Free-for-all sends 'OD'ious message
MAYOR de Blasio’s announcement of two so-called “safe injection sites” for drug users — one in Washington Heights and another in East Harlem — makes New York the first US city to legally permit such facilities.
The hope is, of course, to save lives. But the city will also be taking a side in a pitched legal and moral debate about the effectiveness of such sites — and, in fact, authorizing facilities that will be operating in violation of federal drug law. An upcoming court case based on a similar proposal in Philadelphia will reveal whether the Biden administration will move to permit such “harm reduction” facilities nationwide.
The underlying assumptions of the “harm reduction” movement are clear. Drug addicts will continue to seek and use increasingly powerful, illegal street drugs — and it’s better to provide clean needles and the on-site overdose reversal drug naloxone than let them join the more than 100,000 Americans who died from an overdose in the year that ended in April, a tragic new record.
Such sites already operate abroad, including in Amsterdam and Vancouver, Canada. And there is no doubt that reversing an overdose — as it’s happening — will prevent death. Ronda Goldfein, an advocate for such sites in Philadelphia, recently argued that the overdose crises require an all-hands-on-deck approach despite the inconclusive results of prior research: “The idea that we’ll wait, we’ll develop the perfect study, and then we’ll open the doors . . . . What about the people we’re losing every day?”
The two new Overdose Prevention Centers — and two more planned — will apparently resemble those medical labs where one gets blood drawn. Charles King of Housing Works, which hopes to open a site, told Gothamist/NYC that he envisions a setting with white partitions and a mirror, such that addicts can selfinject hard drugs such as heroin but be observed by nurses or an EMT, in case of an overdose.
But there are still good reasons to be concerned about such facilities. As David Murray, longtime chief scientist at the federal Office of National Drug Control, has said, safe injection sites may not actually be safe: The new generation of fentanyl-laced street drugs may be so potent that overdose-reversal drugs may not be effective. The Harlem and Washington Heights sites, to be operated by OnPoint NYC, will, per the city’s feasibility study, offer walk-ins the opportunity to have their drugs tested for fentanyl or impurities to minimize risk. But would such testing be required? What if addicts decline such a test? And what if, despite precautions, someone dies in a “safe” injection site? Such concerns have prompted opposition to such facilities from Bronx District Attorney Darcel Clark, who has said that “government should not be involved in taking on that type of liability.”
But most notably, there is little definitive research that demonstrates SIS improve their surrounding neighborhoods or reduce overall overdoses. Studies abroad have found a decline in syringes in their neighborhoods — but found no reduction in area crime, which one would think would be an important measure of success.
Murray notes, “Addicts may shoot up in safe injection sites but those are not open 24 hours a day. They will continue to inject drugs elsewhere.”
Moreover, he adds, our goal should be to help addicts build productive lives, not simply to facilitate their addiction. Thus, any safe injection sites should closely
monitor the fate of those who use them — no easy task, given the transience and risks associated with addiction.
There’s another important reason, however, that cities including Philadelphia and San Francisco, where harm reduction advocates have pushed for SIS, have not seen them open. Federal law — the Controlled Substances Act — prohibits the operation of a facility “for the purpose of unlawfully using controlled substances.”
The city Health Department brushes off the law, saying “our overarching recommendation is to support the piloting of four supervised injection sites . . . despite the risk of criminal prosecution for clients, staff and operators, as well as the risk of loss of licensure of clinical staff and the forfeiture of property for facility operators and landlords.” Oh.
Indeed, the efforts of the Philadelphia group Safehouse have been, to date, blocked by the federal courts after the city’s Trump-era US attorney brought suit. Safehouse is, however, trying a new legal tack, based on a religious exemption, that will challenge the courts’ interpretation of the law. In the process, its new suit, due to be heard in early January, will reveal whether the Biden Justice Department will continue the Trump-era opposition to safe injection sites. Acquiescence could open the door to such sites nationwide.
There is much at stake here, including, to be sure, the lives of the addicted. But so, too, is the message that we are sending regarding drug use. At a time when we have already legalized marijuana, as states scrounge for sin tax revenue, we must decide whether we want to give a social seal of approval to what amounts to hedonism — to a lifestyle that promotes pleasure and thrill-seeking over the sense of satisfaction and achievement that comes with work well done and healthy families.
A full spectrum of behaviors that were once rightly viewed as temptations to resist, including drug use and gambling, are not only permitted but actively promoted by state governments. Now New York City is asking two low-income neighborhoods to provide sites where addicts will gather and legally use illegal drugs. What message will we send to those in East Harlem and Washington Heights who are raising children to work hard and play by the rules?
For now, this looks to be a fait accompli, as Mayor-elect Eric Adams has expressed strong support and the incoming state health commissioner, Mary Bassett, has just finished serving in the same role in the city. But what if overdoses citywide continue to rise anyway? What if crime surrounding the sites actually climbs? We can only hope that those involved will truly view these sites as pilots and remain open to the possibility that they may bring more costs than benefits.