After years of stalled progress, New York City is preparing to open its first overdose prevention centers -- otherwise known as supervised injection sites. The two centers, located in East Harlem and Washington Heights, will allow people to use drugs such as heroin under the care of medical professionals, while giving them the option to access addiction treatment and other services.

The nonprofits New York Harm Reduction Educators and the Washington Heights Corner Project, which are merging to form the organization OnPoint NYC, will operate the centers. These are the first government-sanctioned spaces for drug use of this kind in the United States.

The sites come as the city struggles to cope with overdose deaths. In its announcement, the mayor’s office said during 2020, over 2,000 individuals died of a drug overdose in New York City, the highest number since reporting began in 2000.

“New York City has led the nation’s battle against COVID-19, and the fight to keep our community safe doesn’t stop there,” Mayor Bill de Blasio said in the statement. “After exhaustive study, we know the right path forward to protect the most vulnerable people in our city. And we will not hesitate to take it.”

Supervised injection sites have been proposed in other cities and states around the country but none have opened yet. Some have been held up by fear of a crackdown by federal prosecutors, similar to what happened in Philadelphia, where litigation is ongoing. But Rhode Island is developing regulations for the facilities after successfully legalizing them in July, and a bill to authorize them in San Francisco, Los Angeles and Oakland is making its way through the California state legislature.

Critics of safe injection sites argue that they normalize drug use and will attract drug users and dealers to the neighborhoods where they open. But similar projects in Canada and Australia have proven successful at preventing overdoses, reducing drug use in public places and promoting safer injection practices. Policymakers will now be able to observe how these centers fare in the U.S. and whether they can withstand legal scrutiny under the Biden administration.

“One of the goals of the programs that [are opening] is to establish themselves, demonstrate that there is no major crisis from having done that, and use that to counter any public opposition,” said Charles King, CEO of Housing Works, another nonprofit planning to open an overdose prevention center in the city.

De Blasio first announced in 2018 that he would open four of these centers as part of a pilot program. The mayor previously said the city needed approval from the state health department to move forward with the pilot, and advocates lobbied former Gov. Andrew Cuomo -- and more recently Gov. Kathy Hochul -- for approval.

In recent weeks, stakeholders have told WNYC/Gothamist and other news outlets that the city health department was working aggressively to open the sites before de Blasio leaves office at the end of the year. In late October, de Blasio said his administration continued to “work energetically” on the project.

WNYC/Gothamist was tipped about the pending opening in early November, but the city wouldn’t confirm that the pilot was finally ready.

“No site has opened. The City believes in the lifesaving power of Overdose Prevention Center services, and that it's an idea whose time has come,” a health department spokesperson said on November 10th. “Though the City does not have a specific announcement to make at this time, it's something we continue to look into.”

At the time, Hochul continued to hedge on the issue.

“Governor Hochul is deeply and personally committed to combating the opioid epidemic, and all options are on the table to save lives,” a spokesperson for the governor’s office said in early November in response to a query about the pilot. “The Governor will work with experts and impacted communities to determine how best to reduce harm and keep New Yorkers safe.”

Mayor-elect Eric Adams has made it clear that he supports overdose prevention centers.

While two of the pilot sites are ready to go, the others do not currently have a clear launch date. One will be run by the harm reduction and advocacy group Vocal-NY. The organization is in the process of moving its operations to a new building in Park Slope, Brooklyn, said Jasmine Budnella, Vocal-NY’s drug policy coordinator.

King said he is close to picking a building for Housing Works’ overdose prevention center, but the organization first needs to secure liability insurance for the facility and then get approval from the building’s landlord. That’s not an easy task since the site may be in violation of the Controlled Substances Act or the so-called "crack house statute," which makes it illegal to knowingly provide premises for people to use drugs. King would not reveal the location of the potential site.

St. Ann’s Corner of Harm Reduction in the Bronx has also been in talks with the city about opening a center but is not quite ready to take the leap. Joyce Rivera, the founder and CEO, said the organization’s “conditions for opening an overdose prevention center are currently under review.”

What will overdose prevention centers look like?

All of the pilot sites will be run by nonprofits that operate syringe exchange programs. Staff at these programs already often monitor clients’ substance use because people tend to inject drugs in the bathrooms, King noted. The Washington Heights Corner Project and Vocal-NY have both gained national attention for saving lives through their bathroom-monitoring protocols.

New York Harm Reduction Educators would not offer more details on their overdose prevention centers ahead of the announcement. A photo that circulated on social media before being taken down depicted a table with white partitions and a mirror behind it.

King was willing to divulge plans for the center at Housing Works. It will include an intake area where clients can get their drugs tested for laced substances such as fentanyl, a synthetic opioid more powerful than heroin that can increase the risk of overdose. The facility will also have partitioned booths where clients can inject the drugs under the supervision of a nurse or emergency medical technician and a comfortable area for people to hang out afterwards.

“We're not sending people out to go nodding off on the streets,” King said.

For harm reduction advocates, the rise in overdose deaths in New York City and nationally over the past year has lent a sense of urgency to this project.

“We have surging overdose rates that are catastrophic,” Budnella said. “Throughout the pandemic, public injection was more visible. And so obviously, bringing people into safe, sterile, dignified places to use is both good for people who are using and for communities.”

Legal Gray Area

Supervised injection sites have been proposed in cities including San Francisco, Denver and Seattle, but none have opened so far. Some observers have recently speculated that Rhode Island would be the first state to break ground. By beating others to the punch, New York’s pilot sites will lead the way into the murky legal waters.

Since announcing the pilot in 2018, the de Blasio administration has been working with the NYPD and district attorneys to ensure the sites can operate without the interference of municipal law enforcement. Reached for comment in early November, spokespeople for the Manhattan and Brooklyn DA’s confirmed their support for overdose prevention centers.

WNYC/Gothamist did not get a response from Bronx DA Darcel Clark, who has previously spoken out against the facilities. “Government should not be involved in taking on that type of liability,” Clark said in 2019.

Asked about the pilot, a police department spokesperson said, “The NYPD is aware of the program and has no plans to target people connected to authorized sites that are meant to reduce overdoses of dangerous drugs. Our enforcement efforts remain targeted to those who illegally sell and distribute the illegal drugs that have led to record numbers of overdose deaths in our streets.”

The legal standing of the centers could be bolstered by support from the state, and de Blasio said last month he was optimistic that he could get that support under Hochul after being stone-walled by Cuomo. Dr. Mary Bassett, the incoming state health commissioner whose appointment begins December 1st, was the top doctor for New York City under de Blasio when the pilot was first announced three years ago.

“You want to try and keep people alive, get them into treatment, and not punish them, which pushes people away,” Bassett told the news outlet The City in March.

But even with state and municipal clearance, the centers could still be challenged by a federal prosecutor.

Under former President Donald Trump, the U.S. Attorney for the Eastern District of Pennsylvania sued the nonprofit Safehouse for seeking to open a supervised injection site in Philadelphia. Lawyers for the Trump administration said it violated the “crack house statute.”

President Joe Biden was an architect of that law as a senator in the 1980s, but he and his Department of Justice have not clarified their stance on whether it should be enforced against supervised injection sites.

A U.S. district court initially ruled in favor of Safehouse, but an appeals court overturned the decision earlier this year. The U.S. Supreme Court then declined to hear the case. The nonprofit is still pursuing additional arguments at the federal level, and the Biden administration has until January to respond to those claims. That means the federal government cannot avoid the issue for much longer.

De Blasio has acknowledged the possibility of a federal crackdown. In April, he and other mayors sent a letter to U.S. Attorney General Merrick Garland urging him to issue a statement on behalf of the Department of Justice saying the enforcement of federal law against supervised injection facilities would not be a priority.

Although he never received that assurance, de Blasio said last month he was optimistic the centers would be allowed to stay open.

“We have a new administration in Washington, a new administration in Albany,” de Blasio said in a press conference on October 26th. “It was the right time to do something on this topic while we could finally have the kind of potential cooperation we need.”