Saving Lives: Steps Forward and Steps Backward

If you know someone who’s died of a drug overdose, you are far from alone. A new study from the esteemed RAND Corporation is shocking; it finds that 2 in 5 Americans know someone who’s died of a drug overdose.

Here in New York, the problem is only getting worse. More than 5,100 New Yorkers died from an opioid-related overdose in 2022 alone. That same year in New York City, a record number of people died of overdoses; fentanyl was involved in the vast majority of those fatalities. I’ve written before that it’s become almost commonplace to see people overdosing publicly in New York.

One bright spot in this darkness is OnPoint NYC, which operates the only two Overdose Prevention Centers (OPCs) up and running in the United States. (I’ve written about OPCs before, here and here.) These centers are clinical, safe, hygienic spaces where people can use drugs under the supervision of trained professionals. They provide medical and social services like free meals, counseling services, and showers.

Most importantly, they work. In just their first year of operations, the OnPoint sites prevented more than 600 overdoses in nearly 50,000 visits.

Despite their proven ability to save lives, the future of OPCs remains in limbo. For every step forward, it also feels like we are taking a step backward.

In the positive column:

• New York City soon won’t be alone. The Providence City Council recently approved Rhode Island’s first OPC, which is expected to open later this year.
• OPCs don’t harm their neighborhoods. New research in Journal of the American Medical Association examined the East Harlem and Washington Heights neighborhoods that are home to New York City’s OPCs. It found “[n]o significant changes…in violent crimes or property crimes recorded by police, 911 calls for crime or medical incidents, or 311 calls regarding drug use or unsanitary conditions observed in the vicinity of the OPCs.”
• New York State’s Opioid Settlement Fund Advisory Board has repeatedly expressed support for expanding OPCs across the State, including to rural areas, citing their role “in saving lives and offering another day to drug users.” And it specifically recommends using opioid settlement funds to support OPCs. New York State lawmakers have repeatedly introduced legislation to establish safe consumption sites, since at least 2021.

On the other hand:

• OPCs have failed to spread widely. California, Colorado, Massachusetts, and Vermont have taken steps in recent years to authorize OPCs, but all have fallen short. Philadelphia was set to open the very first OPC in the nation back in 2019, but the federal Justice Department sued to stop its launch.
• The main impediment to scaling OPCs is the lack of public funding. It was widely expected that the Biden Administration and its DOJ would drop opposition to OPCs, paving the way for wider adoption and government financing. But the Philadelphia case was still dragging on at the end of last year. It’s unlikely that there will be any meaningful federal action in an election year.
• In light of these stalled federal efforts, Governor Hochul has refused to allow opioid settlement funds to go toward OPCs. And New York’s legislative bills have failed to gain broad traction.

So here we are: stuck in second gear while the death toll mounts. It will take a lot more than OPCs to curb the opioid epidemic. Harm reduction takes many forms, and New York is doing a lot of things right, like making naloxone more widely available and expanding access to substance use treatment programs. There is even a glimmer of hope in the data. New York State’s Opioid Data Dashboard shows that high schoolers’ rates of heroin and other drug use are holding steady or even dipping a bit. That could mean fewer New Yorkers are getting hooked on opioids in the first place.

But there’s no time to waste. Every three hours, someone in New York City is dying of an overdose. One step forward followed by one step back is not going to cut it. If we are serious about stopping the opioid crisis, we need bold action. We need courage.