Here’s What Really Happens at Safe Drug Injection Sites

New York opened the only supervised injection sites in the U.S. Tuesday, and already two lives have been saved. Here’s what else to expect.
safe injection site supplies
A model of a safe injection site in San Francisco. AP Photo/Eric Risberg 

At least two people’s lives were saved within the first few hours of New York City opening the only supervised injection sites in the U.S. 

As of Tuesday afternoon, 72 people had used the two sites, located in East Harlem and Washington Heights, and staff had reversed two overdoses, according to the New York Times.


The opening of legally sanctioned supervised injection sites comes at a time when overdoses in New York and the country at large are at record highs. According to provisional data from the Centers for Disease Control and Prevention, 100,000 Americans died of an overdose in a 12-month period ending May 2021. Fatal overdoses linked to synthetic opioids like fentanyl, which is up to 50 times more potent than heroin, accounted for about 64 percent of deaths. 

“I’m excited to be part of this... first in the United States,” Dr. Chinazo Cunningham, executive deputy commissioner of the New York City Department of Health and Mental Hygiene, told VICE News. 

With 2020 being the deadliest year on record for overdoses, Cunningham said, “We cannot wait any longer as more and more people are dying... We know that overdose prevention centers are evidence-based and strategies that save lives.”

The sites won’t be run by the city but by OnPoint NYC, a merger of the groups New York Harm Reduction Educators and Washington Heights Corner Project, which were previously providing syringe-exchange services in the same locations. 

But there are still a lot of fears and misconceptions about how these sites operate, their legal status, and what they do and don’t offer. Here’s what to expect from these sites and what comes next: 


What’s a supervised injection site? 

Supervised injection sites, also called overdose prevention centers, safe injection sites, and supervised consumption sites, are facilities where people can come and use drugs with medical supervision and clean supplies. They can get their drugs tested to find out what’s in them—important because the illicit drug supply is becoming more and more unpredictable. 

Typically, the people who come to a site are using injectable drugs, which includes fentanyl. The sites provide people with clean needles, which can reduce infection and transmission of disease. If someone overdoses, staff on site can provide treatment, including naloxone, which can reverse opioid overdoses. 

“They also provide medical services for people who are ready to enter into treatment for their addiction or HIV or hepatitis C,” Cunningham said.

Do these sites offer drugs? 

No. People using supervised injection sites bring their own drugs. 

Do supervised injection sites encourage drug use? 

Multiple experts who spoke to VICE News said these sites do not encourage drug use. “There’s no evidence of that at all,” said Cunningham. “In fact, the evidence shows the opposite. And what we do know is that people who use overdose prevention centers are less likely to have risky drug use, and they’re more likely to be linked to treatment.” 

Research from Vancouver’s Insite—North America’s first safe injection site, which has been running since 2003—has shown they reduce needle debris and public drug use and there’s no evidence they increase crime or drug dealing. One study of 1,000 people who attended Insite found a 30 percent increase in the use of detox services. 


 Are supervised injection sites legal? 

The sites in New York are not legal under federal law. Under the federal statute known as the “crackhouse statute,” you cannot open a property that will be used to consume drugs, which would make all supervised consumption sites illegal. In Philadelphia, for instance, the nonprofit Safehouse has been thwarted from opening a site because it would be in violation of this statute.

However, Cunningham said New York City has had “productive conversations with our federal partners as well as our state partners.” New York City Mayor Bill de Blasio told the operators he doesn’t expect law enforcement to shut them down, according to the Times.

What federal legislation would make it easier to open more sites up? 

At a minimum, the federal government could broker an agreement similar to the Cole Memorandum, which was used for states who legalized weed, said Melissa Moore, director of civil systems reform for the Drug Policy Alliance. The memorandum essentially says people can operate weed businesses as long as they are in accordance with local and state laws, and the federal government will not interfere. 

Has anyone ever died at a supervised injection site?

There are more than 100 supervised consumption sites throughout the world, mostly in Canada, Australia, and Europe, and no one has ever died at one. The first site opened in Berne, Switzerland, in 1986. 


Would the operators be legally liable if someone died? 

Moore emphasized that no one has died at a supervised injection site. But she said the liability isn’t greater than any other harm reduction medical intervention. 

“Absent any gross negligence or intentional harm, any such claim is very likely to fail.” 

She said one reason the Drug Policy Alliance is pushing for states to legalize the sites is it would include protection from civil liability. Rhode Island became the first state to legalize supervised injection sites in July, but they won’t be running until next March at least. 

What makes the sites so effective? 

Dr. Ryan Marino, medical director of toxicology and addiction medicine at University Hospitals in Cleveland, previously told VICE News supervision is key. Part of the reason more people died of overdoses during the pandemic was that they were using drugs alone, with no one around to help them if they overdosed. But at supervised injection sites, there are trained personnel on site with naloxone. 

“Every single overdose is entirely reversible. Every overdose death is entirely preventable,” Marino said. 

Will more supervised injection sites open up? 

San Francisco, Philadelphia, Boston, and Seattle have all taken steps towards opening safe injection sites. Other harm reduction groups in New York City have told VICE News they hope to open sites soon. 

What about providing people with a safe supply of drugs? 

Many drug experts agree that providing people access to a safe supply of drugs—including prescription heroin—will be crucial in saving the lives of drug users. That’s because the illicit drug supply has been flooded with fentanyl and other synthetic opioids. New analogs even stronger than fentanyl are also creeping into the market. 

Cunningham said safe supply is not on the table in New York City right now. “Right now, that’s not our focus,” she said. “Our focus is really to expand treatment that we know saves lives and harm reduction services that we also know saves lives.” 

Follow Manisha Krishnan on Twitter.