The Future of Drug Policy Should be Supervised Injection Sites

Photo via OnPoint NYC

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The number of drug overdose deaths has increased more than 16% from 2020 to 2021, and from August 2021 to August 2022, over 3,000 drug overdose related deaths are estimated to have occurred in New York City. The opioid crisis is not as widely reported on as it was before the COVID-19 pandemic, but it has gotten worse. Many local and state governments are trying to pass comprehensive legislation addressing this crisis, and “harm reduction” strategies have begun to be taken more seriously.

Harm reduction is an approach to engaging with people who use drugs that is focused on keeping them alive and as healthy as possible. Common harm reduction strategies include equipping people with items such as clean needles, drug tests, and the overdose-reversing drug Naloxone so that they can use drugs safely. Supervised injection sites, however, are a more controversial aspect of harm reduction. At these sites, people are able to hygienically inject their own illicit drugs in a medically supervised space, preventing overdose deaths that most frequently occur when people use drugs alone.   

There are two supervised injection sites in New York City, and they are currently the only two in the country. As supervised injection sites are federally illegal, OnPoint—which operates the two facilities in NYC—only opened their sites after Joe Biden took office in 2021, as they were concerned about being shut down by the Trump Administration. These two centers have prevented over 1,000 deadly overdoses since they opened in 2021.

Although supervised injection sites are illegal across the United States due to federal law, in 2018, then-mayor Bill de Blasio announced that the Government of New York City would not take action against any supervised consumption programs. Although no legal challenges have been brought against OnPoint thus far, Damian Williams, Manhattan’s top federal prosecutor, has said that his office could crack down on or even shut down their supervised consumption site.

Legislators in the state government are currently crafting legislation that uses the $2 billion that New York state won in settlements with opioid manufacturers as the primary funding source to fight the opioid epidemic. A major debate related to this legislation is the future of supervised consumption sites in New York state. Senate Health Committee Chair Gustavo Rivera, a Democrat from the Bronx, wants $45 million of the $2 billion to fund safe injection sites. 

There is still serious opposition to supervised injection sites, as much of it is rooted in stigma around cultural perceptions of drugs and the people who use them. When OnPoint opened in East Harlem, they needed to convince skeptic residents that their programs can help the community. Many civic groups believed that OnPoint’s strategy would only make the problem worse. Harlem residents have said that they are frustrated that the supervised injection sites are in their neighborhood, especially considering their neighborhood is already saturated with drug treatment facilities. 

The Anti-Drug Abuse Act, signed by Ronald Reagan in 1986, raised mandatory minimum sentences for many drug-related offenses. It also instituted what is commonly referred to as the “crack house statute,” which made it a federal felony punishable up to 20 years in jail for operating a space or building that allowed illegal drug use. It is because of the “crack house statute” that supervised injection sites are illegal under federal law, which causes state governors to reject spending on supervised injection sites. Governor Kathy Hochul of New York and the governors of California and Massachusetts have rejected supervised injection sites on the grounds that the state cannot invest in a project that is federally illegal.

In 1986, the same year that Reagan signed the Anti Drug Abuse Act, Switzerland opened their first supervised injection sites. The Swiss government had decided to stop trying to eradicate drug use, “but [to] take care of problems generated by the situations around people being addicted to drugs,” said Jean-Félix Savary, Secretary General of the Romand Group of Addiction Studies in Geneva. Since 2000, the number of opioid-related deaths in Switzerland has fallen by 64 percent, while in the United States, opioid related deaths have increased by 200 percent.

It is clear that the American method of criminalizing drugs and drug use is not solving the opioid epidemic. As state and local governments address drug use in legislation, it is important that they center harm reduction strategies that have been shown to work in Switzerland, and also in Germany, Spain, the Netherlands, and other European countries. Supervised injection sites do save lives, and they need to be taken seriously as a resource in fighting overdose deaths. However, none of this can happen until the “crack house statute” is repealed at the federal level.

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This article was edited by Sofia Benzi and Sydnee James.