Can supervised injection sites save lives?

A much-delayed report from the city health department last week suggested two things: First, we are watching the unfolding of an opioid-driven health crisis, with 1,441 total overdose fatalities logged provisionally in 2017, a record-high in New York City. Second, that one way to deal with this situation is to let people inject drugs safely and care for them when they do.

This would happen at “supervised injection facilities,” which have sprouted in cities internationally but have not yet caught on in the United States (though programs are in development in places like San Francisco and Philadelphia). That’s because, as the city report calmly puts it, there’s a “risk of criminal prosecution for clients, staff, and operators,” plus potential property forfeiture for landlords and facility operators.

But the report also notes that as many as 130 lives a year could be saved by the creation of four injection sites around the city, which is why Mayor Bill de Blasio is tentatively moving ahead with a test of the idea, pending state approval and input from local communities and law enforcement.

For advocates like Alyssa Aguilera of VOCAL-NY, this plan is extremely necessary, given the dire situations of the drug users and other New Yorkers who seek refuge and aid at the nonprofit’s Brooklyn office near Atlantic Terminal.

A nonprofit called Research for a Safer New York has asked the city for permission to operate the injection sites. In Brooklyn, the group would operate under contract with VOCAL-NY.

This complicated arrangement is partially due to the illegality of the drugs at hand and most behavior associated with them. Landlords are liable to get skittish, for one. Exact locations haven’t been set. De Blasio’s administration, similarly, says the sites would be operated by the harm reduction groups and not funded with public money. Nothing to see here.

But none of that obscures how strongly advocacy groups like VOCAL-NY feel about this mission. Currently, people come into the VOCAL-NY offices for addiction-related services like needle exchanges, help finding housing or medical aid or community activities like Tea Tuesdays and movie nights. Some of the guests are homeless, says Aguilera, and they might come to the office multiple times a day. If they are drug users, they might go into the building’s bathroom and wash their hair, or shoot up. If the latter, VOCAL-NY staff can check in if the bathroom’s been occupied too long, and be ready with the lifesaving nalaxone drug if an overdose has occurred. That’s a pale imitation of actual watchful supervision, however, and the imitation could result in lives lost.

One much-cited example of a functioning supervised injection facility is located in Vancouver, Canada. There, Aguilera notes, there are relatively open booths where drug users can sit. The site is well-lit, sterile and clean. There is a place to relax. Pictures of the site show mirrors lining the wall. Medical professionals and other workers are on hand to care for the visitors and potentially connect them to drug treatment services.

That would all be extremely helpful to some of the clientele at VOCAL-NY, who are now likely shooting up alone and quickly in a Starbucks or Target bathroom, risking overdoses from super-potent fentanyl. “When we’re not open, they’re on the street,” Aguilera says.