In an attempt to curb a surge in overdose deaths caused by increasingly potent street drugs, New York City will authorize two supervised injection sites in Manhattan to begin operating as soon as Tuesday.
Trained staff at two sites — in the neighborhoods of East Harlem and Washington Heights — will provide clean needles, administer naloxone to reverse overdoses and provide users with options for addiction treatment, city health officials said. Users will bring their own drugs.
New York, the country’s most populous city, will become the first U.S. city to open officially authorized injection sites — facilities that opponents view as magnets for drug abuse but proponents praise as providing a less punitive and more effective approach to addressing addiction.
Other cities including Philadelphia, San Francisco, Boston and Seattle have taken steps toward supervised injection but have yet to open sites amid debate over the legal and moral implications of sanctioning illegal drug use.
The two Manhattan sites are already operating as needle exchange programs, and some residents in the communities have already raised concerns about the decision to place them in less affluent areas of the borough.
In an interview, Dr. Dave A. Chokshi, the city’s health commissioner, said the city was moving forward to address a public health crisis.
“2020, unfortunately was the deadliest year on record for overdoses both here in New York City as well as nationally. Every four hours, someone dies of a drug overdose in New York City,” he said. “We feel a deep conviction and also sense of urgency in opening overdose prevention centers.”
Mayor Bill de Blasio began championing safe injection sites in 2018, citing their use and success in European and Canadian cities. The decision to officially allow the sites to open comes during the mayor’s last few weeks in office and as he considers a run for governor. He said in a statement that the decision will show other cities that “after decades of failure, a smarter approach is possible.”
The mayor also sent a letter to the providers promising “not to take enforcement action” against their operations and saying that the city has secured the support of law enforcement agencies. Four of the city’s five district attorneys — excluding only the Staten Island district attorney, Michael McMahon — support supervised drug sites.
“We have always been trying to strike the right balance between enforcement, rehabilitation and prevention,” Cyrus R. Vance Jr., the Manhattan district attorney, said in an interview. “I would rather have people who are going to shoot up do it in a safe and secure venue as opposed to a McDonald’s bathroom, an alleyway or a subway staircase. ”
Nationally, overdose deaths rose to more than 100,000 in the 12-month period that ended in April, according to the National Center for Health Statistics, an increase of close to 30 percent from the 78,000 overdose deaths during the same period in the previous year.
More than 2,000 people died of a drug overdose in New York City in 2020, the highest total since the city began keeping track of overdose deaths in 2000. During the first three months of 2021, there were close to 600 overdose deaths, according to preliminary data.
The city will not operate or staff the drug injection sites, Dr. Chokshi said. The two nonprofits that run the needle exchange programs — New York Harm Reduction Educators and Washington Heights Corner Project — are merging to form OnPoint NYC and will expand their services to offer supervised injection at the current sites, he said. The city provides funding to the two nonprofits.
“I know deep in my soul that we are doing the right thing,” said Sam Rivera, the executive director of OnPoint. “The data doesn’t lie.” He said the sites expected to start operating on Tuesday.
Federal law, however, has yet to catch up. A federal law often referred to as the “crack house statute” makes it illegal to operate, own or rent a location for the purpose of using illegal substances. The Justice Department, under the Trump administration, sued in 2019 to stop a supervised injection facility in Philadelphia from opening.
The Biden administration has embraced harm reduction methods but has not explicitly endorsed supervised injection sites. Dr. Chokshi said the city has had “productive conversations” with federal and state health officials, and he believes that the facilities will be allowed to operate because of a “a shared sense of urgency” about addressing the overdose crisis.
Michael Botticelli, the former director of the White House Office of National Drug Control Policy under President Barack Obama, said the Department of Justice did not prosecute states when recreational marijuana use began to be legalized around the country.
“Many cities have been waiting for someone to go first, particularly to see what the federal Department of Justice reaction is going to be,” Mr. Botticelli said. “It’s hugely important, not just from a public health perspective but for other communities around the country that have been contemplating this to be able to point to New York City and say we are doing this in the United States.”
In East Harlem, already home to a heavy concentration of methadone clinics and other drug treatment centers, Eva Chan, a member of Community Board 11, has been bracing for the opening of an injection site and lamented that it would just further cement the neighborhood’s status as a place where drug use and sales are tolerated.
“If every district in New York City has one site and it’s not right next to my home, I’m not against it,” Ms. Chan said. “But the root cause of why people are shooting up here is that they’ve been using East Harlem as a dumping ground for a long time. So they don’t address the root cause.”
Proponents of supervised injection sites argue that the facilities will not only prevent overdose deaths but can actually stem the problem of public drug use that often leaves a trail of used syringes on the street and in parks.
An official with a network of homeless shelters in the Bronx, which is home to some of the neighborhoods with the highest overdose rates in the city, said that safe injection sites could also help to reduce street homelessness.
“For a lot of our street-homeless clients, the reason they’re out there is because they have serious addiction,” said Scott Auwarter, assistant executive director of Bronxworks. “For them to be in a facility, to be able to use safely, gives us a chance to engage them and maybe convince some of them to take a low-threshold bed someplace.”
Supporters of the injection sites have been gearing up for this moment. On Nov. 7, there was a celebration at the East 126th Street site in anticipation of the announcement.
Dr. Chinazo O. Cunningham, a deputy commissioner in the city health department who has since been named commissioner of the State Office of Addiction Services and Supports, popped a bottle of Veuve Clicquot. “It’s really an amazing moment,” she said in a speech captured on a video that was provided to The New York Times. “To bring evidence-based lifesaving treatment and initiatives to people who deserve it, finally to do that with love and respect and with dignity, I really am incredibly proud to be here at this moment.”
Though the celebration may have seemed premature, the East 126th Street needle exchange has already been operating as an unofficial injection spot for months, at least, according to two former heroin users who said they shot up there several times in the spring. (Mr. Rivera confirmed that “unsanctioned” use has occurred.)
Inside the space, there are bathrooms set aside for drug users, equipped with a chair, a desk and a diaper-changing table, said the couple, who asked to be identified only by their first names and last initials, Jonathan D. and Kira D., so as not to jeopardize Jonathan’s job.
“If you’re in the bathroom longer than 15 minutes, they knock on the door and ask if you’re OK,” said Kira, 26. “If you don’t answer, they come in.”
After injecting, users are encouraged to come out to a waiting room lined with chairs — “kind of like the D.M.V.,” said Jonathan, 36 — where workers in medical scrubs stand by ready to treat overdoses.
“People that are nodding out too hard, they go over and make sure you’re nodding out and not falling out,” Jonathan said.
Jonathan, who is now on methadone, was delighted to hear that the city would finally allow the site to operate openly.
“It’s about time,” he said.