The Radical Experiment Saving the Lives of Drug Users
THE OTHER EPIDEMIC 8:00 A.M.
The Radical Experiment Saving the Lives of Drug Users
How a once fringe idea — making it safe to get high — became a reality.
I’m nearly two hours into an interview with Sam Rivera, who runs one of America’s first supervised-drug-consumption sites, when a voice cuts abruptly through his serene, incense-filled office.
“Code Blue,” a radio crackles. Two floors below me, someone has just overdosed.
It is the 80th overdose in just five weeks between two sites operated by the nonprofit group OnPoint NYC; this one is in East Harlem, the other in Washington Heights. “We are like an ER here,” says Rivera, the group’s executive director. “Just wait here. Don’t leave the room,” he says and hurries out the door to investigate.
Less than 30 minutes later, he’s back, sweat glistening on his forehead. He tells me that a young woman who had injected fentanyl started to have trouble breathing and began to lose consciousness. The staff gave her oxygen and, sensing that wasn’t enough, opted for a small shot of the overdose-reversal drug naloxone, which almost instantly revived her. Within ten minutes, she was on her way out the door. He clasps his hands studded with rings as he thinks what might have happened if she overdosed outside instead of under OnPoint NYC’s supervision. “How could anyone object to saving lives?” he asks.
The site opened during the waning days of Bill de Blasio’s tenure as mayor; he entered office as fatalities exploded across the country due to an influx of illicitly made fentanyl into the U.S. heroin supply. The facility in Harlem opened on November 30, a campaign promise that de Blasio waited until the very end of his term to fulfill. The case for supervised consumption is straightforward: As Rivera said, it saves lives, and at a moment in which overdoses claim the lives of more than 100,000 Americans per year — 2,243 in the city alone by last count — the government can’t stand in the way of any solution no matter how controversial.
The entrance to the Corner Project’s overdose-prevention site in Washington Heights. Photo: Graham MacIndoe
While de Blasio deserves credit for harnessing the political will, albeit late in the game, to green-light the opening of OnPoint NYC, it is really the accomplishment of a handful of dedicated activists and their allies in city government who spent more than a decade advocating for supervised consumption — sometimes over the objection of their own peers — before taking matters into their own hands.
“You know, I get a lot of credit for being the first,” says Rivera, his eyes filling with tears. “But it’s hard to take credit for that when I know a lot of brothers and sisters died trying to open these.”
At first glance, OnPoint NYC’s Harlem site may look like a resource center for the homeless and transient, with a television and a computer, laundry machines, and two showers. Deeper inside, however, behind a single locked door, is a room with eight brightly lit stainless-steel booths, four on each side. Rivera and I wait behind a patron to get buzzed in. The facility has strict limits on how many people can be inside the room at one time. As we enter, a man in one booth is preparing a syringe. To his right, another man has just finished injecting and is now dancing in place to music only he can hear. Large mirrors, which face the center of the room, let people who inject here find veins under the arm or in the neck and help staff members observe their faces for signs of overdose.
Along the back wall, two doors open into separate rooms where people can smoke crack or other drugs. Currently, only one person at a time is allowed in each room, to discourage drug sharing. But demand has been so high that the facility plans on combining the rooms and adding a plexiglass window to accommodate multiple people at once. Posted outside the doors are two crash carts stocked with naloxone, pulse oximeters, and laryngeal tubes for opening restricted airways. Rivera says his staff is trained to identify overdoses early, so for most people, only oxygen is needed. All the overdoses at OnPoint’s two facilities have been successfully reversed, and only one — an individual who suffered a seizure — required a call to 911.
Staff provide clean needles and other paraphernalia in the supervised-injection room.
Clients fill out an intake form upon arrival.
Photographs by Graham MacIndoe
Users have to bring their own drugs, but they may choose from an assortment of paraphernalia that includes glass stems and Chore Boy for smoking crack, straws and plastic cards for cutting and snorting drugs, and, of course, syringes in a variety of sizes and gauges. First, though, they must answer a short anonymous survey about which drugs they plan to use and in what quantity, the places they typically go to inject, and how they dispose of syringes when they use outside the facility. Given that supervised consumption is such a controversial issue, keeping data is critical to both substantiating proponents’ claims about its effectiveness and creating a road map for other cities to follow. Rivera says he’s been receiving almost daily calls from city leaders across the U.S. asking for advice.
A middle-aged man who said he came from Staten Island rattles off answers to a young staffer named Rayce, a slender young man with ringlets of long brown hair that hang beneath his shoulder blades, before washing his hands and choosing a syringe, tourniquet, and cooker for his heroin. Rayce led him to a booth close to the entrance and wheeled over the privacy screen that the man had requested.
“In the beginning, I think people were more shy or whatever, and a lot more people asked for the screens,” says Rayce. “But now that people feel more comfortable, we don’t pull the screens out as much.” The staff insists that reducing the shame and self-stigmatization associated with drug use — being greeted with a smile and without judgment — can help users begin the road to healing and self-care. “Many times, people finish up here and think, You know what? I’m gonna go see the on-site nurse and get tested for hepatitis C,” Rivera says.
The sites also serve as a means for people who want to reduce their drug use or quit altogether. The day before my visit, according to Rivera, a man came to use but opted to see the doctor instead. “He had had a good experience with family over the recent holidays, brought them here to see the place, and that day he decided he was ready to go to detox,” Rivera says. OnPoint staff called for a van to take the man to treatment.
The man from Staten Island prepared his shot from behind the screen as Rayce finished jotting answers on the questionnaire. “Do you need help tying off today?” he asked with the attentiveness of a bartender. “How about water?” About ten minutes later, he indicated he was done. Rayce removed the screen and told him to leave his trash on the table. With that, the man thanked the staff, put on his brown leather jacket, and stepped out into the cold afternoon air.
When Louis Jones started using heroin in the ’70s, sometimes he would duck between cars or in an alley, relying on other users to keep lookout as he prepared his heroin in the cap from a bottle of cheap wine he carried with him. It was common for shooting galleries to recycle injection equipment, sometimes renting reused needles out of containers full of water that were tinged pink from blood. In 1986, a public-service announcement about HIV caught Jones’s attention, and he decided to get tested. Two weeks later, a nurse took his hand and told him he was positive for the virus. “I said, ‘Hell no!’” he recalls. Jones spent the next three years refusing to accept his diagnosis until a friend took him to his first meeting of the AIDS Coalition to Unleash Power, or ACT UP. “I knew right away I was in the right place,” he says. He began attending ACT UP meetings regularly and participating in its protests.
In the late 1980s, in violation of a state law against distributing drug paraphernalia, ACT UP started passing out clean needles in Manhattan. The act of civil disobedience led to the arrest of eight activists on the Lower East Side. The following year, the state followed ACT UP’s lead and authorized the opening of five syringe-exchange programs in the city. Thanks almost entirely to the work of these exchanges, less than 5 percent of intravenous drug users today have contracted HIV/AIDS, according to state data.
Jones took retroviral meds for his HIV and endured a six-month course of interferon that cured his hepatitis C. His transition from addict to activist now complete, Jones, who is now 65, channeled his rage into advocacy and eventually started a Brooklyn-based drug-user union, composed largely of people of color like himself, to advocate for racial equity in the treatment of HIV and hepatitis C. He called it Voices of Community Activists & Leaders, or VOCAL-NY, which would become one of the most aggressive proponents of social justice for drug users and of supervised consumption. Along the way, he met Rivera, who, like Jones, brought the message of harm reduction to the back alleys and underpasses, where many others feared to go. Recently, he called to tell me he had a new job at OnPoint NYC, just a short distance from where he contracted HIV.
“It’s hard to believe it, man, to think how far we’ve come,” says Jones in a thick Brooklyn accent. “This whole area was surrounded by shooting galleries. And now we’re helping people live.”
A client is supervised as he prepares to use drugs.
Drugs are tested for fentanyl to curb overdoses.
A supply of Narcan nasal spray, an overdose-reversal drug.
A supply of clean needles. Photographs by Graham MacIndoe
THE OTHER EPIDEMIC 8:00 A.M.
The Radical Experiment Saving the Lives of Drug Users
How a once fringe idea — making it safe to get high — became a reality.
I’m nearly two hours into an interview with Sam Rivera, who runs one of America’s first supervised-drug-consumption sites, when a voice cuts abruptly through his serene, incense-filled office.
“Code Blue,” a radio crackles. Two floors below me, someone has just overdosed.
It is the 80th overdose in just five weeks between two sites operated by the nonprofit group OnPoint NYC; this one is in East Harlem, the other in Washington Heights. “We are like an ER here,” says Rivera, the group’s executive director. “Just wait here. Don’t leave the room,” he says and hurries out the door to investigate.
Less than 30 minutes later, he’s back, sweat glistening on his forehead. He tells me that a young woman who had injected fentanyl started to have trouble breathing and began to lose consciousness. The staff gave her oxygen and, sensing that wasn’t enough, opted for a small shot of the overdose-reversal drug naloxone, which almost instantly revived her. Within ten minutes, she was on her way out the door. He clasps his hands studded with rings as he thinks what might have happened if she overdosed outside instead of under OnPoint NYC’s supervision. “How could anyone object to saving lives?” he asks.
The site opened during the waning days of Bill de Blasio’s tenure as mayor; he entered office as fatalities exploded across the country due to an influx of illicitly made fentanyl into the U.S. heroin supply. The facility in Harlem opened on November 30, a campaign promise that de Blasio waited until the very end of his term to fulfill. The case for supervised consumption is straightforward: As Rivera said, it saves lives, and at a moment in which overdoses claim the lives of more than 100,000 Americans per year — 2,243 in the city alone by last count — the government can’t stand in the way of any solution no matter how controversial.
The entrance to the Corner Project’s overdose-prevention site in Washington Heights. Photo: Graham MacIndoe
While de Blasio deserves credit for harnessing the political will, albeit late in the game, to green-light the opening of OnPoint NYC, it is really the accomplishment of a handful of dedicated activists and their allies in city government who spent more than a decade advocating for supervised consumption — sometimes over the objection of their own peers — before taking matters into their own hands.
“You know, I get a lot of credit for being the first,” says Rivera, his eyes filling with tears. “But it’s hard to take credit for that when I know a lot of brothers and sisters died trying to open these.”
At first glance, OnPoint NYC’s Harlem site may look like a resource center for the homeless and transient, with a television and a computer, laundry machines, and two showers. Deeper inside, however, behind a single locked door, is a room with eight brightly lit stainless-steel booths, four on each side. Rivera and I wait behind a patron to get buzzed in. The facility has strict limits on how many people can be inside the room at one time. As we enter, a man in one booth is preparing a syringe. To his right, another man has just finished injecting and is now dancing in place to music only he can hear. Large mirrors, which face the center of the room, let people who inject here find veins under the arm or in the neck and help staff members observe their faces for signs of overdose.
Along the back wall, two doors open into separate rooms where people can smoke crack or other drugs. Currently, only one person at a time is allowed in each room, to discourage drug sharing. But demand has been so high that the facility plans on combining the rooms and adding a plexiglass window to accommodate multiple people at once. Posted outside the doors are two crash carts stocked with naloxone, pulse oximeters, and laryngeal tubes for opening restricted airways. Rivera says his staff is trained to identify overdoses early, so for most people, only oxygen is needed. All the overdoses at OnPoint’s two facilities have been successfully reversed, and only one — an individual who suffered a seizure — required a call to 911.
Staff provide clean needles and other paraphernalia in the supervised-injection room.
Clients fill out an intake form upon arrival.
Photographs by Graham MacIndoe
Users have to bring their own drugs, but they may choose from an assortment of paraphernalia that includes glass stems and Chore Boy for smoking crack, straws and plastic cards for cutting and snorting drugs, and, of course, syringes in a variety of sizes and gauges. First, though, they must answer a short anonymous survey about which drugs they plan to use and in what quantity, the places they typically go to inject, and how they dispose of syringes when they use outside the facility. Given that supervised consumption is such a controversial issue, keeping data is critical to both substantiating proponents’ claims about its effectiveness and creating a road map for other cities to follow. Rivera says he’s been receiving almost daily calls from city leaders across the U.S. asking for advice.
A middle-aged man who said he came from Staten Island rattles off answers to a young staffer named Rayce, a slender young man with ringlets of long brown hair that hang beneath his shoulder blades, before washing his hands and choosing a syringe, tourniquet, and cooker for his heroin. Rayce led him to a booth close to the entrance and wheeled over the privacy screen that the man had requested.
“In the beginning, I think people were more shy or whatever, and a lot more people asked for the screens,” says Rayce. “But now that people feel more comfortable, we don’t pull the screens out as much.” The staff insists that reducing the shame and self-stigmatization associated with drug use — being greeted with a smile and without judgment — can help users begin the road to healing and self-care. “Many times, people finish up here and think, You know what? I’m gonna go see the on-site nurse and get tested for hepatitis C,” Rivera says.
The sites also serve as a means for people who want to reduce their drug use or quit altogether. The day before my visit, according to Rivera, a man came to use but opted to see the doctor instead. “He had had a good experience with family over the recent holidays, brought them here to see the place, and that day he decided he was ready to go to detox,” Rivera says. OnPoint staff called for a van to take the man to treatment.
The man from Staten Island prepared his shot from behind the screen as Rayce finished jotting answers on the questionnaire. “Do you need help tying off today?” he asked with the attentiveness of a bartender. “How about water?” About ten minutes later, he indicated he was done. Rayce removed the screen and told him to leave his trash on the table. With that, the man thanked the staff, put on his brown leather jacket, and stepped out into the cold afternoon air.
When Louis Jones started using heroin in the ’70s, sometimes he would duck between cars or in an alley, relying on other users to keep lookout as he prepared his heroin in the cap from a bottle of cheap wine he carried with him. It was common for shooting galleries to recycle injection equipment, sometimes renting reused needles out of containers full of water that were tinged pink from blood. In 1986, a public-service announcement about HIV caught Jones’s attention, and he decided to get tested. Two weeks later, a nurse took his hand and told him he was positive for the virus. “I said, ‘Hell no!’” he recalls. Jones spent the next three years refusing to accept his diagnosis until a friend took him to his first meeting of the AIDS Coalition to Unleash Power, or ACT UP. “I knew right away I was in the right place,” he says. He began attending ACT UP meetings regularly and participating in its protests.
In the late 1980s, in violation of a state law against distributing drug paraphernalia, ACT UP started passing out clean needles in Manhattan. The act of civil disobedience led to the arrest of eight activists on the Lower East Side. The following year, the state followed ACT UP’s lead and authorized the opening of five syringe-exchange programs in the city. Thanks almost entirely to the work of these exchanges, less than 5 percent of intravenous drug users today have contracted HIV/AIDS, according to state data.
Jones took retroviral meds for his HIV and endured a six-month course of interferon that cured his hepatitis C. His transition from addict to activist now complete, Jones, who is now 65, channeled his rage into advocacy and eventually started a Brooklyn-based drug-user union, composed largely of people of color like himself, to advocate for racial equity in the treatment of HIV and hepatitis C. He called it Voices of Community Activists & Leaders, or VOCAL-NY, which would become one of the most aggressive proponents of social justice for drug users and of supervised consumption. Along the way, he met Rivera, who, like Jones, brought the message of harm reduction to the back alleys and underpasses, where many others feared to go. Recently, he called to tell me he had a new job at OnPoint NYC, just a short distance from where he contracted HIV.
“It’s hard to believe it, man, to think how far we’ve come,” says Jones in a thick Brooklyn accent. “This whole area was surrounded by shooting galleries. And now we’re helping people live.”
A client is supervised as he prepares to use drugs.
Drugs are tested for fentanyl to curb overdoses.
A supply of Narcan nasal spray, an overdose-reversal drug.
A supply of clean needles. Photographs by Graham MacIndoe
