New York Opens First Safe Injection Sites in the US

The sites open as more than 100,000 Americans died in a one-year period due to fatal overdoses.
drug paraphernelia
The first supervised drug injection site in the U.S. is opening in New York City. Photo by Chad Hipolito/The Canadian Press 

New York City has become the first city in the U.S. to open legally sanctioned supervised injection sites for people who use drugs, as the country grapples with record overdose deaths. 

On Tuesday, the city announced that two overdose prevention centers—places where people can use drugs and be provided with clean needles, drug testing services, and medical supervision—have started operating. 


The sites, located in Washington Heights and East Harlem, currently offer syringe exchange services. They are being operated by New York Harm Reduction Educators and Washington Heights Corner Project, which together have formed OnPoint NYC. 

“For more than 29 years, we have dedicated our lives to ending #overdose deaths & the criminalization & stigma associated with substance use. Being the 1st OPC site in the US is an honor & incredible step forward in ending the #overdosecrisis,” New York Harm Reduction Educators tweeted on Tuesday. 

In a news release, New York City Mayor Bill de Blasio, who is running for governor next year, said the move will protect “the most vulnerable people in our city.” 

“Overdose prevention centers are a safe and effective way to address the opioid crisis. I’m proud to show cities in this country that after decades of failure, a smarter approach is possible,” he said. 

The opening of supervised injection sites in the U.S. is a significant boon for harm reduction advocates, who have long called for an evidence-based approach to dealing with the overdose crisis. Recently, the Centers for Disease Control and Prevention announced that for the first time, more than 100,000 Americans died of a drug overdose in a 12-month period, largely due to the flooding of synthetic opioids like fentanyl into the illicit drug supply. The record-high came during the first-year of the COVID-19 pandemic, which exacerbated the overdose crisis by disrupting the drug supply, increasing stress, and cutting off people from harm reduction services and each other. 


According to the city, 596 New Yorkers died of an overdose between January and March 2021—the greatest number of fatal overdoses in a single quarter since reporting began in 2000. The overdose rate is highest among Black New Yorkers—38.2 per 100,000 residents versus 32.7 per 100,000 residents for white New Yorkers. 

The city’s news release said supervised injection sites could save 130 lives per year. 

Dr. Ryan Marino, medical director of toxicology and addiction medicine at University Hospitals in Cleveland, said there are a number of ways supervised injection sites save lives. But the supervision is the most critical piece because the staff on site can administer naloxone—an antidote to opioid overdoses. 

“Instead of using in secret, in hiding, and using alone, they are monitored. If someone has an overdose, we know that every single overdose is entirely reversible, every overdose death is entirely preventable,” Marino said. 

He said the sites reduce infection and transmission of disease by providing people with clean needles, and can provide people with information on harm reduction and recovery. From an economic perspective, he said, saving lives and preventing overdoses is far less costly to society as a whole.  

“There’s no increase in crime in communities and these really just seem to be kind of a win-win.” 

Supervised injection sites are not new. The first North American facility, Insite, opened in Vancouver, Canada, in 2003. Others are spread around Europe and Australia. No one has ever died at a supervised injection site and despite concerns that it will encourage drug use, research has shown that this isn’t the case. 


According to Vancouver Coastal Health, the local health authority, more than 3.6 million supervised injection visits have taken place at Insite between 2003 and 2019. No one has died and there have been 6,440 overdose interventions. 

Marino said the sites haven’t taken off in the U.S. because “U.S. drug policy is way behind the times. Our laws do not reflect reality.” 

But strides towards opening supervised injection sites are taking place in San Francisco, Portland, and Philadelphia. In July, Rhode Island became the first U.S. state to legally authorize state-wide safe injection sites as part of a pilot project, though they won’t be up and running until March 2022. 

Philadelphia’s site, which would be operated by the nonprofit group Safehouse, has been tied up in legal battles since 2019 after former U.S. Attorney William McSwain sued to prevent it from opening. In January, a federal court ruled against Safehouse on the grounds that a safe injection site would violate federal law. 

The law in question, known as the “crackhouse statute,” says you cannot open a property that will be used to consume drugs. 

According to the New York Times, de Blasio said told city’s site’s operators law enforcement will not shut them down. 

Melissa Moore, director of civil systems reform for the Drug Policy Alliance, said there could be a parallel between safe injection sites and states that have legalized cannabis. 

The Cole Memorandum says that people can operate weed businesses in legal states and avoid federal prosecution as long as they abide by local and state laws.

“We’re at a moment of reckoning,” Moore told VICE News. “It’s the anniversary of when (President Richard) Nixon declared the war on drugs and we’re seeing the highest rates of overdose every recorded in this country, taking more people than homicides, suicides, and car accidents combined.” 

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