Nation’s first overdose prevention centers face uncertain future

OnPoint NYC made history in November 2021 when it opened the nation’s first overdose prevention centers (OPCs), where people can consume illicit drugs under medical and/or peer supervision.

Since then, more than 2,300 participants have visited Manhattan’s East Harlem and Washington Heights facilities more than 55,000 times, and the nonprofit’s staff has intervened in more than 700 overdoses that may have otherwise been fatal.

Despite those results, the OPCs—which operate in a legally gray area due to the federal 1986 Anti-Drug Abuse Act (sometimes called the “crack house” statute)—have struggled to maintain their overdose prevention services. The statute prohibits public funding for that work, forcing OnPoint to rely on private fundraising.

That could all change, though, if the Department of Justice drops its opposition to OPCs in a pending federal lawsuit.

Still, OnPoint Executive Director Sam Rivera argues there’s another way to ensure the nation’s only OPCs can keep their doors open: funding them with dollars secured through national opioid settlements. New York Attorney General Letitia James secured more than $1.6 billion from settlement agreements with companies that manufacture, distribute, and sell opioid painkillers. The money must be used to help communities hit hardest by the overdose crisis.

New York leaders have declined to allocate some of the opioid settlement funds to support OPCs—even as Rhode Island prepares to use more than $2 million in its own settlement dollars to support a forthcoming safe consumption site.

Rivera spoke with Healthcare Brew about the financial challenges facing OnPoint’s OPCs, and why he’s fighting to use opioid settlement dollars to operate the New York City sites.

This interview has been edited and condensed for clarity.

How much does it cost to run the two OPCs?

With our current schedule [of 6am–8pm Mondays through Fridays in Harlem and 9am–4:30pm on weekends in Washington Heights], both OPCs combined are about $1.4 million to run annually. We’re looking at $4.4 million, so we can operate both locations 24 hours a day. We’ve had an impact on reducing overdose deaths, but we close every night, and the overdose rates in New York have only gone up. This isn’t the time to maintain the schedule, this is the time to really move into 24 hours and open additional OPCs.

What happens when these facilities close that makes you want to expand to 24-hour operations?

Those are the only times we’ve had deaths. Recently we lost two members who would utilize the OPC every day—both died during off-hours. That’s the toughest part of the day for us: Every time we have to close our doors, we worry. When we show up the next day, we’re waiting to hear and making sure everybody returns.

The other thing is that the drug supply is so contaminated at this point. We’re getting to a place where it’s going to be difficult for people to use drugs almost anywhere other than an OPC because of our ability to respond to an overdose within seconds. [What happens when we’re closed] becomes an issue for the community—this is why some community members say they still see an impact, but we’re not open 24 hours a day.

Why should opioid settlement dollars be used to help run OPCs?

Because that’s the gist of the lawsuit—and the purpose of the lawsuit. That money is earmarked specifically for opioid users. The city and state get a fee for administering those dollars—that’s it. Instead, they’re putting some of this money in their pocket and in well-funded treatment programs. What they’re doing is perpetuating the fact that more people are going to die—and they won a lawsuit to prevent people from dying. It makes no sense!

What happens if OnPoint can’t use any of the settlement funds? Can you continue to operate?

Hundreds, if not thousands, more people die. And if that happens, then it’s a clear sign that people in politics are using politics to allow people to die but don’t have to die. We have to fight to be able to provide those health intervention, evidence-based, life-saving services. We have raised money, and we’re also talking to another large foundation. So right now, we’re OK. We were a month and a half away from closing. Individuals, a couple of foundations, and a couple of other groups have basically facilitated their own fundraising activities to make sure we stay open.

The last fundraising announcement we put out was close to $900,000, but we don’t have that final dollar amount right now. It costs us, with the current schedule, about $120,000 a month to operate. As people step up, we know we have four months to five months more to operate while we’re also doing everything possible to get some of these other dollars.