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As fentanyl overdose crisis hits Americans hard where's proof that 'safe injection sites' work?
March 14 2023, 08:00

As recently as his State of the Union address, President Joe Biden decried the wave of fentanyl overdose deaths in the U.S., decrying the fact that, as he said, "fentanyl is killing more than 70,000 Americans a year." But daily in New York City, the Biden Justice Department is turning a blind idea to sites where illegal drugs may be used, contrary to federal law. Two so-called "safe injection sites" have been operating in Manhattan for more than a year, contrary to a January 2021, federal court decision, which judged a similar site in Philadelphia to be in violation of the federal Controlled Substances Act.

Nonetheless, New York City Mayor Eric Adams’ administration, clearly without fear of federal intervention, last week announced plans to open five more such sites, where addicts can inject illegal drugs under medical supervision. We know that they’re illegal. What we don’t know is whether they actually help stem the wave of drug use and deaths. That’s because neither New York nor Washington is actually asking that or other key questions about "safe injection."

Let’s assume that the sites reflect a sincere effort to reduce the wave of drug overdoses that claimed the lives of more than 2,000 New Yorkers last year. But before they expand — including to the entire state of Rhode Island, which has authorized them — we must make sure of something — that they actually work. 


City Health Commissioner Dr. Ashwin Vasan assumes that they do. "The goal is to reduce overdose deaths by 15% by 2025," he says. "We must have more overdose prevention centers in order to reach that goal." 

But as modest as that goal is, the city has no way to determine whether the sites operated by the nonprofit group OnPoint actually help attain it. The group’s own data shows, to be sure, that it has, per executive director Sam Rivera, "intervened in 750 overdoses." But that is little more than a snapshot; the city desperately needs the big picture of what happens to the street addicts who come through OnPoint’s doors once they leave. 

Just as the FDA scrutinizes — even over-scrutinizes — the efficacy of new drugs, safe injection sites deserve the same careful examination. They must be considered a pilot program, a new and untested idea which, like any treatment regimen, must be put under a magnifying glass. A serious, evidence-based approach to doing so must involve tracking every individual who walks in through OnPoint’s doors and out again. 

How many continue to buy and use illegal drugs? How many overdose and die outside the "safe sites?" How many use the magnet of such sites to deal drugs outside? How many are arrested for criminal acts in which they engage to get the funds to buy street drugs? How many sell drugs to finance their habit? Who supplies their illegal drugs? How many are later found sleeping on subways — and must be shooed into shelters by transit cops?

Any serious study — perhaps funded by the National Institute of Mental Health in conjunction with the Substance Abuse and Mental Health Services Administration — should ask these questions and more. To do so, it may be reasonable to ask safe injection clients to wear ankle bracelets and other identification so they can be electronically tracked.

Those that have cellphones — and many likely do — should be tracked through those. City Health authorities should work with police to gather data on criminal activity of safe site addicts. 

Civil libertarians may protest that such study would be an invasion of privacy. But keep in mind that each of OnPoint’s clients is engaging in at least one illegal activity — purchase of a controlled substance. By agreeing to overlook that, City Health and police must make a deal with addicts: we will help you but you must let us learn from your experience. 

They should be mindful of growing backlash. Former Washington State Republican Rep. Jaime Herrera Beutler introduced legislation in 2022 — the Stop Injections Sites for Illegal Drugs Act — that would limit federal funds to jurisdictions that permit the sites.


A key data point to consider: do overall overdose deaths in New York actually decline by that 15%? The city must not rule out the possibility that normalizing drug use encourages more addiction — potentially raising the overall number of ODs. 

All of the above becomes even more crucial in light of the emergence of neighborhood concern about the effects of the existing sites. As Morgan McKay has reported for New York’s Fox5 News, neighbors are being asked to tolerate a use they consider noxious.

One East Harlem resident identified only as Yvette, told McKay of illegal overflow activity outside the OnPoint site. "I see them dealing right in front of my face, like I’m walking by, you see the dealer, passing the goods, they’re giving them the money. These needles are being left in the street in my neighborhood, they’re all over." She worries about letting her grandson visit her — and seeing all that. 

City Health has already identified the South Bronx as a future safe injection site; one can be sure there won’t be one in Gramercy Park. That, of course, makes sense; new sites, to follow the city’s logic, must open where the addicts are found. But magnets for drug use will not improve the quality of life in neighborhoods already plagued by violent crime and lousy schools.

Of course, it’s not impossible that safe injection sites will be a net positive. But that must not be taken as an article of faith. Follow the addicts and study the evidence — before this questionable experiment continues and expands to communities across the country.