Policymakers would be wise to listen carefully to neighborhood residents who criticize the facilities.
New York City’s two overdose prevention centers, run by the organization OnPoint, allow individuals to use illicit substances under medical supervision. They are the first such centers to be authorized in the United States and have been in operation in East Harlem and Washington Heights for three years. Preliminary data released on the program’s website suggests a story of success: Since they began operating, more than 1,600 potentially fatal overdoses have been reversed by the centers’ staff. Research on similar sites around the world has consistently shown a range of mental and physical health benefits for the clients of such centers. Given the surge in substance use disorder and subsequent overdose increases in the United States over the last two decades, OnPoint has enjoyed a wave of support from local and national leaders in its efforts to stem rising overdose deaths.
Despite this seemingly positive consensus among public health professionals and left-leaning politicians, community members in the OnPoint neighborhoods are less quick to voice their support. Many residents, especially those who have lived through the crack epidemic and the broader sweep of the War on Drugs, feel conflicted by the rising rate of drug use in their streets and want to see meaningful enforcement of drug activity in their neighborhoods. Yet concerns with such programs are often dismissed as “not in my backyard” (NIMBY) resistance, which positions unsupportive community members as selfish and not civic-minded. Rather than dismissing or minimizing their concerns as kneejerk or parochial resistance, policymakers would be wise to try to understand what’s driving them.
Drug policy has long failed to effectively address the concerns of community members and the health of drug users. Punitive policies to criminalize drug use and sale have had devastating consequences on urban neighborhoods of color and criminal justice institutions. At the same time, policies to address the public health consequences of drug use have struggled to move forward. Overdose prevention centers have been banned in Philadelphia and vetoed in Los Angeles and San Francisco, despite high rates of overdose deaths in both cities. In New York, state leaders remain silent on the acknowledgment of the OnPoint programs, whereas city officials have moved forward with expanding them even though evaluation outcomes on the efficacy of the programs are many months, if not years, away.
As a criminal justice researcher with a background working in harm reduction programs, I felt compelled to better understand the OnPoint programs from the perspective of community members living in the areas where the centers have been implemented. My conversations over the last seven months with more than 30 residents, business owners, and service providers in East Harlem and Washington Heights shed light on the challenges these communities have endured on the ground, and offer insights on how to move forward.
Impact on the local communities
Unlike traditional drug treatment programs, OnPoint promotes a philosophy of “meeting someone where they’re at,” rather than pushing for abstinence and medication-assisted strategies. Clients who want to use the facility are not required to enlist in treatment or utilize integrated social services if they do not want to, but are informed that support is available whenever they are ready. Supporters of OnPoint believe that this approach can only work through the destigmatization of drug use, which will help clients address the unresolved trauma that causes them to turn to drugs in the first place — without having to stop using.
Yet there is a caveat to this approach. It takes time and resources to establish trust and develop a continuum to stabilize people who may use drugs erratically. Even those in support of OnPoint’s services acknowledge that this may come with growing pains. A current drug user who lives near one of the centers admits that the overwhelming presence of “addicts” is probably “disturbing to the average citizen,” because the centers themselves are so crowded with people.
It is therefore not surprising that some residents and local leaders oppose the approach that OnPoint necessitates. In East Harlem, the center is located directly across the street from a daycare center, creating distress for parents who do not want their kids to walk through areas of drug dealing and sedated people in the street. Likewise, neighbors from both areas are concerned that individuals who utilize OnPoint generate disorder for small businesses and community parks that want an accommodating environment for young children and patrons. Some residents believe that more drug users are traveling into their neighborhoods from around New York and New Jersey to utilize OnPoint’s services, in effect making the centers magnets for disorder. In Washington Heights, a Dominican community member who has lived in the area for over 30 years told me that any long-term local would be able to confirm the reality of this demographic shift: “I eat, sleep, and work in this neighborhood — I know who’s who.”
Whether or not OnPoint is solely to blame for these issues, residents voice frustration that drug activity has become a common facet of everyday life. This direction is hard to accept for community members living predominately in neighborhoods of color that are recovering from War on Drugs policies, crack and opioid epidemics, housing shortages, and the fallout from COVID-19. Neighbors want their communities to move in a positive direction. Yet, the presence of OnPoint, for some, is frustratingly confirming that their neighborhood is and will continue to be, where drug activity occurs. A woman from East Harlem who has lived in the area since the 1970s asks, “Of course, drugs have always been in the neighborhood, but am I meant to be okay with that? Am I meant to just suck it up and live with it?”
I sat down with OnPoint representatives to discuss these concerns from residents. They said they were committed to being accountable for how their program impacts the neighborhoods it serves, which has been a key component of OnPoint’s community outreach team, especially in East Harlem. Many community leaders consistently remark their amazement at OnPoint’s ongoing attendance at local meetings, collaboration with other local programs, and its willingness to act as a sounding board for the concerns of unsupportive community members. As one East Harlem leader described it, “OnPoint is on point” with their readiness to show up for the community.
But even with this ongoing community work, concern about the impact the centers have on the communities remains strong. Evaluation research shows uncertainty on whether these concerns are grounded in reality. A study conducted by a team of criminologists and public health researchers found that the programs did not appear to contribute to any type of crime or disorder. A subsequent study found slightly different results; it revealed that when looking at the two areas with centers separately, there appeared to be an uptick in property crime in Washington Heights, suggesting that the program may be causing more theft in the area. Nevertheless, crime evaluations typically rely on arrest data which cannot measure the very real challenges of disorder that residents face while they go to work and raise a family in their neighborhood.
Moving forward and listening to residents’ suggestions
How can New York City and these communities move forward? Many residents lament that their voice is being left out of policy decisions that would impact their daily lives and wish for more say on what would happen next. Supporters of overdose prevention centers have to consider: For communities that have long been negatively impacted by overly punitive drug policies and are now witnessing the seeming normalization of drug use on their doorstep, what would a responsive strategy look like?
On the smallest scale, residents wish that sedated individuals had a place to sleep other than the streets, which is a common issue for those who spend nights in homeless shelters and are forced to leave in the morning. A conversation with an integrated health service provider confirms that this is indeed a problem, as many OnPoint clients want a place to sleep during the day or after using drugs within the facility. OnPoint currently does not provide a safe, private place for its service users to sleep.
Other community members suggest that there is a need for comprehensive enforcement that would help monitor OnPoint clients and dealers to hold them accountable for keeping nearby streets clean. Some believe more effective policing measures could reduce the concentration of individuals congregating outside the center, while others say that OnPoint should have an explicit contractual obligation to clean up the streets where its clients have been observed discarding used syringes and other drug paraphernalia.
But to some, it’s hard to imagine a good way to properly integrate the facilities into these areas. Many East Harlemites I interviewed argued that the center being located across the street from a school is unacceptable, regardless of the ongoing collaboration that OnPoint has established with the daycare. Some point out that laws that restrict liquor stores from being located within 200 feet of a school should certainly apply to a place where people consume illicit drugs. In Washington Heights, locals argue that OnPoint’s location, which is adjacent to a slew of Dominican-owned businesses, is leading to theft that small businesses cannot afford. The issues raised by locals are undoubtedly difficult for OnPoint representatives to confront as the main advocates for their groundbreaking approach to drug policy. But listening to the concerns of the community can start a dialogue about how to move forward, toward a future in which drug policy can integrate the needs of both the drug-using community and other residents.
Across New York City and the United States, policymakers remain uncertain of the best approach to drug policy that takes public health and public safety concerns into account. As other cities in the United States move to introduce overdose prevention centers, policymakers shouldn’t be so quick to dismiss the concerns of the communities, but rather acknowledge, take seriously, and address them. Otherwise, harm reduction initiatives will simply be seen as trading one set of community harms for another.