Step off the New York City subway at 125th and Lexington, and you will find yourself in what can only be called an open-air drug market. The subway entrance is an easy place to score—the day I visited, one man stood yelling, “Drugs! Drugs! Drugs!” like a ballpark vendor. On every block, people slump where they stand, “nodding out” from opioid intoxication.
According to one resident, however, last Tuesday morning NYPD cars temporarily replaced the users and dealers in advance of the media-heavy launch of New York City’s Safe Consumption Sites (SCS), officially sanctioned centers where people can use drugs under the supervision of medical professionals armed with overdose-reversing medication. In their first day, the two sites—one in East Harlem and the other in Washington Heights—permitted more than 70 people to consume drugs in a designated “overdose prevention center,” then ride out the high in a DMV-like waiting room.
The launch culminates years of work by outgoing mayor Bill De Blasio; his successor, Mayor-elect Eric Adams, has indicated he plans to support the project. The two seem to agree that the urgency of New York’s drug crisis—2,000 deaths last year alone, and a 200 percent increase in the overdose death rate in the last two decades—justifies this radical approach. As city councilman Mark Levine put it, “This strategy is proven to save lives, and is desperately needed at a moment when fatalities are rising fast.”
Desperate times call for desperate measures, and with 120 of them in operation across ten countries, Safe Consumption Sites are not an untried idea. But contrary to the reassurances of New York’s leaders, a sober reading of the evidence reveals how little we know about how well they work and their social side effects. New York is essentially conducting an experiment—an illegal one—not only on drug users but also on residents of some of its most-challenged neighborhoods, without any clear metrics for success.
The site is a particular burden to the residents of East Harlem, which already hosts many of the city’s drug-treatment facilities. Data obtained by the Greater Harlem Coalition, a neighborhood advocacy group, show that while central and eastern Harlem are home to just 3 percent of New Yorkers, 18 percent of the city’s drug-recovery patients go there for treatment. Just 17 percent of those people are from East Harlem proper, while 75 percent are from outside Harlem altogether.
The blocks surrounding the new SCS are already awash in drug users, who bring with them drug dealers—a nuisance, and sometimes a threat, to law-abiding citizens and their kids. The introduction of SCSs, research based on Vancouver and Sydney’s sites suggests, is not generally associated with an increase in measured crime, but that doesn’t mean it doesn’t depress community quality of life.
The day after the launch, when I and a group of colleagues visited East Harlem, it was clear that the SCS had already become another site for users—and dealers—to congregate. A group, clearly ready to sell, assembled in front of the bodega next door; only when two cops arrived did they make a hasty retreat. That didn’t stop the concerned looks from parents dropping their children off at preschool across the street (many drug-treatment facilities in the area are adjacent to schools). One young mother, her two-year-old in her arms, told me that she worried the city’s imprimatur would attract even more of a drug trade to the neighborhood where she was trying to raise her daughter.
Most of the parents were black or Latino, representatives of one of New York’s poorest and most heavily minority neighborhoods. The proliferation of drug-treatment sites in East Harlem is particularly concerning, the GHC argued in a recent letter to New York State’s addiction authority, because of the racially disproportionate impact of their placement: over 90 percent of the city’s opioid treatment programs are located in previously redlined communities. Methadone clinics, treatment facilities, and a needle exchange are all just blocks from the SCS.
The new facility differs from these others in an important respect: safe consumption sites categorically violate federal law, as established when a series of federal court rulings shot down Philadelphia’s attempt to erect a site. The Third Circuit Court of Appeals found that the sites contravene the Controlled Substances Act’s so-called Crack House Statute, which prohibits opening a space with the express purpose of facilitating drug use.
Four of the city’s five district attorneys have said that they will not prosecute the SCSs, as has incoming Manhattan D.A. Alvin Bragg. A Biden-appointed U.S. Attorney is similarly unlikely to go after the sites. That’s part and parcel with city leaders’ hands-off approach to drug crime: one East Harlem resident told me that she would be more willing to accept the sheer number of drug-related facilities in her neighborhood if the law also made sure users and dealers stayed off the street, but no such luck.
Advocates of the SCSs say that the federal laws are unjust and argue that the sites will help clean up neighborhoods by drawing drug use inside. But their fundamental position is that any nuisance for the community is worth it to save lives. The NYC Department of Health and Mental Hygiene estimated that opening four SCSs would prevent between 67 and 130 overdose deaths annually—a 6 percent to 12 percent reduction in mortality (relative to the 2015/2016 baseline they used). Studies of other jurisdictions’ sites claim similar effects. “The data doesn’t lie,” Sam Rivera, executive director of the nonprofit consortium overseeing the city’s sites, told the New York Times.
Data don’t lie, but the data on SCS’s life-saving efficacy are more equivocal than proponents suggest. In its glowing “feasibility study,” the DOHMH cites two studies to support the proposition that SCSs “reduce overdose mortality and associated harms.” One, a study of Sydney’s site, identified a significant decline in opioid-related ambulance calls in the city relative to the rest of New South Wales. But the agency does not mention an earlier study of the same data, which produced the same ambulance finding but found no significant effect on actual overdose deaths. The other study, focused on Vancouver, identifies a large drop in overdose deaths within the 500 meters adjoining the site. But that analysis not only relies on a questionable control group (the rest of Vancouver), but also implies that the effects of SCSs are reserved to their immediate proximity, raising questions about the real scale of their efficacy.
It makes sense that a designated room with Narcan and clean needles would prevent deaths, both by overdose and by disease transmission, and many currently operating sites claim thousands of lives saved. The operators of New York sites’ claim to have reversed two overdoses in their first day of operation.
But two considerations challenge this logic. First, causality is hard to infer. Most people who use drugs don’t patronize SCSs, even when they’re available—Vancouver’s site, for example, supervised only 5 percent of injections in its neighborhood in the early 2000s. This implies that those who do use the site are particularly attuned to the need to use “safely,” meaning that they may have sought other means of overdose prevention—e.g., widely available Narcan—in the absence of the site. Secondly, an individual overdose reversed is better thought of as a death delayed than a life saved. By facilitating the cycle of use, several drug policy scholars have argued, SCSs increase the cumulative risk that a person will overdose and die outside of the site after their overdose is reversed within it.
And the risk remains that by normalizing drug use and concentrating the drug market, SCSs can contribute at the margins to drug-taking and even death. To rebut the claim that SCSs promote drug use, the DOHMH cites a study that not only lacks a control group but takes as its population of concern active intravenous drug users. But what the parents at the school across from the SCS worry about is how the site will increase the chances of their kids getting hooked—a possibility on which the research is conspicuously silent.
New York’s SCS could help answer this question. Municipal leaders could pre-identify “control” neighborhoods and compare various measures between those with and without SCSs: drug-overdose deaths, crime, litter and discarded needles, and public fear and discontent. Reached for comment, a DOHMH press representative told me that “as with other OPCs around the world, there will be research evaluations to study their impact in addressing overdoses,” but did not respond to further questions about how these evaluations would be done. (Most such prior analyses “merely report associations that do not permit causal inference,” three RAND analysts note, and even the causal work is of questionable quality.)
New York City’s political leaders, then, are conducting what amounts to a haphazard experiment. It’s possible that the experiment will be worth it. With more than 100,000 drug deaths in the year preceding April 2021 alone, we should not necessarily dismiss radical means to keep people alive. But it’s also possible that New York’s adoption of SCSs will further immiserate several already-miserable neighborhoods— subjecting the worst-off New Yorkers to the daily indignity of life in the city’s designated dumping ground for drugs.
Photo by Spencer Platt/Getty Images