A Safe Space for Users: A Conversation With Sam Rivera

Two uptown Manhattan overdose prevention centers run by OnPoint, a local nonprofit, are flashpoints in New York City’s debate about how to handle drugs and drug overdoses. The sites, which formally opened in November 2021, are the first of their kind in the nation: They go beyond needle exchanges to offer drug users indoor “supervised consumption” — meaning, if they overdose on opioids, trained staff is equipped with naloxone to revive them.

In August 2023, OnPoint announced that the facilities had averted more than 1,000 overdoses since their official launch. Also in August, U.S. Attorney Damian Williams said the sites were operating in violation of federal law, declaring, “My office is prepared to exercise all options — including enforcement — if this situation does not change in short order.”

Amidst debates about the sites’ legality, efficacy and effect on the Harlem and Washington Heights neighborhoods in which they’re located, supporters argue that the centers are an essential piece of the strategy for combating New York City’s rising tide of drug overdoses and urge additional funding so the centers can at least stay afloat if not expand.

Others, including the state’s chief executive, disagree. In November, as allies urged that OnPoint’s centers get a share of state opioid settlement funding, Gov. Kathy Hochul made clear her opposition to such investments, saying only initiatives that can “withstand a legal challenge” should qualify for the funding. Asked if she would support state legislation authorizing the operation of the centers across New York, she demurred.

The man at the center of the storm is OnPoint Executive Director Sam Rivera, who’s worked with people struggling with addiction for 30 years. We spoke with him in December. The following interview has been edited for length and clarity.

Vital City: Walk us through what happens, step-by-step, when someone walks into OnPoint as a drug user.

Sam Rivera: Many people who haven’t visited immediately assume when you walk in, people are just using drugs. But when you walk into our drop-in center, you are welcomed by the staff in the front. People are having coffee, watching movies, a bunch of stuff going on, having a meal. They’ll ask you what you’re here for and if someone wants to use the Overdose Prevention Center (OPC), you would say, “I want to use the OPC.” 

Then, “Have you been here before?” “No.” “All right, so you have to be registered.” The first time takes a little longer because we want to make sure we have a conversation with you, let you know what we do. One of the most important things for us at that moment is to talk about all of the services.

VC: What are those other services exactly?

SR: Case management, mental health services, holistic health services. So that’s acupuncture, Reiki, low-threshold medical services, medication-assisted treatment, Suboxone as an alternative. Respite services, so a place for you to rest. There are washers and dryers where we wash the clothes for them, and showers as well. Fresh underwear and socks, which a lot of people love, up to full clothing for them to access.

We have an outreach and public safety team. Drug testing as well. So if they’re concerned about their drugs or want to know, just curious about what’s in their drugs, we will test their drugs for them as well.

VC: Okay. So let’s go back to what happens if I want to use.

SR: Right. So they come in now, there’s an interview process, a quick registration where you will be included into our system and the team will ask you a series of questions. How did you hear about us, basic demographics, what are you using and how, questions about your use.

We ask you your name and what name you want to use. It’s an anonymous program if clients want it to be. One of the biggest blessings we’ve had is while it’s anonymous, I believe it’s 90%-plus of the people give us their full name and everything. They feel safe with us. If they don’t initially, they come back and say, “This is who I am. I have no problem sharing.”

We find out what they’re using, how and how much. That’s really important because it allows them and us to track this together. One of the things we’ve been able to look at together is people saying, “Oh my god, six months ago, I was using this, this and that. I was using that much? I didn’t realize I’m reducing.” 

They get called into the room, the staff member has their information, repeats it again or asks them to confirm. 

We introduce you into the space. We ask everyone to wash their hands and use a pedal. They’re not touching anything. And depending on what they’re using, they might go get their own supplies. Smoke kits we give because it’s just easier for us to manage it that way. If they’re smoking, they’re going through the smoke room. If they’re injecting or sniffing, they go to a booth.

VC: You mentioned you can track their use in some cases and tell whether they’re decreasing or not. What is your objective and how do you convey that objective? There’s a lot of talk in the harm reduction world about not being judgmental, but do you want them to quit? Do you want them to reduce, and if so, what’s the way that you get that across?

SR: We’re harm reductionists. We want, literally, it might sound cheesy or whatever, we want them to do what’s best for them when they’re ready. What I know in my 30-plus years of this work is people stop using if they want to or attempt to stop using when they’re ready and if they choose to. And what I know, and what we do is by offering all the services I said to you, that’s the beginning of people seeing themselves, building a relationship with themselves by going to these other programs. So our goal is, number one at this point where we are today, is to keep people alive. We want to make sure they’re here with us.

Within that, we want to start them participating in their own health process, meaning connections to health care, connections to mental health services if needed, anything they feel they need. For some people it starts with that shower I mentioned. 

What we call ourselves now is a “harm-reduction health hub.” For instance, we’re opening a barbershop and a salon. People don’t understand that there’s a mental health element to that. If people feel good about how they look, things change.

VC: We’ve seen the numbers touted by OnPoint and by others commending OnPoint and calling for more resources for your approach. Overdoses reversed don't necessarily translate into a lower overdose death rate, as research from Spain, Australia and Canada has shown. Drug overdose death rates continued to rise in East Harlem following OnPoint’s opening there. Would a better indicator of success be how many of the people you serve haven’t overdosed in any setting because they’ve broken free of the grips of addiction?

SR: I wouldn’t say it’s more important, and to help answer why, I could expound on my answer to your previous question. This is why all of these other services really matter. People will show up with a plan to use the overdose prevention center, but might start upstairs at the holistic health program and receive acupuncture and wait. They’re building this relationship itself so that what we’re also seeing is when people use the OPC, they do use less outside. They do feel safer and connected to using in our space. When they use outside, they’re rushing. It’s dangerous for many reasons. It’s dangerous even in the community because people don’t want them using and oftentimes they’re abused for doing that.

We’ve had only, that we know of, a couple of people who have overdosed on the outside who were participants. 

VC: What percentage of your clients enter treatment, and is that a number that you want higher or you’re agnostic about?

SR: I think we’re agnostic about it, but here’s what we know: Every person who asks for treatment, we connect. So as harm reductionists, we’re not shoving it down their throat like most people do. We’re not giving them the guilt treatment. 

Here’s the other thing, let’s talk about treatment success. It’s a shame that harm reductionists or harm reduction services are measured against people going into treatment. We don’t measure what happens in treatment, what happens after treatment. It’s extremely important that harm reduction exists for all of those folks who have tried. 

VC: I understand being nonjudgmental when offering services. But do you have a personal opinion about whether the use of drugs is good or bad? Whether addiction is a bad thing worth breaking free of?

SR: My personal opinion? This job is personal to me. And what’s missing in this conversation is why people use. The alternative for many people, and the alternative in this country is to put them on some prescribed medicine. And in the opioid settlements, we just won billions of dollars in lawsuits for killing our people. So I look at it personally from a lens that people are using to self-medicate, primarily to self-medicate pain and trauma, and mental health conditions. 

Until this world we live in figures out a better way to treat our people — primarily Black, brown and poor white people — then we’re going to continue to be in the same place. When I hear that question in general, I hear it as placing blame on people and missing the simple thing that there’s no war on drugs in this country. There’s a war on drug users. 

In fact, there’s a war on specific drug users. Because drugs are allowed to enter specific neighborhoods. Those people use and sell those drugs and then are punished for doing so. And then from the outside, people want to decide what’s best for them or blame them for using these drugs. 

I want people to be as healthy as possible. And whatever that means for them. Which is why I run this organization and push to have so many services that are about wellness and not about any one specific thing.

VC: Are there associated problems around your two facilities? We’re familiar with the recent study that says crime levels don’t rise in the surrounding area compared to neighborhoods with needle exchanges, and that there’s limited evidence of increases in disorder. Is that the end of it or is there more to the story? The second question is, what do you say to the good-faith critics who say, “I love my neighborhood and I’m worried. I’m also worried in part because we already have well more than our share of methadone clinics. We have well more than our share of outdoor drug use.” What do you say to them?

SR: I grew up on the Lower East Side, so I know the feeling. I know the perception that our programs bring more drug users into the neighborhood. Second, I’ll say methadone clinics and what we provide are very, very different. 

You’re talking about a neighborhood in East Harlem that has been impacted in this way for decades. It’s not new. For decades. I respect where people are coming from until it becomes an attack on the individuals. 

I’ll give you the perfect example. Let’s take a ride up to our other site at 180th and Amsterdam. There we have the same program, the same population. Why is it empty and quiet there? Because we don’t cause more people to come into a neighborhood and use.

Now, if we were two blocks over where we are located in Washington Heights, we’d be likely to be blamed for what’s happening. That’s a street, that’s a busy street, that’s known for drug dealing. But that has nothing to do with the organization.

VC: But is it not the case that if you’re going to OnPoint in order to use, you are likely to buy somewhere near OnPoint?

SR: People use where they buy. That’s been true since drugs were first sold.  If we weren’t here tomorrow, they would buy in the neighborhood, and they would use in the neighborhood. I mean, we know that because we’ve been responding to overdoses in that same neighborhood for many, many years. 

The other thing is this: We ran an unsanctioned program for six years before we officially opened. Why wasn’t anybody saying, “Look what you’re doing. More people are coming in here. Look at this, look at that.” Because no one knew. So when people say to me, “Since you opened, look how many people are using … look at this neighborhood,” I ask them, when did I open? And they go, “A year ago, two years ago.” I’m like, “No. Eight years ago.”

For six years, no one said anything. No one accused us of causing more drug sales. No one accused us of all these things. Now they claim we’ve created all this. The study you mentioned debunks a lot of that. And even within that, I will say, going back to your question, which I thought was a really great one, I am still extremely sensitive to the neighborhoods and their concerns. I really am. 

VC: Explain to me your current relationship with the NYPD, and also with the U.S. Attorney. He made noise earlier this year, saying you might have to be shut down. Where are both of those relationships in the current moment?

SR: First I want to be very clear, I’m not going to repeat that what we’re doing is illegal ever again because there is no pure clarity on what we’re doing that’s illegal. 

Our relationship with the NYPD is one of our best relationships. It’s one of our most important relationships. We’ve been blessed to have a healthy one. I’ll tell you communications I’ve had with the NYPD since we opened two years ago. We told them, “We’re going to make your job easier.” At first, they didn’t agree, they didn’t understand it, but we have, and they’ve said it. 

They were arresting people for using drugs. They were arresting people who were in pain. And today, instead of doing that, they’re going to the same people and saying to them, “Hey, go into OnPoint, I’m not going to arrest you. Go into OnPoint.”

VC: What if somebody’s selling fentanyl in the immediate orbit of OnPoint? Would you ask the NYPD to arrest those people?

SR: I think law enforcement needs to do their jobs if they think someone is doing something illegal. 

VC: But just to be clear, that would include fentanyl sales or any kind of currently illegal drug sales, nearby?

SR: Yeah, definitely. If people are committing crimes. I’m a person who committed crime and I was arrested. I didn’t blame the police. That was something I did and was held accountable for. At the same time, like I said before, these are drugs that are allowed to enter specific communities and then folks in our communities are held and punished for selling and using these drugs. It’s a system. It’s modern-day slavery and it continues and what we’re doing is blaming the individuals involved in this pain. There are studies on grade schools in these same neighborhoods that say a high percentage of these children are going to end up in the criminal justice system. And the criminal justice business system literally views them as stock. I want to focus more on that than who’s getting arrested here for selling drugs. I’m not saying one’s better than the other.

VC: What would you say to kids about drug use itself?

SR: I would talk about having a safe place for them to figure out how, if they’re dealing with any traumatic experiences, if they’re dealing with what leads to drug use. What leads to it? What leads to overeating? This is about pain. I am not going to allow anyone to minimize this to “Just Say No” or some message that we believe prevents people from doing something. I think that is one of the poorest approaches to life change I’ve ever heard in my life. 

So if I’m talking to a kid about drugs, it’s a conversation. It’s not “don’t use drugs” or “use drugs” or “do this.” No, it’s a conversation.