On September 30, activists gathered for a town hall and to launch SIFNYC, a coalition of criminal justice and drug policy advocates campaigning to bring Safe Injection Facilities(SIFs) to New York City. SIFs in Europe, Canada, and Australia already provide clean needles, health services, and a police-free place to use intravenous drugs to users who would otherwise be forced to use in public where rates of overdose and contraction of infectious disease dramatically increase.
Along with immediate safety improvements, SIFs offer access to clinical professionals and recovery services but, importantly, don’t mandate recovery efforts in exchange for use of the sites. SIFs go one step further than needle exchanges, offering both clean needles and a place to use drugs beyond the reach of law enforcement and the public eye, relieving the threat of discovery that leads to unsafe injection. According to Vocal New York’s Policy Director, Matt Curtis, access to clean needles does not solve the problems associated with public use, still leading to hurried use in public restrooms, parks, and subways cars.
“We have an unprecedented homelessness crisis right now and increasing heroin use,” Curtis said. “We’re giving them supplies to inject more safely, connecting them with mental health, but many, many people don’t have a safe hygienic place to go once we give them that syringe. Without also offering a safe place, we’re saying ‘okay go inject in the Dunkin Donuts bathroom.’”
SIFNYC launched shortly before Governor Cuomo announced the “2015 Blueprint for Ending the Aids Epidemic,” which specifically names SIFs among its proposed reforms. In general, public use has been shown to make overdose and contraction of infectious disease substantially more likely. In densely populated urban areas, where the risk of discovery and arrest is particularly great, there’s a high premium on speedy injection leading to imprecise dosage and recycling or sharing of needles.
New York City has seen a significant uptick in overdose and related deaths since 2014. In 2014, overdose rates tripled over three years, and in 2014 and 2015, heroin overdoses killed more New Yorkers than homicide. In a 2011 report, The Drug Policy Institute promoted safe injection sites and needle exchanges as opposed to drug courts, finding that drug courts fail to address problems 
in the long term, partly due to the manner in which they combine treatment with punishment and require users commit to a recovery plan.
Despite the overwhelming need, SIFs offend the sensibilities of many who believe the sites send a dangerous message of approval. According to Curtis, this is the same argument opponents have made for years in response to visible harm reduction services.
“It’s not about condoning anything, it’s about good public health practice,” Curtis said. “How can we improve peoples’ health, give them the support they need, save money for the system, and improve the health of communities?”
Thanks in large part to the efforts of grassroots campaigning like SIFNYC and VOCAL, New York State relaxed regulations on the sale of sterile needles in pharmacies in 2002 to allow for the Expanded Syringe Access Program. The Federal Government followed suit in 2009.
Other successful campaigns put Naloxone, the most common overdose antidote, in the hands of thousands of New York City police officers beginning last year. But experts say that with a hike in need, prices of the drug are soaring, which may mean SIFs are all the more crucial.
Curtis said he’s optimistic that SIFNYC will be equally successful as those prior campaigns in resisting its opponents’ efforts to derail their work.
“We hear the same knee jerk response again and again—this is a soft landing that makes it easier for people to continue to use drugs without the threat of overdose or arrest,” Curtis said. “The logic is that the threat of overdose is the only thing that will stop them, but that’s just not how people think. It’s a cruel way of looking at the situation.”
Philosophical resistance aside, the state legislature’s authority to fund SIFs is based in its obligation to protect the safety and welfare of its citizens, and according to activists, SIFs are the most effective way to fulfill that very basic duty for intravenous drug users. Curtis said part of the campaign’s efforts will be aimed at convincing opponents that intravenous drug users deserve that protection. If New York State doesn’t take action to fund the SIFs, the mayor, a local health agency, or city council also have the power to authorize, fund, and operate SIFs in New York City.
The New York State Department of Health can immunize SIF clients and staff from criminal prosecution by labeling the site as a Syringe Exchange Program. However, whether it’s the State or the City that moves to fund the City’s first facility, it will still be vulnerable to prosecution under the federal “crack house statute,” which makes it illegal to “knowingly open, lease, rent, use or maintain any place…for the purpose of manufacturing, distributing, or using any controlled substance,” as well as New York State’s criminal nuisance statute.
Earlier this month congress announced that is considering lifting the ban on federal funding for needle exchange programs in response to a rash of HIV infection in rural white communities in the Midwest. The bill would only lift the funding ban in regions that the Center for Disease Control first identifies as exhibiting crisis levels of infection. Although incomplete, the move may signal growing acceptance of harm reduction solutions, and pave the way for SIFs in New York, and perhaps beyond.
Healthcare providers in Boston have responded to the same crisis by working to launch a “safe space” in a preexisting facility that would provide medical monitoring, food, and shelter for the duration of a heroin high. Short of a place to administer drugs, the space would mean immediate response time in the event of an overdose. Such a site presents substantially fewer legal and logistical concerns as compared with SIFs, however, fails to combat the problem of public use that is at the center of the life saving potential SIFs offer.
Photo: (Hypodermic Needle, Steven Depolo, https://www.flickr.com/photos/stevendepolo/3021193208/in/photostream/)