Will NYC’s Supervised Injection Sites Bolster Overdose Prevention Efforts in Other Cities?

Two months ago, New York City became the first U.S. city to officially open supervised injection sites in an attempt to curb overdoses. The opening was a long-awaited victory for harm reduction advocates across the country, some of whom already have plans for opening sites of their own. 

A supervised injection site, or an overdose prevention center (OPC), is a facility where people can use injectable drugs like heroin, cocaine, methamphetamine, and various opioids, in a clean environment with access to safety resources. The sites do not provide drugs, but people are allowed to bring their own.

The main goals of the sites are “to reduce the acute risks of disease transmitted through needle sharing, prevent drug-related overdose deaths, and connect persons who use drugs with addiction treatment and other health and social services,” according to the National Institute on Drug Abuse (NIDA).

OPCs are meant to save lives, according to harm reduction advocates and addiction researchers.

“The idea is to reduce health harms associated with drugs,” Emily Einstein, PhD, chief of NIDA’s Science Policy Branch, told Verywell. “So far, the evidence suggests that no one has ever died of a drug overdose in one of these sites.”

NIDA supports evidence-based harm reduction, and supervised injection sites in other countries have not been detrimental, Einstein said. Going forward, the institute will monitor the NYC sites and others in the U.S. to get a better understanding of their effectiveness.

Studies found that OPCs have significantly reduced public injection drug use, unsafe disposal of needles, and syringe sharing rates among users, according to NIDA.

“There’s been an exponential increase in overdose deaths for at least the past few years, so this is a really entrenched problem that has only been growing,” Einstein said. “It’s especially important that we are innovative and come up with improved evidence-based ways to address addiction overdose, because this problem is incredibly serious.”

The New York City sites, located in East Harlem and Washington Heights, are run by trained staff from harm reduction organization OnPoint NYC. They provide users with clean needles, referrals to addiction treatment centers, and Narcan (naloxone), an overdose reversal medication.

In the first three weeks of operation, staff at the sites averted at least 59 overdoses, according to the city’s health department.

How Did Overdose Prevention Centers Come About?

OPCs, or supervised injection sites, have operated since the 1980s. The first OPC opened in Berne, Switzerland in 1986. More than 120 such sites currently operate in Europe, Canada, and Australia. The sites in New York are the only OPCs authorized and operating in the U.S. to date.

In fact, the victory in New York City came on the heels of a Philadelphia harm reduction loss. For years, harm reduction advocates in Philadelphia have sought to implement a safe injection site—by the name of Safehouse—in the Kensington neighborhood, which has been hard hit by the overdose epidemic. 

In 2019, a federal judge used the “crack house statute,” which was cosponsored by then-Senator Joe Biden in 1986, to block the supervised injection site from opening in Philadelphia. The Biden administration has expressed support for harm reduction, but not specifically for supervised injection sites. They have yet to voice concerns for or against the sites in New York City.

Advocates from Safehouse are expecting the case to be reviewed by early March.

Legal Victory in Rhode Island

Despite its first two sites being up and running, New York City hasn’t passed any law making supervised injection sites legal. Instead, the city has received agreement and support from former mayor Bill de Blasio and the police force.

Focusing on the law seemed to have squashed the plans for an injection site in Philadelphia, while some have applauded New York City for reaching an agreement without legal intervention.

Legal routes appear more successful elsewhere. Rhode Island, which also plans to open supervised injection sites, passed a law in July 2021 to authorize a two-year pilot program for harm reduction centers.

Officials still have to decide on the locations and logistics of the centers, but advocacy groups welcome the legislation.

“I’m very excited for Rhode Island, that hopefully we will be the next after New York,” Colleen Daley Ndoye, MS, executive director of Project Weber RENEW, one of the organizations advocating for supervised injection sites in Rhode Island, told Verywell.

“We’re really proud, because we’re sort of a small state, and I think sometimes we get overlooked,” she said. “We really pushed for this to happen, it didn’t just happen. It took many years for this legislation to get passed.”

Setting up supervised injection sites in the area could help harm reduction organizations respond to fentanyl overdoses quickly, Daley Ndoye added.

Overdoses in Rhode Island have risen in the last few years, with most overdose deaths involving fentanyl. In 2020, over 250 people in the state died of fentanyl-involved overdose.

“About 25% of the Narcan that we distribute is used to save a life,” Daley Ndoye said. “We really feel this pressure that we have to be out there every single day, during COVID, during whatever. There’s a sense of urgency on everyone’s part, and everyone is affected by overdose.”

Amy Nunn, ScD, MS, executive director of the Rhode Island Public Health Institute, told Verywell that she and her team are working to see how they can contribute to the cause in a way that shows their strengths.

“In my dream world, we would have a variety of different harm reduction services,” Nunn said. 

Despite local support, Nunn said she has worries about federal backlash.

“A lot of people think ‘should we be doing this, is it ethical for me?’ I don’t have that conundrum,” Nunn said. “It’s more just like, how do you work the legal stuff? When the Feds come after you, we have a change in leadership, or they don’t like the way you’re doing it and you don’t have anywhere to go legally—I’m looking to New York with keen interest for that.”

Fear of Community Backlash and Stigma

Community support plays a role in facilitating the opening of supervised injection sites in Rhode Island. Daley Ndoye said that harm reduction organizations are prepared for community backlash even with the state law in place.

“We’re not naive to think that everyone is going to immediately jump on board and is going to say, ‘yes, I want one of these sites, and I want it to be right next to me,’” Daley Ndoye said, adding that regulations for the sites will be finalized around March.

“It’s difficult to wait,” Daley Ndoye said. “If we could wave a magic wand, we would already have a site open today or multiple sites open today. And I know it would save lives.”

In Philadelphia, residents in Kensington have mixed views about opening an injection site. The neighborhood is often described as neglected by the city in terms of upkeep and policing. Arguments against the site often revolve around not wanting children to walk by the site and fears that drug problems would get worse.

“We have to listen to each other and actually come to some agreements,” Sterling Johnson, a harm reduction worker in Philadelphia and member of the Philadelphia Overdose Prevention Network, told Verywell.

“What we have is, I would say, a healthcare apartheid, that lots of White people seem to be very comfortable with,” Johnson said. “It’s going to be why we don’t move forward in a real way on things like overdose prevention.”

Racial disparities in harm reduction and overdose care are prevalent in Philadelphia, he added. Since the onset of COVID-19, overdose deaths have spiked among Black Philadelphians by more than 50%, according to a recent study.

Johnson said he hopes people will start to see the pilot injection sites in New York as healthcare sites. “Overdose prevention centers are health care, syringe access is health care, drug testing is health care,” he said.