New York Mayor Bill de Blasio and the New York Health Department have announced that the nation’s first publicly recognized overdose prevention centers will open November 7 at New York Harm Reduction Educators (NYHRE) and Washington Heights Corner Project, two existing facilities that provide syringe exchange services in the Manhattan neighborhoods of East Harlem and Washington Heights.
The organizations are merging to form OnPoint NYC, a service that will expand syringe access programs to offer supervised injection services at their current locations. The announcement from Mayor de Blasio cites a Health Department feasibility study which found that the centers, known in New York City as OPCs, would prevent up to 130 New Yorkers a year from dying of a drug overdose.
“Overdose Prevention Centers are a safe and effective way to address the opioid crisis,” said de Blasio in the statement. “I’m proud to show cities in this country that after decades of failure, a smarter approach is possible.”
According to the New York City Health Department, more than 2,000 people died of a drug overdose in New York City during 2020, the highest number since reporting began in 2000. The figures show a steep increase in overdose deaths throughout the U.S., primarily among those using opiods.
A new report from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics reveals that more than 100,000 people died of an opioid overdose in the 12-month period ending in April, 2021.The record breaking figure represents a 30% increase over the previous year, or nearly 275 deaths per day.
According to the CDC, escalation in opioid overdose deaths have been fueled by an increase in availability of the potent synthetic opioid fentanyl and reduction of social services due to the Covid-19 pandemic. The Drug Policy Alliance and other advocacy organizations also point to a delay in the implementation of evidence-based harm reduction policies and are urging policy makers to take action.
Overdose prevention centers go by a variety of names – supervised consumption sites, safe injection facilities, drug consumption rooms, supervised use sites, harm reduction centers, and safer drug consumption sites. They all have a common goal: reduce drug related harm and prevent avoidable deaths by offering safe spaces where people who use drugs can bring their own previously acquired substances without fear of arrest.
Despite escalating overdose deaths, explicit support for OPCs and similar safer drug consumption sites is missing from a new Biden Administration plan to address the unfolding public health crisis.
While supervised consumption services have expanded globally over the past decade in response to increasing numbers of overdose deaths, the U.S. has been slow to adopt policies supporting this strategy. A recent case by the Department of Justice against a supervised consumption site in Philadelphia shows that past drug criminalization policies supported by Biden and other policy makers continue to impact public health initiatives.
White House Releases Its Plan of Action
Following the release of the CDC’s overdose data, the White House released a statement detailing the administration’s plans to address what they described as the “overdose epidemic.”
“The Biden-Harris Administration is using every tool at our disposal to reduce these overdose deaths and to ensure that people with substance use disorder can get the support they need,” reads the statement.
While the Biden administration put forward a list of actions to address overdose deaths, it is not throwing its weight behind OPCs and other safer consumption services where people who use drugs can bring previously acquired substances to consume in an indoor environment.
The Administration’s plan instead includes new model legislation that states can use to tap federal funding to expand access to emergency opioid antagonists, such as naloxone, which can reverse an overdose. It is also urging Congress to regulate fentanyl analogs as Schedule 1 substances, which some believe will further criminalize those who use drugs.
The statement lists other initiatives led by the administration such as the American Rescue Plan, the $1.9 trillion economic stimulus bill passed by Congress and signed into law by President Biden in March 2021. The bill includes $1.5 billion to fund mental health and substance use disorder services, with $30 million earmarked for harm reduction services such as syringe service programs.
Other strategies championed by the administration include new guidelines to expand access to Buprenorphine which is used to treat opioid dependence. The White House is also supporting policies that allow states to use federal funding to purchase fentanyl test strips, finance education and research programs, and to support “evidence-based practices in healthcare, community and justice settings.”
In addition to some harm reduction measures, the administration is also supporting policies that attempt to reduce drug supplies by supporting regional law enforcement efforts to disrupt and dismantle drug trafficking organizations.
In a press release by the Drug Enforcement Administration, DEA Administrator Anne Milgram said, “This year alone, DEA has seized enough fentanyl to provide every member of the United States population with a lethal dose and we are still seizing more fentanyl each and every day.”
Despite an increase in large drug seizures, NPR and other sources report that U.S. law enforcement is struggling to curb the online marketplace for fentanyl and the large quantities of the substance produced in China and Mexico. Some analysts believe that medical approaches such as Medication assisted treatment and heroin-assisted treatment would be a safer regulated way to address the illicit market.
San Francisco Isn’t Willing to Wait
Faced with one of the highest number of overdose deaths of any major U.S. city, San Francisco is considering whether to break state and federal laws to create these services and help save lives.
With overdose deaths double that of deaths from Covid-19, San Francisco Mayor London Breed is weighing the potential legal consequences of opening a supervised consumption site in the city’s Tenderloin District where people openly use and sell drugs.
According to the San Francisco Chronicle, some experts believe that opening supervised consumption services could put those who work or use illegal drugs at these locations at risk of prosecution. The city could also possibly be fined and property used for the site might be at risk of being seized.
In November, Breed introduced legislation to the city’s Board of Supervisors to acquire a building as an initial step towards opening a supervised consumption site.
The move signals optimism around California Senate Bill 57 (SB 57), a proposed state law which would allow pilot programs for such services in Oakland, San Francisco, Los Angeles and Los Angeles County. SB 57 is being held in the Assembly Health Committee until the next legislative session begins in January, but is expected to move ahead quickly. A similar bill made it through the state legislature in 2018, but was vetoed by then-governor Jerry Brown.
“We cannot delay opening safe consumption services in San Francisco,” said San Francisco AIDS Foundation’s director of harm reduction policy Laura Thomas in a press release. “Every day, we lose San Franciscans to overdose. We know from the experience of many other countries around the world that safe consumption services save lives. The time to act is now.”
Supervised consumption services are considered by some public health advocates to be an important piece of a larger strategy for combating the opioid crisis that accepts people where they are. They have shown to be effective in other countries and are gaining support among policy makers in some states throughout the U.S.
In the past year, a number of bills aimed at establishing supervised consumption services across the U.S. have gained momentum. In September, Rhode Island became the first state in the U.S. to approve the establishment of harm reduction centers, legalizing a two-year pilot period in which the state will allow the establishment of supervised consumption services. Similar bills have been filed in Massachusetts (S.1258; H.2088; S.1272), California (SB 57), New Jersey (NJ A677), New Mexico (HB 123), Illinois (HB0110).
Thirty-Five Years of Supervised Consumption
The idea of establishing supervised consumption services to help prevent overdose deaths is well-established around the world. The first Drug Consumption Room was opened in Bern, Switzerland by Contact Netz in 1986.
In the thirty-five years since, similar programs have been established in other countries. Sites in Canada, such as the Moss Park Overdose Prevention Site, reverse hundreds of overdoses each year and similar services now exist in at least ten countries.
Lifesaving interventions such as naloxone make it possible to reverse what would otherwise be fatal overdose, but such interventions require another person to administer them, making the risk much higher for those using alone. Supervised consumption spaces offer a safer setting, where facility staff can reverse an overdose, and provide services to address a variety of drug related harms.
These sites offer a hygienic space to consume illegal substances under the supervision of staff trained to prevent and treat overdoses and provide additional harm reduction services. Sterile supplies, disposal services and access to naloxone are a few common services. Many facilities also offer primary medical care, mental health services, education, and resources for understanding and preventing HIV and hepatitis.
A report published by the New England Institute for Clinical and Economic Review, suggests that “no client of a Safe Injection Facility has ever experienced death from overdose within a facility.”
Decades of research supports evidence that overdose rates can be reduced by offering people who use drugs a safer space in which to do so, moving drug use off the streets and trading stigma for dignity.
In an interview with NPR, Health and Human Services (HHS) Secretary Xavier Becerra, who was appointed by Biden, made comments that signal the department’s interest in pursuing broader harm reduction approaches that were not on the table in earlier years.
“We’re not going to say ‘but you can’t do these other types of supervised consumption programs that you think work or that evidence shows work,'” Becerra said.
However, an HHS spokesperson later walked back the comment in a statement to NPR. “HHS does not have a position on supervised consumption sites,” the statement read. “The issue is a matter of ongoing litigation. The Secretary was simply stressing that HHS supports various forms of harm reduction for people who use drugs.”
Laws Championed by Biden Pose Barriers To Harm Reduction
The litigation referenced in the statement from HHS refers to a civil lawsuit filed in February 2019 against a Philadelphia nonprofit called Safehouse which was trying to establish a supervised consumption site.
The suit was filed by Trump appointee and former U.S. Attorney William McSwain. It asked a federal court to declare that supervised consumption services are illegal under a section of the Controlled Substances Act commonly referred to as the “crack house” statute. The lawsuit did not seek to seize property, impose financial penalties, or criminally prosecute any party.
In the same year the first Drug Consumption rooms were being established in Switzerland, then-Senator Biden was among the authors of the “Emergency Crack Control Act of 1986” (S.2715), later a provision of the Anti-Drug Abuse Act of 1986, and colloquially referred to as the “crack house” statute (21 U.S. Code § 856).
The law makes it illegal to “knowingly open, lease, rent, use, or maintain any place, whether permanently or temporarily, for the purpose of manufacturing, distributing, or using any controlled substance.” Biden advocated for expanding the law as recently as the early 2000’s to apply to buildings hosting raves.
While President Biden has reformed a number of his views on drug policy, the legacy of legislation he authored and championed during his tenure as senator continues to get in the way of evidence-based harm reduction policies his administration seems willing to support. In the case against Safehouse, a key question centers around legal language authored by Biden in the 1980’s.
The Department of Justice lawsuit against Safehouse has led to a series of appeals and an amicus brief filed on September 17 in which seventy-nine current or former prosecutors and law enforcement officials urged the Supreme Court to hear the case. Despite this support, the Supreme Court declined in an October 12 order. Safehouse managers said they were not surprised by the administration’s lack of support.
The case is currently back at the District Court after the Third Circuit Court of Appeals ruled against Safehouse in January of this year. A page on Safehouse’s website says its current strategy aims to force the DOJ to respond to a counterclaim filed on First Amendment grounds. A response from the DOJ due January 5 should clarify whether the Biden Administration intends to enforce the crack house statute against supervised consumption services.