For any lawmakers in the nation considering legalizing the safe injection site (Bill S399 and A338), we hope you can learn from the failures of this safe injection site (view more here) and embed these safety guardrails into the law that sanction such site so as to balance the needs for everyone in the community:
(1) Ahead of choosing a location, ample community engagement is needed. “To ask for forgiveness later” approach sets the site up for failure. Special permit for zoning akin to adult establishments or liquor license should be obtained, and studies to enable Certification of Needs should be conducted to local needs and environmental impact. Importantly, if such sites are to be established, they should be installed in the majority of the 59 NYC districts in order to prevent the congregation of drug dealers and users in a few locations, creating quality of life issues for nearby residents. If a site is to be established in a district already over-burdened with social services not needed by local residents, the government should de-densify other social services while setting up the safe injection site.
(2) For the on-going monitoring of the program, ample funding must be provided to closely monitor the impact on the areas within a 10 blocks radius, hire police and install security cameras to address increase in drug dealing, support continuous community engagement. In addition, standardized data must be recorded to analyze whether the site is indeed serving local residents, and to track whether the site is successful in referring clients to treatment and for clients to remain in the treatment program
Harlem’s experience with a rushed Overdose Prevention Center (OPC) rollout and its inappropriate siting is that the OPC, while saving lives inside the OPC, has failed to curb open-air drug dealing and drug use in the neighborhood, which in fact has increased significantly(0).
We learned that we must balance the needs of both the drug users and the community. While harm reductionists aim to meet clients where they are at, we must be honest that unless the site operates under a well-controlled environment, they can be serving people who were not from that district and they draw in even more criminal elements into the district, thus perpetuating structural racism.
Harlem community recommend Senator Gustavo Rivera and Assembly Member Linda Rosenthal to amend their bills (Bill S399 and A338) with these safety guardrails, many of them would be considered in New York State’s Certification of Needs (1) process and the government licensing and renewal process (2) had such process been required:
- Open many supervised injection sites (SISs) or none at all
- Keep injection sites 1000 feet from schools and playgrounds
- Allocate more funding to arrest drug dealers and end open-air drug scenes
- Establish a Community Advisory Board to formalize community engagement
- Collect data to hold SIS’s providers accountable for referring users to treatment
- Prioritize Treatment. Add treatment programs to NYC’s 36 Assembly Districts that are treatment deserts
The Safety Guardrails in Detail:
1. No containment zone. Many sites or none at all
What we know is when a city creates “containment zones” to place excessive density of social services unwanted by wealthier districts in a small area, the patients suffer and the residents in the community suffer. Owing to decades of redlining, neighborhoods of color, such as South Bronx and Harlem, often are burdened with excessive number of drug treatment programs, adult only shelters, and adult only supportive housing; these well-intentioned facilities in excess draw in criminal elements. To only place the OPC in these historically red-lined district is a grave mistake. OPCs must then be equitably distributed throughout a MAJORITY of New York City’s 59 community districts.
Realistically, to expedite siting of 30+ OPCs in NYC, consider placing them in mobile units or existing community health centers and hospitals as part of their mandated service.
The government must reduce the density other social services not needed by local residents to help mitigate quality of life issues. For example, Central and East Harlem has 3.5% of NYC’s population but 18% of NYC’s drug treatment capacity, 10% of NYC’s adult only shelters. Both OPC and drug treatment capacities should be widely distributed to improve healthcare accessibility.
Funding must be provided to monitor whether users of OPC, harm reduction and drug treatment programs are originally from the neighborhood.
Note that for this reason, in some countries, eligibility criteria (3) are established so the sites are only reserved for residents who live in the district or those who can consistently appear in the site.
2. Location Choice and zoning restrictions:
Similar to any adult establishments, OPCs should therefore be located away from schools, playgrounds, faith-based organizations, drug treatment programs, or other harm reduction programs via zoning laws and a special permit. This would help minimize objectionable influences in residential areas and allow for adequate expert review and processes to capture public feedback.
Specifically for NYC, consistent with zoning for adult establishments, OPCs should not be located within 500 feet of schools, playgrounds, faith-based organizations, or similar treatment establishments, such as harm reduction programs and drug treatment programs. For reference, 200 feet is the restrictions for liquor stores.
Currently, in Harlem, the OPC is placed within 2 blocks from 7 schools attended by 4200+ students. The impact? Read the parents of the Pre-K school across the street from OnPoint’s OPC pleading for help here to the local community board in Feb 2023 (see recording here from 1 hour onwards), and note the school installed bullet-proof glass window (see our post).
3. Deter criminal activities and Open Air Drug Scene near the site:
Near the site in Harlem, we found our police force to be overstretched and unable to patrol the safe injection site vicinity. Therefore, funding must be provided
To ensure NYPD is adequately staffed and trained to arrest drug dealers, who are now emboldened
As in the case of Portugal, drug users with less than 10 days worth of substance, should be put before a Dissuasion Commission(4) staffed with social workers and psychologists to help them get on the path of recovery where drug use is interfering with their lives and public safety. About 10-20% of these users are sanctioned for treatment. Currently, little can be done by the police to deter open-air drug use.
NYPD should pay special attention to break up open-air drug scene (5).
That there are enough security cameras in the vicinity to support the possible increase in criminal activities nearby. Besides having high-quality security cameras inside and outside of the site, we found the increase in drug use and drug dealing is observable up to 10 blocks away. Therefore funding should be provided to install security cameras in various locations a few blocks near the site, particularly in the public housing nearby where drug dealers have turned into their market place.
4. Community engagement before and during operation:
Community engagement is critical to the success of the site. “To ask for forgiveness later” approach sets the site up for failure and, on an on-going basis, a community advisory board should be established akin to the management of a healthcare facility. In the least, the safe injection sites must be required to:
Like a drug treatment center, obtain a letter of support from their community board for initial establishment and ahead of each contract renewal
Obtain letters of support from local elected officials
Form a Community Advisory Board (CAB) that will channel community feedback
Create a formal engagement plan with nearby businesses, as is required in Alberta Canada
5. Mandated Data collection on program effectiveness and local needs:
Funding should be provided to help centrally collect and disclose data to account for the safe injection sites’ effectiveness in treating patients and steering patients on to recovery. Data should include(6):
- Patient’s identity and healthscore, which helps to track whether OPC is effectively steering patients towards treatment, thus saving lives (see #33 in Alberta government guideline)
- Are we serving local residents: collect zip code where patients resides
- Success metrics such as the number of patients that accept and stay on drug treatment for [6 months] or more, the number of patients who come consistently to the site, the number of times one patient use the site each week, number of hospital visits reduced
- Operational metrics, such as staff turnover, use of funds (see misappropriation example), staff qualification
- Objective studies of Environmental Impact: Sufficient funding should be provided to perform robust environmental impact survey of nearby community residents and businesses before establishment and periodically thereafter. This would help monitor any worsening of open-air drug use and drug dealing nearby. Such studies should at least review the following data: Local arrest data related to drug use and drug dealing, syringe pickup data, related 311 complaint data zip code
6. OPC must be accompanied by Recovery and Treatment focused program:
OPC should be implemented as a part of the continuum of treatment services for users, and not be used as a low-cost bandage to avoid spending needed funds to support Prevention and Treatment programs. In general, as GHC proposed, New York City should allocate funding for these programs based on quantitative measurement of treatment demand, such as overdose rates, in different districts so NIMBYs cannot push back on these life saving programs. Currently, 36 out of 64 NYC assembly districts have no treatment programs. NYC should ensure these programs are developed before, or in parallel to, the placement of OPC. To quote João Goulã, the architect of Portugal drug policy, “Decriminalization is not a silver bullet,” he said. “If you decriminalize and do nothing else, things will get worse.” “The most important part was making treatment available to everybody who needed it for free. This was our first goal.” (read more about Portugal’s approach to drug treatment policy here)
New York’s opioid crisis impacts us all. Overdose prevention centers are one approach to reducing EMS calls and emergency room visits. New York needs many more of these facilities in an equitable and racially just distribution. We hope you will work with your colleagues to add the (above) amendments to NYS Senate Bills S399 and A338.
If you have any questions or would like to learn more about The Greater Harlem Coalition, feel free to reach out at info@GreaterHarlem.nyc.
Key research articles:
- Detailed description of Portugal’s Dissuasion Committee by Portugal’s SICAD
- Description of Portugal’s drug policy and the infrastructure needed before decriminalization drug use by their architect João Goulão’: drug users with less than 10 days worth of substance, should be put before a Dissuasion Commission
- Regulatory requirements of safe consumption sites in Alberta Canada
- Safe Consumption Site are typically reserved for local residents and consistent users as described by European Monitor Center for Drug and Drug Addiction (EMCDDA)
(0) Studies of community impact of OPC is not conclusive, especially since the studies are done in other countries operated with more restrictions. For negative impact, one can review this page from Alberta’s studies. One research in Australia (1 , 2) found no impact.
(1) To ensure all the above considerations are in place before operations, an application akin to Certification of Needs should be filed with New York State following similar procedures to ensure: Such district is indeed the few with the highest need. There is minimal environmental/community impact. There is sufficient governance to monitor the ongoing effectiveness of the operations and the environmental/community impact. Equitable distribution must be considered so as to avoid OPCs disproportionately being placed in lower-income districts, thereby contributing to systemic racial injustice.
(2) It might seems obvious, but similar to an opioid treatment program, OPCs must obtain a license from a New York State or City agency subjected to ANNUAL renewal. Agencies such as the New York State Department of Health or Department of Health and Mental Health in New York City should be responsible for issuing the license and making contract renewal decisions accounting for feedback from the community board, community advisory board and NYPD. Needless to say, OPC should not be allowed to operate without a license and the law should be modified to clarify that operating such site without license is a prosecutable offence.
(3) Eligibility critera adopted by various sites include reserving the site for registered users, users from nearby location, users who are able to present themselves regularly. Quote from European Monitor Center for Drug and Drug Addiction (EMCDDA) “A number of features are common to the majority of drug consumption facilities, irrespective of where they are located. For example, access is typically restricted to registered service users, and certain conditions, for example minimum age and local residency, have to be met.” To avoid enabling drug use, some treatment is reserved for those on methadone treatment but have repeatedly relapsed. More discussion of eligibility criteria can be found in this article, e.g. irregular users, first time user, underaged user…
(4) Even in Portugal, drug users are still arrested. Here is a quote from APA.org American Psychological Association “the law decriminalized the use and possession of up to 10 days’ worth of narcotics or other drugs for individuals’ own use. (Dealers still go to jail.) Instead of facing prison time and criminal records, users who are caught by police go before a local three-person commission for the dissuasion of drug addiction, a panel typically composed of a lawyer plus some combination of a physician, psychologist, social worker or other health-care professional with expertise in drug addiction. The commission assesses whether the individual is addicted and suggests treatment as needed. Nonaddicted individuals may receive a warning or a fine. However, the commission can decide to suspend enforcement of these penalties for six months if the individual agrees to get help—an information session, motivational interview or brief intervention—targeted to his or her pattern of drug use. If that happens and the person doesn’t appear before the commission again during the six-month period, the case is closed.”
- Read more about the Portugal model from the International Drug Policy Consortium , General Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD) and the Drug Policy Alliance.
- Do refer to the archive in the Obama Administration regarding the downside of drug decriminalization and the benefits of drug courts or Dissuasion Committee.
(5) Open air-drug scene attracts less stable drug users. See this study on BMC Public Health
(6) Here are some references that describes best practice in data collection: Alberta data requirements