After decades of failed zero-tolerance crackdowns, debates on drug policy are finally coming around to seeing drugs as a public-health issue. But that recognition hasn’t yet changed the fundamental aspects of drug dependence: There’s nowhere in the country where someone can use illegal drugs in a designated safe and humane setting. Instead, users resort to parking lots, abandoned stairwells, and public toilets, alienated by shame and exposed to illness and violence.
As the overdose-death toll swells nationwide—shattering once stable communities as opioid addiction grows more widespread and the drugs more powerful—some cities are trying to end the cycle of criminalization and alienation by moving an underground habit into public light. Through supervised injection facilities (SIFs), injection-drug users can seek a medically supervised safe space where they know they are protected from overdose and shielded from police. They are provided with clean facilities, sterile equipment, and, most importantly, trained health practitioners who can make sure users don’t become another statistic in the opioid crisis’s increasing body count.
In New York City, where overdose rates have soared—there were more than 1,370 overdose deaths in the city in 2016—and about 60 percent of surveyed intravenous-drug users said they had recently injected in “semi-public spaces,” like a public bathroom, public pressure to establish SIFs is rising. Though the stereotypes and stigma around inviting “junkies” into the neighborhood have impeded the process, the sheer scale of the crisis is clearing a way through the political impasse.
Advocates for harm reduction—the ethical framework centered on promoting public health and individual and community rights when it comes to substance use—are awaiting a long-overdue report commissioned by the city government to explore the feasibility of an SIF project. Nearly 100 such sites exist around the world—helping people cope with addiction in roughly 66 countries, primarily in Western Europe and Canada. Empirical research continually shows that SIFs have not resulted in increased drug use or drug-related crime in the surrounding community, but have led to “increased preventive healthcare and drug treatment utilization.” So the US lags behind, without a single official SIF. Despite making strides in other harm-reduction interventions such as needle exchanges, distribution of the OD-relief medication naloxone, and methadone clinics, the US has yet to establish a legal and infrastructural framework for safe consumption spaces.
New York City, along with San Francisco and Philadelphia, could be the pioneers for SIFs in the United States, and advocates hope the city’s feasibility study will add evidence to their unassailable moral case. But the delays in the report have dragged on for two years now. At a recent rally and City Hall press conference, Kassandra Frederique, New York State director of the Drug Policy Alliance, declared, “If we want to save lives, reduce criminalization, and end racial disparities, we need comprehensive, innovative, and forward-thinking approaches like safer consumption spaces.”
Following the protest, Mike Selick, a social worker and organizer with the Harm Reduction Coalition, expressed the mounting public frustration with the Mayor’s ongoing reticence as the opioid death rate climbs: “The mayor has publicly said ‘soon,’ but it has been over two months and still we wait. Every seven hours, someone dies of a drug overdose in New York City. It is clear that life won’t wait for Mayor de Blasio to release the feasibility study—we cannot continue to be patient while people are dying.”
At recent public hearings on the possibility, people expressed unease about the legal conflicts that might be precipitated by such sites, including potentially running afoul of federal drug codes. But SIF proponents emphasize that the legal workarounds are well established: There is no explicit regulation allowing or barring the establishment of SIFs currently, so state or municipal legislation simply authorizes a state-sanctioned SIF program under the rubric of protecting the public health. And at the city level, the mayor could craft policies that protect SIFs by establishing operating standards and oversight mechanisms. Many point to the success of a similar initiative, needle-exchange programs, which help drug users protect themselves and are shielded from law enforcement under Good Samaritan and other public-health protections. According to a policy analysis published in the journal of the APHA, since syringe exchanges “have successfully operated in several cities in Pennsylvania, California, and Ohio without state authorization,” expanding the service to include medical supervision and a safe setting would be legally feasible. And if the city can provide the tools for safe injection, why not provide a safe space as well?
And consider the alternative. Without SIFs, people are driven into fatal risks: A 2015 study by the Injection Drug Users Health Alliance showed that people who had engaged in public injection suffered twice the rate of overdose in the previous year compared to those who had avoided using in public, and were more than four times as likely to report reusing injection equipment, which could exacerbate the spread of HIV, hepatitis C, and other infections. People who were insecurely housed or homeless were three and five times more likely to report having injected in the street or a park, respectively, compared to the stably housed.
A recent survey by the grassroots community-health group BOOM! found that the majority of New York City business owners had “encountered people using drugs in their bathrooms in the previous six months.” Beyond the legalities of SIFs as a remedy for the drug crisis, the growing harm-reduction movement looks toward a more holistic goal: It’s simply impossible to demand abstinence from every drug user, but drug users will accept help if it lets them live healthier, more dignified and stable lives.
New York has come a long way following a generation of drug-war politics. From zero tolerance in the 1980s to harm reduction today, there is a growing consensus, even among law enforcement, that the most effective way to treat substance dependence is to focus on public health rather than criminalization or stigma. Yet, even though we may claim to want to treat people struggling with drugs like human beings, every day we force them into dehumanizing environments.