Welcome to the latest edition of this NYC election-focused newsletter. I’m journalist Felipe De La Hoz, and today we’re going to discuss the epidemic. No, not Covid-19—I’m referring to the other epidemic, the one that has flown under the radar, overshadowed by the glare of the pandemic, but which seems to be intensifying even as Covid-19 deaths in New York have waned: opioid addiction and overdose.
Overdose deaths spiked about 30 percent year-over-year in the country as a whole, including a surge to over 2,300 in New York City alone in the 12-month period ending in April 2021, according to Centers for Disease Control and Prevention data. Many experts believe that the devastation of the coronavirus not only happened in tandem with the increase in mostly opioid deaths, but actually partially led to the crisis, as social isolation, economic calamity and anxiety over an indefinite public health catastrophe drove some people to a greater dependence on opioids. Some also point to what appear to be higher incidences of the very potent synthetic drug fentanyl showing up unexpectedly in other drugs.
It hasn’t become a dominant political question in New York quite yet, but expect to see it become a greater issue going into next year’s elections, particularly as it becomes a referendum on the effectiveness of policies that are being rolled out right now. There have been a few key developments in recent weeks, perhaps the most salient and potentially transformative being the recent announcement that the City of New York is becoming the nation’s first jurisdiction to formally sanction the operation of safe injection facilities (SIFs), also called overdose prevention centers.
At these centers, trained staff are on hand to monitor drug users and ensure that they don’t succumb to overdoses. Beyond that, they provide clean needles—a proven way to combat the spread of diseases like HIV and hepatitis—test drugs for things like toxins and fentanyl, and often provide an entry point to get people suffering from addiction into treatment programs, including medication-assisted ones, counseling, social services and in some cases, even supportive housing.
I recently had the opportunity to speak with Sarah Evans, former director of the pioneering Insite SIF in Vancouver, Canada, and now a director for the Open Society Foundations. Insite opened in 2003, becoming the first legal SIF in North America and overcoming some initial resistance to reach, according to one study conducted five years later, a 76 percent approval rating in the city of Vancouver. For those of you who don’t keep up with polls and studies of public sentiment, let me tell you: it is very hard to get 76 percent of any population to agree about literally anything, let alone something as stigmatized as safe injection sites.
This goes to show ultimately how effective this center has been at achieving its core objectives: bringing drug use out of the street, where people who are overdosing can easily die without access to help or counteractive medications like Naloxone, as well as generally utilize dirty drugs and needles that are sometimes left out in the community; and ultimately helping these people get a fuller suite of services that allowed them to stabilize their lives. Evans emphasized that SIFs get tarred as somehow endorsing the use of opioids, when the opposite is true; they want fewer people to die while combating their dependencies, and indeed no one has ever died on-site in the over 15 years of Insite’s operation.
Here in New York, the sites are being run by the new nonprofit OnPoint NYC, which was formed out of the melding of the existing New York Harm Reduction Educators and the Washington Heights Corner Project, which each ran a needle exchange in Upper Manhattan (though needle exchanges often get conflated with SIFs, the former provide clean needles but not technically a place to use drugs). These centers opened as fully fledged SIFs just Tuesday and already some in the political firmament and the media are banging the war drum. An article in the New York Post, referring to the SIFs as the “first legal shooting galleries for drug users” in its headline, ran ominous images of intravenous drug users and noted in its first sentence that five people had overdosed on the first day at the site in East Harlem.
You’re probably going to be seeing a lot more of this sort of coverage going forward, but it’s worth remembering—people overdosing in the centers and not out on the street is the whole point. Those people didn’t die, which is not something we can say with certainty had they had their overdoses in a subway station or an alleyway instead. It’s also worth noting that this is a big step not only for New York, but for the United States, as municipalities and states around the country have basically been waiting to see who would go first. Part of the reason for this is the little issue that knowingly providing space for the use of illegal drugs is technically federally illegal.
It appears the city has communicated with the feds and the state and everyone is on the same page, but it remains a fact that the federal government could legally intervene. In fact, under the Trump administration, it did, suing Philadelphia over its own plans to open up a safe injection site. It’s unlikely that this will happen under President Biden, as the optics of moving against a proven harm reduction system amid a spiraling crisis and flagging poll numbers would probably be pretty bad.
Since this is a political newsletter, we should discuss the political angle, which is that combating opioids will become a plank in next year’s races. Mayor Bill de Blasio is almost certain to tout these SIFs as he continues his almost certainly doomed campaign for governor. Gov. Kathy Hochul, for her part, will probably lean on a number of bills that she signed in October that, among other things, decriminalized possession and sale of syringes, mandated access to medical-assisted treatment for drug users in state prisons, and prohibited criminal courts from negatively weighing possession of drug antagonists like naloxone.
Meanwhile, her biggest challenger, State Attorney General Letitia James, has been touring the state as a part of her flashy “HealNY” tour, where she is announcing disbursements to bolster local efforts to combat the opioid epidemic from a pool of up to $1.5 billion in settlement funds resulting from lawsuits against pharmaceutical companies. Observers have noted that the announcements are a perfect venue to pseudo-campaign while acting in her official capacity.
These efforts add to existing harm reduction principles that have slowly seeped into most levels of public policy in New York. The state was one of the first, for example, to create drug diversion courts, which are intended to allow people arrested on drug crimes to avoid jail time and criminal records by completing alternate programs like treatment and rehabilitation. As candidates fully embrace a humane approach to combating the opioid crisis as a good electoral strategy, it seems like we’re at a moment of critical mass for hopefully turning things around.