In mid-2018, Mayor Bill de Blasio announced a pilot program to bring four supervised injection sites to New York City. The facilities would allow opioid users to inject drugs in a clean environment with staff nearby equipped with the overdose antidote naloxone. Governor Andrew Cuomo said later that year that he was working with the city to make the pilot a reality.

Three years on, the sites—referred to by the city as Overdose Prevention Centers—have yet to materialize. Now, with his term almost up, Mayor de Blasio has made it clear he wants to fast-track the pilot.

In April, “the [city] Department of Health reached out to us to let us know that the mayor is very interested in moving this forward before he leaves office,” Charles King, CEO of Housing Works, which would operate one of the proposed pilot sites, told WNYC/Gothamist. “They wanted to know how soon each of the pilots could open up once they were given authorization.”

But one of the last hurdles standing in the mayor’s way is President Joe Biden—and it’s still unclear where he stands.

Former President Donald Trump’s Department of Justice stymied the creation of supervised injection sites in the U.S. in 2018, when it sued Safehouse, an organization seeking to open a facility in Philadelphia. Governor Cuomo has repeatedly cited this legal battle as a reason to hold off on opening the sites in New York. A U.S. district judge’s decision sided in favor of Safehouse in 2019. But in January of this year, an Appeals Court ruled that, while innovative, supervised injection facilities violate federal law.

The court cited the “crackhouse statute,” which makes it illegal to knowingly provide premises for people to use drugs. The provision, enacted as part of the Anti-Drug Abuse Act of 1986, was authored by then-U.S. Senator Biden. While gearing up for his 2020 presidential run, Biden said he regrets some of the “Drug War” legislation he championed in the 1980s and 1990s. He has also expressed support for policies that prioritize harm reduction over criminalization.

But the president still has not weighed in on supervised injection facilities since his inauguration, and the Cuomo administration says they are on shaky legal ground following the January decision. The White House did not respond to a request for comment.

“We continue to explore all options to reduce opioid overdose deaths and combat addiction in New York State,” the state Health Department said in a statement to WNYC/Gothamist. “While we fully support efforts to reduce the harms caused by the opioid epidemic, we are also reviewing the ruling in Philadelphia over supervised injection facilities and considering the impact it could have on efforts to launch similar facilities here.”

While Cuomo continues to “explore all options,” de Blasio has taken a more proactive approach. The latter is among eight mayors across the country who sent a letter in April to U.S. Attorney General Merrick Garland that urged him to issue a statement on behalf of the Department of Justice deprioritizing the enforcement of federal law against supervised injection facilities. Such a move would mimic the Cole Memorandum, issued by the Justice Department in 2013 to limit federal enforcement against marijuana facilities in states where the drug is legal.

Given the increase in opioid overdose deaths in New York City during the pandemic, advocates say supervised injection facilities are needed now more than ever. Research on supervised injection facilities—mostly conducted in Canada and Australia—shows that they are associated with fewer overdoses, less public drug use and greater access to health services for users without increasing injection drug use or crime. The New York City Health Department estimated in a 2017 report that the supervised sites could prevent some 130 overdoses per year and save at least $7 million annually in public health costs.

State legislators are split on the issue along party lines. Democratic lawmakers in Albany introduced a bill to legalize supervised injection facilities this session, while Republicans introduced a proposal to prohibit them. State authorization could also come via the regulatory powers of the Health Department or via an executive order from the governor.

Should de Blasio fail to get the pilot off the ground before leaving office, most top mayoral candidates have said they support opening the centers. If the Biden administration gave supervised injection facilities the green light but Cuomo continued to drag his feet, it’s possible the city could attempt to move forward with the pilot without state support. But legal analyses posit that state authorization would put supervised injection facilities on steadier ground.

King from Housing Works said his organization and the others tapped to open Overdose Prevention Centers have been receiving the funds initially set aside for the pilot—$250,000 per year from the city—and have been allocating the money to other services. He says the programs would now need additional municipal funds for the supervised injection facilities to move forward.

Asked whether the mayor feels he can advance the pilot without Cuomo’s approval, a city spokesperson said, “We do continue to communicate with the syringe service programs doing their life-saving work in the hopes that Overdose Prevention Centers can become an immediate reality.”