Tackling Public Drug Use: Would Supervised Injection Facilities Work in New York City?

When the first needle exchange program received approval after much controversy during the late 1980s, New York City's Department of Health initially put the facility near City Hall.

"People had to come from the South Bronx to Chambers Street and go through a phalanx of police officers to cash in three needles," said Ric Curtis, professor of anthropology and chairman of the department of law, police science and criminal justice administration at John Jay College of Criminal Justice.

His point is that there was only one, and it wasn't located in a community where it was most needed. However, once the program began to show positive results, more were added in diverse neighborhoods. Today, there are at least 16 in the five boroughs, plus vans and walk-around services aiding users and bringing down the spread of HIV/AIDS and Hepatitis C.

Another program aimed at helping intravenous drug users is at a similar crossroads: supervised injection facilities. SIF NYC, a coalition of more than a dozen nonprofits focused on reducing harm toward at-risk populations (e.g., drug users, individuals with HIV/AIDS, the homeless) aims to bring such centers to New York City. The coalition formed about two years ago to address the growing number of fatal heroin overdoses in the city, which has increased 120 percent since 2010 (see the slider below).

Locations of injection drug use depend on the housing status of the user. Those with stabile housing tend to shoot-up in private at home. Others who are homeless or in temporary housing situations are more likely to inject in public restrooms, on the street, in parks and in building stairwells, according to the Injection Drug Users Health Alliance, negatively impacting the quality of life for those living nearby. SIFs, often housed inside centers that provide needle exchange, abuse counseling, housing aid and other services, provide a semi-private, sterile environment where users can inject in the presence of a healthcare professional trained to assist in the case of an accidental overdose.

Talk of bringing such a center to New York City and elsewhere across the country where opioid overdoses have reached record highs has gained traction in recent months, with Ithaca, N.Y., Boston, San Francisco and Seattle also considering them. However, not one SIF currently exists in the U.S., while there are about 100 in 66 cities around the globe — with France recently approving four new ones, and this month the new government committing to bringing them to Ireland. The first one opened in Bern, Switzerland, in 1986. The only ones in North America are in Vancouver, Canada.

35 percent of individuals who use the centers eventually end up in detox and rehabilitation outreach programs.

Detractors of the controversial program argue that SIFs encourage drug use as opposed to getting addicts into rehab. SIFs give "the wrong message to society," said Luke J. Nasta, executive director of Camelot Counseling Service, a chemical dependency treatment facility in Staten Island —the borough with the highest rate of heroin overdose deaths since 2011. "We surrender to the fact that a portion of our population will be using recreational drugs intravenously, and that this is acceptable."

Proponents claim the opposite, and use statistics from existing SIFs to show that on average 35 percent of individuals who use the centers eventually end up in detox and rehabilitation outreach programs. Still, former users likely don't want current users and the draw of the drugs at these outreach centers around. Others prefer to shoot up in isolation, often because of the stigma and shame associated with drug dependency.

"Addicts who overdose do it in solitary," said Nasta, himself a former addict. "It may start out as a social experience, but once you become addicted, it has nothing to do with socializing. [Users] are not going to injection stations."

Still, there are lines often out the door for the Insite center in Vancouver, which opened in 2003. It offers 13 injection booths where clients inject pre-obtained illicit drugs under the supervision of nurses and health care staff. At the front desk, people can pick up medical equipment to inject safely, such as needles, cookers and filters.

In 2015, the facility averaged 722 clinical treatment visits per day; heroin accounted for 51 percent of the substances used. Last year the center also had 464 admissions from Insite to Onsite, an adjoining detox treatment facility, with a program completion rate of 54 percent. In 1997, before the center opened, 140 people in Vancouver died of a drug overdose. By 2009 that number dropped to 62.

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Insite is funded by taxpayers at a cost of $3 million Canadian per year. A 2010 study by criminologists at Simon Fraser University estimated that the center prevented 35 new cases of HIV and nearly three deaths per year, saving more than $6 million annually. For every tax dollar spent, four are saved by preventing expensive medical treatments for addicts further down the line, according to Vancouver Coastal Health.

Sydney, Australia, has seen similar results.

In 1999, 834 people died as a consequence of opioid drug overdoses, which equaled 77 percent of all accidental drug-induced deaths. Half of these people were from New South Wales, Sydney's state. After the Sydney Medically Supervised Injecting Centre opened in May 2001 on a trial basis, the percentage of people dying that year from opioid overdoses dropped to 58 percent. The results showed that the center improved the safety for drug addicts, and the center got a permanent license to carry on.

According to a 2010 evaluation, the center successfully managed 3,426 drug overdoses since it opened, resulting in zero deaths. Further, 80 percent of the clients surveyed said they were now able to identify early signs of overdoses themselves, and 63 percent of referrals from the center from 2009-2010 completed or were still receiving treatment.

Sydney's MSIC also launched a Needle Clean Up Team to collect needles found near the center. In its first year, the team collected 28,231 needles. Six years later, the number had decreased 55 percent to 12,646. Further, nearly 46 percent of new registrants had injected in a public place the month before coming to MSIC; 96 percent of them had reduced public injecting after.

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In April, New York Mayor Bill de Blasio announced a $5.5 million plan to help tackle the opioid problem, with multiple initiatives that range from a program geared toward youths in Staten Island to expanded Naloxone distribution for community-based organizations that serve people at risk of overdosing.

What was not included was mention of a SIF. The Health Department noted in an email that "the city is not considering authorizing a supervised injection facility," but instead supports and will promote other harm reduction strategies.

However, Councilman Corey Johnson, chair of the health committee, invited SIF NYC to present to the Council in October 2015, to educate lawmakers on what a SIF does, how they operate in other cities and “how would we translate that to have something meaningful for New York,” said Julie Netherland, director of the office of academic engagement for the Drug Policy Alliance. Sources said that in recent weeks Johnson served as the liaison for individual meetings between advocates and council members. Johnson’s office did not respond to multiple requests for comment.

There also have been meetings with the New York Police Department about developing an arrest diversion program, said Peter Schafer, deputy director, family health and disparities at the New York Academy of Medicine. "If we're not arresting people and throwing them in jail, what kinds of services do we need to have available? If part of the problem is police responding to people publicly injecting, then we need to have safe injection facilities."

Based on past meetings, "the health department seems committed to making it happen, but can't officially say that," said Curtis, who also is on the board of four community organizations including BOOM! Health in the South Bronx and the After Hours Project, which he helped found in 2002, in Brooklyn.

"If part of the problem is police responding to people publicly injecting, then we need to have safe injection facilities."

Peter Schafer, New York Academy of Medicine

"When syringe exchanges started, activists made it happen, they didn't seek permission first," he added. "Here, it's the other way around, and it will take longer to increment the process. [SIF NYC] has been systematic about how to go about it. My guess is next year we will see one."

He prefers to reach more people in need, but "one is better than none." So what would a SIF in NYC look like and where would it be located?

Advocates agree housing it in an already existing harm reduction organization that also provides syringe exchange services would be a good starting place. Curtis guesses that Washington Heights would be home to the initial center, should any legal ramifications be overcome and the city opens one.

It'll be tough, though, to get community board approval. "You can have politicians on board, the Health Department, Police Department, and the Mayor's office, but the community board has to be dealt with," Curtis admitted. "That's a tough nut to crack. Those Bible-thumping ladies, this isn't their idea of fun."