On ‘Safe’ Injection Sites, New York Can Learn from Governor Newsom

Governor Newsom of California has uncharacteristically veered from the progressive policy playbook by vetoing a bill that would have legalized so-called “safe injection” sites in the Golden State. Mr. Newsom said that such “harm reduction” facilities, where addicts can inject fentanyl and heroin under medical supervision, lacked “well-documented, vetted, and thoughtful operational and sustainability plans.”That’s jargon for the need to hit pause on an approach whose benefits are unproven — and whose risks are high. It may be that Mr. Newsom, thought to be toying with a presidential run, simply wants to avoid being tagged as Governor Fentanyl. Whatever his motivation, he is sending a message much needed at New York, the only city in the country where two such safe injection sites are being allowed to operate, with the blessing of Mayor Adams. The non-profit OnPoint NYC operates two self-described “overdose prevention” facilities, at East Harlem and Washington Heights — and advocates for state funding to expand.These pilots are meant to serve as proof of concept. But, as Mr. Newsom pointedly notes, they may open the door to a “world of unintended consequences.” If they do, however, the New York experiment won’t tell us; its approach to evaluations — as per an early study published in the Journal of the American Medical Association — fails to ask crucial questions and thus ignores potential harms. The JAMA “research letter,” like the New York City Department of Health and Mental Hygiene and OnPoint itself, focuses narrowly on “overdose prevention”—patients revived when they inject too much or tainted heroin or fentanyl while being monitored by nurses.As the JAMA research letter puts it: “During the first 2 months of OPC operation, trained staff responded 125 times to mitigate overdose risk. In response to opioid-involved symptoms of overdose, naloxone was administered 19 times and oxygen 35 times, while respiration or blood oxygen levels were monitored 26 times.”Declaring victory based on such findings is little more than junk social science — as even the JAMA paper concedes in passing. “Findings are limited by the short study period and lack of a comparison group with individuals not participating in OPC services. “Additional evaluation may explore whether (overdose prevention center) services are associated with improved overall health outcomes for participants, as well as neighborhood-level outcomes, including public drug use, improperly discarded syringes, and drug-related crime.” In other words, it’s far too soon to declare such centers to be successful simply because they reverse individual overdoses. The other measures JAMA suggests could all turn out to be problematic. An open-minded health department would ask all sorts of other questions. Might the safe injection sites signal an official tolerance for illegal drug use — and might overall use rise as a result? The trend in overall rate of overdose deaths in the city — there were more than 2,500 last year, up from some 2,100 in 2020 — is one way to judge. Another measure to track is the effect on drug use in the ZIP codes immediately surrounding the legal shooting sites. I suspect that sending the message that drugs can be used without risk is not one that will help children avoid them. Then, too, there’s the fate of the specific individuals who frequent the safe injection sites. How many overdose elsewhere? How many successfully shake their addiction and become happy and productive citizens? Real pilot programs track a wide range of results — and are open to the possibility of failure. When a nonprofit’s business model is based on running safe injection sites, there is little chance it will measure ill effects and close its doors. It rests on the city’s health department to maintain a sober and analytical perspective. Instead, New York’s officials have been outright cheerleaders. Following just three weeks of operation, the health department was already declaring victory. “These data are promising and show how Overdose Prevention Centers will reduce needless suffering and avoidable death,” the city health commissioner, Dr. Dave Chokshi, said in December 2021. He added “the simple truth is that Overdose Prevention Centers save lives — the lives of our neighbors, family and loved ones. Thank you to OnPoint NYC for launching this vital new service to keep New Yorkers healthy.” This is, of course, a new definition of healthy, one that includes drug-addicted. It may be that safe injection sites have a role to play in mitigating the damage of widespread hard drug use. But acquiescence in drug use can signal acceptance. We are already in the midst of a nationwide experiment in cannabis legalization. Absent are messages, such as those which caution against tobacco use, which tell the truth about drug use: it confuses short-term pleasure with the satisfaction of a life well lived. And, of course, it poses serious health hazards — including the risk of death.Mr. Newsom has, surprisingly, sent a positive message to New York: be careful.

On ‘Safe’ Injection Sites, New York Can Learn from Governor Newsom

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