NEW YORK — In about one hundred locations across Canada, Europe and Australia, supervised drug injection facilities allow visitors to inject heroin and other drugs in a clean, well-lighted space under the watchful eye of trained personnel who can rescue them if they overdose.
Tens of thousands of drug users have visited the facilities, thousands have overdosed and, researchers say, no deaths have been reported. Studies show that a substantial number of drug users who visit safe injection sites end up in treatment, which is routinely offered to them. Research also has shown that the facilities help contain hepatitis C and HIV infections and are a cost-effective way to save lives.
The United States — with an overdose death rate that far exceeds that of any other country — has failed to open a single government-sanctioned facility.
This year, that may change.
Legislatures in California and Vermont are considering bills that would legalize and, in some cases, fund safe injection facilities. Seattle and surrounding King County have approved and budgeted for two such facilities. And advocates in Boston, Denver, New York, Philadelphia and San Francisco are pursuing similar initiatives.
Political momentum for sanctioned injection sites has been building in the United States over the past three years, advocates say. And this year, more state legislatures and local officials appear closer than ever to providing the needed government support.
Groups including the American Medical Association and some state medical societies have backed efforts to launch pilot injection sites. But those and other efforts have been stymied by widespread stigma against drug users and concerns about federal drug law enforcement.
As a result, drug users who do not have a safe place to live furtively inject drugs in parking lots, stairwells, public bathrooms and hidden corners of public parks. And with the increasing presence of the deadly synthetic drug fentanyl in the heroin supply, more of those users are dying.
New York City is no exception.
But in the Washington Heights neighborhood in the northern tip of Manhattan, word has spread about a place called the Corner Project, a drop-in syringe exchange center that provides clean needles, hot coffee, access to health and welfare services — and bathrooms.
Although not sanctioned by the city or state as a safe haven for drug use, it’s an open secret that Corner Project is a place where people can inject drugs in one of two bathrooms while a staff member waits outside the door — and rushes to rescue drug users if they don’t respond to a knock after three minutes.
“It really is just a bathroom. We don’t know that everyone who goes in will be injecting,” said Liz Evans, executive director of Corner Project and founder of Canada’s first safe injection site. “It’s our obligation as a public health facility to make sure nobody dies.”
Opponents of safe injection sites, including some police departments and prosecutors, point to the federal Controlled Substances Act and state laws prohibiting the possession and use of heroin and other drugs. They say sworn police officers and federal agents can’t be expected to ignore people who walk into an injection facility, knowing they likely have dope in their pockets.
And the U.S. attorney in Vermont, Christina E. Nolan, said a proposal in the state legislature to sanction safe injection facilities would violate federal laws that prohibit “maintaining a premises for the purpose of narcotics use.”
Many local officials also worry that allowing people to use drugs in a public facility would send a signal that drug use is acceptable.
Seattle and surrounding King County, Washington, have approved two facilities, but it has been difficult to find a place for them because officials in suburban towns outside Seattle have filed suits to block the facilities from their communities.
Similarly, Boston Mayor Martin Walsh, a Democrat, opposes a bill in the Massachusetts legislature that calls for creating multiple injection facilities in the city.
But despite high-level opposition, advocates for the services say it is only a matter of time before some city, county or state sanctions the first injection site. After that, they predict the results will be so positive that the proven public health approach to reducing drug overdose deaths will spread rapidly.
“Whoever steps up first, despite the controversy, will be recognized as a leader on this in the long term,” said Daniel Raymond, policy director of the Harm Reduction Coalition, a national group that supports safe injection and other public health strategies aimed at saving lives and improving the health of drug users.
Earlier this month, a spell of arctic weather brought record crowds to Corner Project’s always busy second-story respite a flight above bustling West 181st Street.
Throughout the day, a steady procession of men and women of all ages checked in at the front desk and began peeling off layers of clothing, pouring cups of coffee and finding spots to rest and talk with fellow drug users.
Others headed straight to the back of the large open space where the facility’s two bathrooms are located. Before using one of them, visitors must sign in with a staff member who stands outside the door and sets a timer. Every three minutes, he checks on visitors with a knock on the door to make sure they haven’t overdosed.
If there’s no answer or he hears the thud of a body collapsing on the floor, he quickly unlocks the door, calls 911 and administers the opioid antidote naloxone. Staffers here say they have rescued overdose victims hundreds of times since Corner Project began monitoring its bathrooms nine years ago. So far, no one has died.
Alison Darveaux, 34, comes here every day for the coffee and to use the bathroom to brush her teeth, clean up and inject heroin. She’s also been working with one of the center’s social workers to get a photo ID so she can qualify for Medicaid and sign up for a local methadone treatment program.
A Florida native, Darveaux hitched a ride with a trucker and got dropped off here about six months ago. She spends her nights outside the George Washington Bridge bus terminal, and says her life right now is about as bad as it’s ever been. “But it would be much worse without Corner Project,” she said. “This place has saved my life.”
Corner Project isn’t the only unofficial safe injection site in the United States. Another syringe exchange center in the city, VOCAL-NY in Brooklyn, also monitors its bathrooms while users inject drugs. And a site run by a physician in Boston allows drug users to visit after they’ve injected drugs to be watched by health professionals who can rescue them if they overdose.