Plans to open “safe injection sites” in New York City, long stalled, appear to be moving forward, though not at the speed that advocates would prefer. These sites, which Mayor Bill de Blasio prefers to call “overdose prevention centers,” will provide a place for drug addicts to inject themselves with narcotics, under medical supervision. When opioid users overdose, for example, medical personnel will be standing by to revive them.

Assuming de Blasio announces an inaugural date for the program before he leaves office at the end of 2021, New York will be the first municipality in the United States to sponsor “safe injection” as a city service, though Rhode Island is making similar plans at the state level. Philadelphia licensed an injection-site program, but it was blocked after the Trump administration opposed it in court. It remains unclear where the Biden Justice Department stands on the issue, but advocates appear hopeful that it will permit the program to launch.

Proponents say that safe injection sites are an obvious solution to the horrific problem of drug overdoses, which now kill more than 90,000 Americans annually. In 2020, the 30 percent leap in drug-overdose fatalities nearly matched the 40 percent increase in the nation’s homicide rate. Opioids killed 69,000 people that year, most of whom died after either injecting or insufflating synthetic opioids, whose hyper-concentrated nature makes it nearly impossible to titrate.

Establishing safe spaces for addicts to inject themselves, says city councilman Stephen Levin, “saves lives.” He explains that “these centers keep people from dying. The medical data is very clear. Any public health expert says it is not a controversial issue at all. Of course you want supervised injection facilities.” De Blasio echoes this premise. Taking issue with a reporter’s nomenclature, the mayor explained, “I call it overdose prevention centers, because I think it gets to the heart of what this is. It’s to save lives, stop people from overdosing, who could be saved and of course, to in every way, help them towards treatment and support. So, this is an idea that has worked in Canada. It’s worked in Europe. It’s an idea whose time has come.”

Advocates of safe injection sites, whether in government, the media, or in the nonprofit sector, all point to the Canadian experience as positive proof that such programs are a life saver. Insite, which opened in Vancouver, British Columbia, in 2003 as North America’s “first sanctioned supervised drug injection site,” is considered the gold standard of care from the perspective of “harm reduction.”

The principle of harm reduction is that society should ensure that all dangerous, dysfunctional behavior—drug abuse, unsafe sexual practices, failure to comply with psychiatric medical orders, living on the street—happens in as safe a manner as possible. People will not stop using drugs just because they are told not to, so the best way to manage the various side effects of drug abuse—overdose, festering wounds, poverty, crime, child neglect, despair—is to make using drugs as easy as possible. And in addition to preventing death or disease, harm-reduction programs create an opportunity for government social-service providers to conduct outreach, helping addicts or other people in need of services get in touch with care in a trusting, non-stigmatized environment.

It’s not hard, though, to see that harm reduction can be a long, dark tunnel to the light of the prosocial day. At Vancouver’s Insite, “when somebody’s struggling with their injection, like we can see they’re getting frustrated, agitated, poking or stabbing away at themselves, it’s our responsibility to see if we can help make that safer for them, to find a safer vein,” says Tim Gauthier, a nurse and the clinic’s coordinator. The staff at Insite don’t actively inject anyone, but it’s hard philosophically to explain why not, if it would be safer to do so. Similarly, if it is dangerous for an addict to have to go buy impure drugs on the street, how is it not morally justifiable for a harm-reduction center to offer to sell pure drugs on site, at cost? Or to give them out for free?

Advocates would surely object that these thought experiments don’t relate to the real-world work of saving lives. So how are Vancouver and Toronto doing in regard to overdoses? Not so well, it turns out. The British Columbia coroner reports at least 1,200 overdose deaths in the first half of 2021, “the highest ever recorded in the first seven months of a calendar year and . . . a 28% increase over the number of deaths recorded between January and July 2020 (941).” Toronto is doing no better: the Ontario coroner reported a record 521 opioid overdose deaths in the city in 2020, and the situation this year is much worse: one day in early May saw five deaths, the highest ever recorded. Even if, for the sake of argument, one wanted to concede the possibility that these numbers might be even higher in the absence of safe-injection sites, the difference made is on the margins. As Christopher Rufo wrote last year in a City Journal story on Vancouver’s program: “It’s not that addicts who use the safe-injection site are achieving sobriety; they’re just not dying on the floor of the Insite injection room.”

And none of this raises the other problems associated with “safe injection sites,” which are necessarily located in the areas where the scourge is the most acute, and which essentially make the blight permanent by encouraging drug dealers to prey on the sites’ users. Robbery of dealers and users will follow, as will street crime and associated dysfunctionality.

The presumptive next mayor of New York, Eric Adams, has said that he is in favor of the program. If he permits its introduction, he will be living up to the promise that de Blasio has said he sees in him.

Photo by Craig F. Walker/The Boston Globe via Getty Images


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