Could New York City Soon Offer Injection Facilities for Heroin Addicts?

Since 2014, New York has seen more deaths from heroin overdose than from homicide. And often, those who don't have a hygienic place to use — or who prefer not to shoot up at home — will take to parks, public restrooms, abandoned buildings, or other unsafe locations to get their fix. Doing so often leaves addicts vulnerable to infection and possible death, says Matt Curtis, policy director at VOCAL-NY, a nonprofit advocate for low-income New Yorkers affected by strict drug law enforcement.

To combat this problem, a number of advocacy groups have banded together to form the SIF NYC coalition, a group whose aim is to bring supervised injection facilities (SIFs) to New York City. "It's a coalition that came together to try to deal with some of the intractable problems surrounding the overdose epidemic in the city and state and the problem of public injection," says Julie Netherland, New York deputy state director for the Drug Policy Alliance. She adds that the city's growing homeless population leaves even more people at risk.

In response to data released in early December by the city's Department of Health and Mental Hygiene that revealed an increase in heroin overdose deaths for the fourth consecutive year, the coalition released a statement urging the city to encourage the creation of such facilities. 

"Supervised injection facilities can reduce overdose deaths and have proven effective in improving a host of public health and public safety outcomes," the statement read. "We can no longer afford to let fear and stigma stand in the way of saving lives."

SIFs are safe and hygienic, even reminiscent of medical clinics, with trained staff on site, says Netherland. The facilities provide users with clean needles, an anti-overdose drug called naloxone, and sterile cubicles for injecting. Staff are available to offer assistance in the event of a medical emergency — everything from symptoms of overdose to simply finding a vein. A SIF facility also contains an area where users can hang out after they've injected, "to make sure there isn't a problem with overdose," Netherland says. "A lot of overdoses happen because people taking drugs are alone." She notes that it's important to have the cooperation of the local law enforcement. "Certainly you don't want to create an environment where police are able to target and harass users."

Despite the controversial nature of the very concept behind SIFs, they are not new. In fact, nearly 100 facilities (98, to be exact) exist in 66 cities around the world. The only SIF in North America, however, is a single facility in Vancouver, British Columbia. Various peer-reviewed scientific studies have proved the benefits of SIFs, including increased access to drug treatment, increased public safety, reduced risk of contracting HIV, hepatitis C, and bacterial infections via needles, and fewer overdoses. There is little recorded evidence of SIFs having encouraged drug use or drug-related crime.

Still, the campaign to establish the facilities has met with some opposition from public officials. "This proposal, if enacted, would hurt our efforts to help Staten Islanders by perpetuating drug use," Staten Island borough president and former city councilman James Oddo said in a statement. "With one breath we cannot tell children that drug use is bad, and with another breath provide drug-addicted individuals with a government-approved shooting gallery to continue using drugs." In 2014, Staten Island had the highest rate of heroin overdose deaths in New York City. Luke Nasta, a Staten Island resident and executive director of Camelot Counseling Service, believes the proposal amounts to little more than a "surrender" in the effort to slow the city's growing heroin problem. "An epidemic cannot be curtailed by giving it a safe environment in which to thrive," he says. 

Coalition members say they take these criticisms seriously and have tried to respond to them in their campaign. "I understand resistance to the idea that we're accommodating people's use and using that as an entry point to engage people into care," says Peter Schafer, senior policy associate at the New York Academy of Medicine, a member of SIF NYC. "But that's what it is: an entry point to engage people into care, not enabling people to continue their drug use, but to have them be safe and develop relationships so they can get the health services and drug treatment that they need."

The resistance to SIFs among many city leaders mirrors the pushback to other halfway programs of years past, like the clean syringe exchange programs of the Eighties and naloxone distribution in the early 2000s, Curtis says. "They think we're condoning drug use or making it easier to use drugs," he says, "but it's a profound misunderstanding of drug dependence and drug use that is very bound up in what people have been taught." In the past 25 years of syringe exchange, HIV contraction has fallen from 54 percent to 4, Curtis adds. 

The coalition is currently lobbying the city's elected officials, including City Councilman Corey Johnson. “Supervised injection facilities are a successful harm reduction strategy in cities across the world and are a critical facet of the governor’s Ending the Epidemic Blueprint," Johnson says. City Council's more liberal makeup makes it easier to work with, but Curtis says that given Governor Andrew Cuomo's mission to end HIV infection by 2020, the proposal isn't a left-field conversation on the state level, either.

"We're losing people every day to opioid overdoses," says Netherland, "and we know they're preventable." Mayor Bill de Blasio's recent decision to make naloxone available over the counter without a prescription indicates city recognition that this problem is not going away, she adds. "What ties these together is that we're not doing enough and need to do more. It's time to look at research-based solutions to help stem the tide of overdose." 


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