According to the Center for Disease Control (CDC), between May 2020 and April 2021, overdoses exceeded 100,000 nationally for the first time. In New York City, over 2,000 died of a drug overdose in 2020. It was the most deaths since reporting of overdoses began in 2000. 

In response, the city is the first in the nation to open overdose prevention centers. Two centers, run by OnPoint NYC, have been opened in Upper Manhattan. Users bring their own drugs and the centers provide clean needles, counseling and health professionals. These centers exemplify a harm reduction approach to addiction.  

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Given these types of programs are likely to spring up across the country, it’s worth discussing the rationale and the evidence behind them as well as the potential pushback they will no doubt receive. 

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Given these types of programs are likely to spring up across the country, it’s worth discussing the rationale and the evidence behind them as well as the potential pushback they will no doubt receive. 

What’s harm reduction?
Overdose prevention centers are arguably the most politically charged strategy in an overall approach to drug addiction called harm reduction. Harm reduction concentrates on reducing the addiction’s consequences (the harm). These include damage to the user’s health – infections and overdoses, and harm to the community – public disorder and crime linked to drug use. Harm reduction approaches make room for counselors who can help drug users quit when they are ready. The focus, however, is on management, not abstinence.  

New York’s overdose prevention centers are examples of a harm reduction strategy primarily aimed at protecting the user’s health. Clean needles reduce the risk of acquiring and spreading infectious diseases. Health professionals treat an overdose and prevent death (two overdoses were treated the first day of the centers’ operation in NYC.) Other harm reduction strategies, like providing free methadone, are aimed at public safety. Drug users who are sick from withdrawal may steal to gain the money needed to buy drugs. Providing them with methadone, a non-addictive synthetic opioid, can prevent this petty crime and possibly wean the user off their dependence. 

The pushback
New York City’s initiative is not the first attempt. In 2019, Philadelphia tried opening a safe injection site. The Trump administration sued and blocked it. Ditto for a similar attempt by Seattle in January. It’s against federal law to manage sites where drugs are used and distributed. 

However, the cities said their sites were medical facilities. According to local TV news KOMO, “the supporters of opening a site in Seattle are hopeful a Biden administration with a Democratically-controlled Congress will make it easier to open one legally.”  

A Biden administration will not stop a Republican pushback, though. Indeed, it may intensify it, as Republicans search for leverage in upcoming elections. The conservative New York Post has described the centers as “sanctioning smoking crack cocaine.” Republican congresswoman Nicole Malliotakis, representing Staten Island and Southern Brooklyn, has made the centers one of her primary concerns. 

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Republican member of Congress Nicole Malliotakis has appeared on Fox News condemning the centers and has introduced a bill to defund the centers. Malliotakis was quoted in the New York Post, saying, “opening taxpayer-funded heroin shooting galleries is not a proper solution. These centers not only encourage drug use but they will further deteriorate our quality of life.”

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Malliotakis has appeared on Fox News condemning the centers and has introduced a bill to defund the centers. Malliotakis was quoted in the New York Post, saying, “opening taxpayer-funded heroin shooting galleries is not a proper solution. These centers not only encourage drug use but they will further deteriorate our quality of life.”

Malliotakis neatly captures critics’ two main concerns – they increase drug use and lower the quality of life for neighboring residents.   

Good thing, bad thing
If this were a pure matter of research, Malliotakis’ concerns could be answered quickly. A summary of research from the CDC concludes that harm reduction programs “are safe, effective, and cost-saving, do not increase illegal drug use or crime, and play an important role in reducing the transmission of viral hepatitis, HIV and other infections.” 

But let’s dig in a little more. 

The first concern, drug use, is grounded in the perception that drug use is strictly about individual choice. People on the left and right hold this view. By making it easier and safer for someone to choose drugs, the logic goes, more people will choose to be addicted. Another way to think about this concern is that people perceive drug use as a moral failing. Getting high is what slackers do to avoid working hard. By creating safe places to be bad, we condone immoral behavior. 

Fact is, most people are casual drug users, or if they acquire a chemical dependency, they can wean themselves off it. However, people who become addicts are attempting to address a psychological need. 

One of the more compelling communicators of this view is psychiatrist and addiction expert Dr. Gabor Maté. Maté argues in his book In the Realm of Hungry Ghosts that addiction is rooted in childhood trauma. 

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If those issues are not addressed, a person will find an external source to manage the pain. Maté argues that wealth may change how the issues are addressed, but there’s little choice in alleviating the pain. It will be shopping or gambling or drinking or opioids or whatever.

University of Columbia neuroscientist Dr. Carl Hart contends that few people experience adverse side effects associated with illegal drugs. They do not become the walking zombies we see portrayed on television. Hart argues the small percentage of people who do become addicted are using drugs to deal with psychiatric distress. Or, as Hart comments in a recent interview with the New York Times:

If people have a co-occurring psychiatric illness, then that’s where the focus should be … not on the drug the person is taking. Or if this person now doesn’t have a sense of worth because they lost a job that was placing that person’s family in the middle class. If the treatment doesn’t focus on making sure that is replaced, then the treatment is a waste of time.

The second concern is that these centers will lower the residents’ quality of life in the communities where they are located. The thought process here is that drug addicts will gravitate to these centers from other areas, set up homeless encampments and be public nuisances. 

I am sympathetic. Even with no increase in crime, as the CDC reports, residents must still deal with the aesthetic changes to their neighborhoods. More materially, housing prices may go down. There may be less commercial activity as businesses shy away.

This is not a good thing. 

My take
Harm reduction approaches, and specifically, the overdose prevention centers now operating in New York, are superior to abstinence-only approaches. They lower deaths from overdoses, which are at historic levels nationally. Evidence suggests they accomplish this with no increase in crime or drug use. They leverage the modern scientific conclusions from addiction researchers who assert that psychological trauma powers drug use. Harm reduction approaches are an improvement over yesteryear’s “just say no” approaches. 

But there are problems. 

As more cities open overdose prevention centers, they will be placed disproportionately in poor and minority communities. They will be depicted by Republicans as another “woke” policy coddling drug users.

I take harm reduction approaches as their name suggests. They only reduce harm. But if we do not address income inequality, underemployment and affordable mental health services – factors that produce drug addiction – then the opioid crisis will only worsen. 

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