In a few months, New York will celebrate the anniversary of its great experiment with drugs. It’s been almost two years since the city became the first in the United States to open two “supervised consumption sites,” facilities where people can consume controlled substances under the supervision of staff armed with overdose-reversing drugs. Two years in, how’s the experiment going?

Quite well, according to supporters. Last week, on international overdose awareness day, the New York Daily News ran two editorials extolling the sites. One, by State Senator Gustavo Rivera and harm-reductionist Joyce Rivera (relationship unclear), called for more sites, saying they “meet individuals suffering from drug use where they are and provide them a safe space to reduce the harm they are causing to themselves or others while accessing the basic health care they might need.” It is left to the reader to determine how this approach differs from simply enabling drug use. The other piece, by the Daily News editorial board, accused New York’s leaders of cowardice for refusing to expand on this proven intervention in the face of a massive drug crisis.

This claim—that SCSs are an evidence-supported tool for getting the city’s sky-high OD death rates under control—has been a key part of supporters’ argument for allowing a nonprofit, OnPoint NYC, to operate federally illegal facilities. OnPoint director Sam Rivera, for example, has argued that if his group does not receive a share of New York’s opioid settlement funds, “hundreds, if not thousands, more people [will] die.” So it should trouble New Yorkers that the city’s two SCSs do not appear to be having an appreciable impact on actual overdose deaths, at least according to death statistics furnished by the CDC.

Manhattan reported 530 overdose deaths in OnPoint’s first full year of operation, a 5 percent increase over 2021. That’s smaller than the increase in Brooklyn (18 percent) and Queens (25 percent) but on par with that of the Bronx (5 percent) and larger than the small decline (2 percent) reported by Staten Island. Manhattan, with two supervised consumption sites, still experienced 200 more overdose deaths than it did in 2018.

The 2022 statistics are preliminary and may be revised—though such revisions are often upward, as additional data come in. But if the figures hold, they will confirm the evidence in the literature that supervised consumption sites have little to no impact on overdose deaths. An analysis of New South Wales’s SCS found “no evidence of any effect . . . on fatal opioid overdoses or ambulance/emergency service utilisation [sic]” in the area it served. A study of Vancouver’s much-analyzed site did find a reduction in deaths, but only within the half kilometer surrounding the site.

How is it possible that OnPoint’s operation has had no appreciable effect on overdoses, despite reversing (it claims) more than 1,000 overdoses in its first 18 months of operation? The simple answer is that overdoses reversed and lives saved are not the same thing. If one person falls into a lake, and another person rescues him, the second person prevented the first’s drowning. But if the first person falls in again and dies, then the prevention was of little purpose. Analogously, reversing an opioid overdose with naloxone does not reduce the self-harming behavior—drug use—that led to the overdose. This is why more than 15 percent of those administered naloxone are dead within a year of administration.

This is all the more because OnPoint does not oversee anything like a substantial fraction of the drug-use sessions in the city, or even in its catchment area, on any given day. In data that OnPoint provided to Rep. Adriano Espaillat, and given to me by a friend at the Greater Harlem Coalition, the provider reports 48,000 visits across its two sites in the first year of operation. That’s a hefty number, but it becomes less impressive when parceled out on an hourly basis. Specifically, using OnPoint’s operating hours, that’s equivalent to about 6 clients per hour, or about 134 clients a day across both sites. By way of comparison, OnPoint reports 10,262 unique clients served in that period. Assuming these are stable heroin users, they likely need to use one to three times per day. Chronic stimulant users and users of fentanyl may require substantially more.

In other words, it’s not possible that OnPoint serves any appreciable fraction even of the population known to it. That’s not counting people who opt not to use at the supervised consumption site and who are, therefore, more risk prone and so at greater risk of overdose death. Limited capacity was, in fact, also why the New South Wales site had no appreciable impact on OD deaths: according to the study’s authors, it simply did not serve an appreciable portion of the area’s drug-using population.

Advocates of the SCSs might protest that at least those who use at the sites are being connected to treatment that might save their lives in the long run. Maybe, but the data don’t support that assumption. By OnPoint’s own estimation, only 9 percent of clients are getting medical treatment—an expansive category including buprenorphine prescription—and only 5 percent are receiving counseling services. Twenty percent are receiving “referrals,” though what fraction of those go to treatment is unreported. The referral rate is, incidentally, about the same share as those getting “holistic treatment,” which includes “acupressure, acupuncture, yoga, massage, and aroma therapy.”

Some may see these low rates of service provision as a reason to construct more SCSs: if one SCS can’t cover all the drug use in an area, build ten. Yet this is hardly a solution. Doing so would be politically infeasible, as one area of concentrated drug use is unpopular enough as is. It would also go against the experience of European SCSs, which have not scaled up in their several decades of operation. Most importantly, it would ultimately mean spending limited funds that could go to drug treatment—an intervention that actually does save lives.

Far from being the revolutionary tool their proponents claim, supervised consumption sites are a band-aid on the problem of drugs and drug addiction. And, as their own data show, they are not a particularly effective band-aid. As a dubious bonus, they contribute to the systematic normalization of drug use. Until New York’s leaders get serious about drugs—arresting dealers, shuttering open-air markets, and shifting as many people as possible into high-quality, medication-assisted treatment—the problem won’t go away. Don’t let advocates tell you there’s another way to do it.

Photo by Kent Nishimura / Los Angeles Times via Getty Images


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