Only two government-sanctioned “safe-injection sites” operate in the U.S., one in East Harlem, the other in Washington Heights. Their impact—on both those who use their facilities to inject hard drugs under medical supervision and on the neighborhoods where they are located—is thus of national significance. Other states, cities, and the federal government are doubtless closely watching these two experiments. That is why a new research paper on the Journal of the American Medical Association (JAMA) Network Open site is so important and why it has received so much attention.
The study appears to contain a crucial error: its conclusion minimizes the importance of an increase in aggravated assaults in the vicinities (roughly a six-block area) of the injection sites after those sites’ opening, compared with the vicinities of 17 safe-syringe-program sites in NYC that did not offer “safe injection” services. Specifically, the authors include the assault data in a paragraph about findings not deemed “statistically significant,” despite data in a table of the report that indicates otherwise. It can be easy to get lost in the statistical weeds here, but it’s vital not to do so, because advocates likely will use the report to seek to open more safe-injection sites across the country. Indeed, they are already doing so.
A New York Times op-ed summarized the report findings of improved public safety near the injection sites: “Some neighbors, politicians and media have claimed that the centers . . . are increasing crime and public drug use in neighborhoods already burdened with poverty. But an important new study published this week refutes these claims. It shows that violent and property crime rates near the two overdose prevention centers . . . did not increase any more than crime in similar neighborhoods elsewhere in the city. This was in spite of the fact that the police conducted 83 percent fewer drug arrests near the sites (likely to avoid deterring people with addiction from using them) compared with other harm reduction sites that did not offer safe injection.”
One of the report’s coauthors maintained that the sites did not spark an increase in criminal behavior nearby. “We did not observe any increase in crime or disorder or any of the things that people worry about when they see an overdose prevention site opening,” Brandon del Pozo, an assistant professor of medicine at Brown University and a former NYPD precinct commander, told the Times.
It’s a powerful claim, especially coming from a former New York City cop. The report he coauthored notes, but downplays, an increase in “aggravated assaults,” and focuses instead on “overall” crime.
Per the report: “There is evidence of a comparative 30.4% increase in aggravated assaults, offset by a 19.7% decrease in simple assaults. While interpreting these estimates is speculative, we note the distinction between aggravated and simple assaults can be arbitrary, depending on how an incident is reported and the use of police discretion in how it is classified. Neither result was statistically significant.”
But the report’s own detailed data in fact shows a statistically significant and meaningful increase in aggravated assaults in the vicinities of the safe-injection sites relative to the control-site vicinities.
In response, Jay Xu, a doctoral student at UCLA School of Public Health, and Los Angeles attorney Jeffrey Koenig, raised these concerns in the JAMA paper’s comments section. The authors, they wrote, “elected to communicate their study’s findings pertaining to violent crime by constructing a ‘violent crime’ category that pools simple and aggravated assaults together with murders and robberies,” and “adopted a decidedly optimistic tone when summarizing their study’s overall findings regarding crime.” Further, they said, the authors in their key-points section “state that ‘initial data from NYC do not support . . . concerns about crime and disorder [as a result of the potential] expansion of [SISs] in US cities,’” a characterization that Xu and Koenig claimed was “overly rosy as not all crimes are equally severe, and a potential ‘safe injection site’ attributable increase in aggravated assaults is undoubtedly a matter of public concern.”
Del Pozo responded in JAMA by claiming that a typesetting mistake made it appear that aggravated assault was among the categories for which he and the other authors found no statistically significant changes. In fact, he said, the finding of no statistical significance should have been applied to “overall violent and property crime.” Del Pozo does not claim, though, that the specific assault data spotted by Xu is not significant—he just doesn’t mention it. The key point remains: the report’s own findings include a statistically significant increase in aggravated assaults, even though crime overall might be said to have declined because of a drop in “pooled” arrests and nonviolent crime.
Common sense suggests a plausible explanation for a finding of increased aggravated assaults in the two neighborhoods. People who use the safe-injection sites must first obtain illegal hard drugs. It’s highly likely that they would acquire the cash to do so by stealing money or valuables by assaulting people in the neighborhood. What’s more, the study’s finding that arrests have declined is far from reassuring in light of political pressure on police not to arrest “nonviolent” criminals like drug users.
This is more than a dispute about statistics. The question of whether to countenance hard drug use is a crucial one for quality of life in big cities. Yes, those using heroin and fentanyl under the supervision of a medical professional are less likely to overdose—in that moment. But before this essentially useless observation is spread like a new gospel across the country, there is much more to consider, including the impact of such sites on surrounding neighborhoods.