In mid-July, Tony Duffin, CEO of Ana Liffey Drug Project, visited the Overdose Prevention Centres in East Harlem and Washington Heights… here he says we should take inspiration from their recent response to street-based drug use and their attempts to reduce drug-related deaths.

In November 2021, seemingly out of nowhere, New York City opened two fixed site Overdose Prevention Centres (AKA Drug Consumption Rooms). Once the NGO provider, OnPoint, was given the green light, the services were opened in seven weeks.

This was achieved in a country synonymous with a litigation culture and in a city known for its high levels of bureaucracy. Under the Biden administration, they had only recently adopted and begun funding a Harm Reduction approach.

Over the years I’ve visited different types of Drug Consumption Rooms in Sydney; Toronto; Athens; and Lisbon. Each visit has been a different experience; however, without fail, I have felt humbled by the warm reception I have received from service users and staff alike. So, I was really looking forward to meeting everyone at the Overdose Prevention Centres, run by OnPoint, in NYC’s East Harlem and Washington Heights.

Streets of NYC

On a hot Wednesday morning in mid-July, I left my hotel on 35th Street and headed on the subway for the 125th Street station in East Harlem. Carrying my small rucksack, wearing shorts and a short-sleeved shirt, I looked every bit a tourist. A good reason to be aware of my surroundings as I walked into a new area.

Stepping out of the oppressively hot subway into the airier heat of East Harlem, there was a local community vibe; but also, a sense of social deprivation with derelict sites and several groups of men dotted around the street.

I took a left onto 126th Street, immediately I could see that this was a neighbourhood where an Overdose Prevention Centre would be needed. The scene before me was of people who use drugs hanging out individually or in pairs; there were two groups of men from different gangs dealing drugs.

In the street, there were cars double parked or slowing down as they moved through the area. Walking along the sidewalk I passed shopfronts with small groups of men gathered outside the premises; apartment blocks; and across the street, there was a children’s daycare facility – it would later be explained to me that those running the daycare are staunch advocates of the Overdose Prevention Centre; and that the Overdose Prevention Centre had been introduced as part of the response to drug use in the area.

Overdose Prevention Centres

As I waited at the door of the Overdose Prevention Centre, I met a member of the OnPoint team nicknamed Owl. Before I could fully introduce myself, Owl quickly guessed I was today’s visitor from Ireland. Owl told me that he loved Irish folklore and particularly the legend of Cú Chulainn. It was a lovely, albeit brief, conversation which I could not have imagined I would be having before stepping foot into the Overdose Prevention Centre – a visit that would turn out to be inspirational.

Kailin See, Senior Director of Programs, was my host. Kailin provided a thorough overview of the history and operations of the OnPoint Overdose Prevention Centres. She described, and I witnessed, the work of an organisation where co-design and co-delivery, by people who use their services, is implemented at all levels; where significant risks are taken and managed and where a holistic approach to working with people is valued.

Everyone here is treated with dignity and respect.

The centres in East Harlem and Washington Heights offer similar services including drop-in centres which provide hot meals, coffee, food, showers, bathrooms, and laundry. They also provide harm reduction interventions – like providing safer drug use equipment, education, and advice on reducing potential harms associated with drug use.

The on-site drug consumption rooms monitor drug use where staff engage and intervene to prevent fatal overdoses. Importantly local outreach and public safety interventions are delivered as part of a good neighbour approach. Other services include a range of groups that people can attend and referral pathways to other services.

The overdose epidemic took the lives of over 106,000 people in 2021. "The survival of someone struggling with addiction shouldn’t depend on your zip code. OPCs save lives and improve the health of communities," says our ED, @samrivera1111. Learn more: https://t.co/dCICNWKYp5 pic.twitter.com/Ew1uSZn3ZP

— OnPoint NYC (@_OnPointNYC) August 14, 2023

Unlike the other Drug Consumption Rooms I have visited elsewhere, the Overdose Prevention Centres in New York are unregulated. Kailin explained that this was working well and gives OnPoint the scope to respond dynamically to existing and new drug trends. Kailin told me that the Overdose Prevention Centres had just recorded their 1,000th overdose intervention and yet they only had to call an ambulance on 17 occasions – another example of how drug consumption rooms save lives and taxpayer’s money.

A few issues jumped out at me while visiting the Overdose Prevention Centres…

• Firstly, hearing the plight of the Army Vets who are suffering from PTSD and who use drugs to cope. Being told that they are receiving little, or no, help because they use drugs was difficult to hear and tragic. It also drove home to me the decades of similar challenges facing those impacted by the war in Ukraine because of the link between war and PTSD.

• Secondly, working at the frontline of service provision alongside my colleagues, we have managed many difficult situations over the decades; however, guns do not tend to be a concern for us. Indeed, in all the Drug Consumption Rooms I have visited; guns never arose as an issue. I am full of admiration for the team at OnPoint who work in the relatively unique situation of providing such a service in a country where guns are so freely available – in the face of this potential risk the team carry out their duties with care and pragmatism.

• Finally, hearing first-hand about the use of Fentanyl, a powerful synthetic opioid; and the use of Xylazine, which is not an opioid but a powerful sedative. The use of these drugs is part of the reason New York has an increasing overdose rate. Which brings me to my next point…

A threat to Europe

Due to the Taliban’s ban on, and the reported destruction of 90% of, the opium crop in Afghanistan, there may be a Heroin drought across Europe. There are concerns that Heroin will be replaced with other more potent drugs like Fentanyl and Xylazine; and that this could lead to an increase in drug-related deaths across Europe.

With the foresight afforded to us, action should be taken now in Europe to offset the impact of the destruction of the Afghanistan opium crop and the significant concerns about the effects of this across Europe, where Heroin made from Afghan opium makes up 95% of the market.

If the ban is sustained and displaced production does not meet demand, then there will be an opportunity to get more people into treatment – this will depend on the capacity of each jurisdiction’s treatment system to respond to those people seeking treatment. There will also be the likelihood of a significant spike in poisoning deaths due to synthetic opioids (and/or other drugs) that may fill the market void.

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Since launching our OPCs in Nov 2021, we intervened in 1,000+ overdoses. “No one has to die of a drug overdose. There are thousands of beautiful souls that are still with us today because of the intervention of our OPC staff," says our ED @samrivera1111. https://t.co/dCICNWKYp5 pic.twitter.com/JhagLCEdUZ

— OnPoint NYC (@_OnPointNYC) August 9, 2023

There are a number of actions each EU jurisdiction should consider when responding to this threat, these include – ensuring that Naloxone, an opiate antagonist, is easily accessible to people; providing or expanding locally accessible treatment services; providing or expanding Heroin Assisted Treatment; providing or expanding Drug Consumption Rooms; providing or expanding accessible drug checking at festivals, nightlife venues and in specialist drug services.

Finally, where prohibition is the law of the land – change the policy and decriminalise people who use drugs by diverting them away from the courts for a health assessment every time someone is found in the possession of drugs for personal use.

Act now…

Thinking back to the response to Covid-19 and Dr Mike Ryan of the World Health Organization when he said:

Be fast, have no regrets. If you need to be right before you move, you will never win. Perfection is the enemy of the good. Speed trumps perfection. Everyone is afraid of the consequence of error but the greatest error is not to move.

In Europe we should take inspiration from Dr Mike Ryan, from OnPoint and the commissioners of the Overdose Prevention Centres in NYC – the commissioners being the unsung heroes who worked in a flexible and pragmatic manner with OnPoint to quickly set up the Overdose Prevention Centres.

With the foresight afforded to us about the destruction of the opium crop in Afghanistan, there should be a quick and pragmatic response to reduce drug-related deaths across Europe.

Tony Duffin is the CEO of Ana Liffey Drug Project.