakland to host sites on a pilot basis. Newsom cited concerns that the measure authorized an “unlimited” number of sites and could lead to “a world of unintended consequences.”

“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. “Worsening drug consumption challenges in these areas is not a risk we can take.”

More Challenges

Arguments about their efficacy aside, hurdles to opening safe consumption sites also include federal law and funding.

Under what has been commonly called the “crack house” statute of federal law, it is illegal to “manage or control any place” and make it “available for use, with or without compensation … for the purpose of unlawfully manufacturing, storing, distributing, or using a controlled substance.” In Philadelphia, a lawsuit by the Department of Justice under the Trump administration leveraged the statute in seeking to prevent the nonprofit group Safehouse from establishing a supervised consumption site.

A federal appeals court sided with the Justice Department in 2021, yet in a February 2022 report by The Associated Press, the DOJ under the Biden administration signaled it may adopt a different stance. The agency said it was “evaluating supervised consumption sites, including discussions with state and local regulators about appropriate guardrails for such sites, as part of an overall approach to harm reduction and public safety.”

The Justice Department did not respond to requests for comment from U.S. News about its current stance, but reportedly is engaging in mediation with Safehouse.

“We are thankfully in productive conversations with the Department of Justice,” Ronda Goldfein, vice president of Safehouse, tells U.S. News. “We’ve been following up on that conversation about the appropriate guardrails and what would it take to reach a settlement that addresses everyone’s issues.”

Though OnPoint NYC has drawn some congressional ire, federal law enforcement hasn’t posed a problem. Funding, however, has: Rivera says his organization receives public money for initiatives like medical services and needle exchange, but not directly for the safe consumption sites. He says the nonprofit has had to rely on private donations and foundation grants to pay center expenses totaling $120,000 a month.

“We were at a place that we were looking to close by February,” Rivera says. “There’s been a few people who have stepped up and they have committed to supporting us, but we are in a very dangerous time as an organization.”

A potential funding source for safe consumption sites in the U.S. lies in legal settlements. In December, pointing to restrictions in state and federal law, New York Gov. Kathy Hochul’s administration rejected a recommendation from the state’s Opioid Settlement Fund Advisory Board that called for using money from settlements with opioid manufacturers to support activities tied to development of overdose prevention centers. New York has received more than $2 billion through various settlement agreements related to the opioid epidemic.

Still, advocates remain hopeful an eventual agreement in the Safehouse case and potential support for safe consumption sites from the Biden administration – which emphasized harm reduction in the release of its national drug control strategy last year – will prompt officials to use opioid settlement funds to invest in sites. In 2021, Rhode Island became the first state in the U.S. to pass legislation legalizing such sites, and its Opioid Settlement Advisory Committee earmarked $2 million in funds for a supervised consumption center.

Opioid settlements are “a very promising source of funding provided that there aren't restrictions placed by the state or other policymakers on use of the funding,” says Dr. Brian Hurley, president-elect of the American Society of Addiction Medicine Board of Directors.

To be sure, not everyone is convinced of the impact an increased number of supervised consumption sites would have on U.S. overdose deaths. Dr. Andrew Kolodny, medical director of the Opioid Policy Research Collaborative at Brandeis University, argues such facilities are more ideal for urban rather than rural communities.

Making addiction treatment much more accessible to those in need would have a more immediate impact, he says.

“If you know you’re going to be very sick unless you use something right away and you know where you can get something for a few bucks but to find treatment is expensive and complicated, you’re just going to keep using,” Kolodny says. “If we flipped it, so that the treatment was essentially free, then I really think we would start to see deaths come down.”