In the late 1990s, I attended a speech by then-U.S. Secretary of Health and Human Services Donna Shalala.
I don’t remember what she spoke about, but I do remember her getting interrupted and heckled by AIDS activists who were angry at the Clinton Administration’s policy on needle exchanges. And they had every right to be. The Administration had accepted a federally-sponsored scientific review of incontrovertible evidence that found that needle exchange programs reduced the spread of AIDS in intravenous drug users, without increasing the use of drugs. Shalala was even quoted as saying, “The scientific part was easy.” Yet, the Clinton Administration refused to authorize funds for such programs, fearing it would look soft on drugs. It was a political cop-out and the government still has blood on its hands for that decision. How many lives could have been saved if the political will was there to back the science?
It is decades later, and another public health crisis — the opioid epidemic — requires us to be bold. Drug overdoses in New York State and nationally are at crisis levels, with the highest number of overdose-related deaths ever recorded. While the COVID pandemic dominated the news, the opioid epidemic only got worse. The latest reports show that drug-involved overdose deaths in New York State increased by 37% between 2019 and 2020. Opioid-related deaths are growing even faster: a 44% increase between 2019 and 2020. That’s an average of nearly 12 New Yorkers dying every day from opioid-related overdose.
It’s likely that those numbers have climbed even higher as people grapple with the consequences of the ongoing pandemic, including mental health distress, loss of income and housing stability, and disruptions in prevention and treatment services. The cumulative impact of the pandemic, the increasing prevalence of fentanyl in the drug supply, and pervasive racial disparities in overdose deaths are taking a devastating toll, particularly in New York City.
New York City has a history of embracing high-risk, high-reward strategies to address public health crises. Even without federal support, New York City became home to one of the first needle exchange programs in the United States. It had to be so; by the early 1990s, NYC was experiencing the largest HIV epidemic among injecting drug users of any city in the world. Approximately one-half of the estimated injecting drug users in New York were believed to already be infected with HIV.
As opioid addiction continues to ravage lives and communities, one effective model for reducing overdose deaths remains legally precarious: overdose prevention centers, or OPCs. OPCs are clinical, safe, hygienic spaces where people can use drugs under the supervision of trained professionals to prevent deaths and get connected to care and drug treatment. They are co-located in existing needle exchange programs and provide health and social services like free meals and counseling services. Research proves that OPCs reduce drug-related illnesses, improve access to health care, and reduce drug-related crime and public drug use. OPCs have long been in operation in Canada, Europe, and Australia, and not a single overdose death has occurred in any facilities worldwide.
In the United States, though, a 1980s-era provision of the federal Controlled Substances Act prohibits making facilities available “for the purpose of unlawfully…using a controlled substance.” That provision wasn’t designed to prohibit overdose prevention centers, but the unintended consequences could be significant. Absent clear federal guidance, state and local governments are wary of establishing OPCs, despite their proven results.
I’m proud that New York City is once again leading the nation. Late last year, OnPoint NYC became the first organization in the United States to open government-sanctioned OPCs, in East Harlem and Washington Heights. Since their opening, these centers have prevented more than 300 overdoses and served more than 1,000 people.
Although State and federal action is needed to explicitly legalize OPCs and open up pathways for reimbursement and expansion, City officials, including the Mayor, have been supportive. The City Council has also called on Mayor Adams to allocate an additional $10 million to open an overdose prevention center in each borough. Two more OPCs are expected to open this summer in midtown Manhattan and the East Village, under the auspices of Housing Works.
At the existing two sites, OnPoint NYC has exceeded expectations in its first several months of operation, reversing more overdoses in five months than experts expected it would in a full year. OPCs also make good financial sense: the New York City Department of Health and Mental Hygiene preliminarily estimates that OPCs will save up to $7 million annually in health care costs from drug use and overdose. A rigorous, third-party evaluation by academic researchers is expected to further cement the case.
OPCs are a partial response to an opioid epidemic that demands a comprehensive approach. Although a bill to legalize OPCs stalled in Albany, the New York State legislature recently approved several bills to address other elements of overdose prevention, like eliminating insurance co-pays for opioid treatment programs and allowing night clubs to administer Naloxone and other overdose treatments. Drug treatment programs need to be available and affordable.
New York City is poised to demonstrate to the nation that OPCs are a safe, effective, and compassionate tool to curb the consequences of the opioid epidemic. Philadelphia, Seattle, San Francisco, and Rhode Island, along with several other states, are in various stages of establishing OPCs; California and Maryland have already looked to OnPoint NYC as a model for their own work.
History doesn’t have to repeat itself. Embracing needle exchanges sooner would’ve saved lives. Now, we are older and wiser. Reversing the opioid crisis and saving lives will take courage. New York is leading the way with overdose prevention centers. Indeed, in hindsight, we may ask again, “What took us so long?”
By David Sandman, President and CEO, New York Health Foundation
Published in Medium on June 15, 2022
Photo: OnPoint NYC staff at an overdose prevention center in East Harlem. Photo by Timothy A. Clary.