A Visit to the First Legal Safe Injection Site in the USA

to use any type of drug. One of the most popular episodes the Psychoactive to date has been the one where I invited my friend Julie Holland to service my co host and answer questions with me from you the audience. So we're going to record another one of those episodes, and we need your questions. Leave us a voicemail with a question as details as possible at one eight three, three seven seven nine sixty, or you can record a voice memo and send it to Cycleactive at protozoa dot com.

I'm sure it's going to be a great second go with this. Thanks for you. I'm Mizabelle Um. So there's actually really no time limit with the booths, people can take as long as they need. Obviously, they're hello psycoactive listeners. Today we're doing a different kind of episode. Do have a fifteen minute time limit, but right now they're serving

as the smoking rooms and bathrooms. You know. I've recorded almost all the episodes up to this one from a makeshift studio in a closet in my apartment in New York City. But for this episode, I finally got to come out of the closet, jump on the subway, and right a few stops up to East Harlem, just three miles from where I live on the upper west side of the had it headed east toward Park Street, where one of the bigger harm reduction programs in New York City,

now called on Point, is located. I was going there because they recently opened the first government approved overdose prevention center in the United States. These centers go by many names, safe injection sites, supervised injection facilities, drug consumption rooms, and now most commonly, overdose prevention centers because that's really what they're about. They're basically surge exchange programs with a back room where people can inject or smoke their drugs. In

the presence of a health professional. That eliminates the risk of dying from an overdose, and it also cuts the health risks associated with injecting, like getting an infection or contracting HIV or hepatitis C. Yeah, yeah, you know, I've visited these things all around the world. This is a very similar set up. Yeah yeah, and that's outdoors is somewhat similar to you know, now over those prevention centers like this one have been operating around the world for decades.

There's dozens of them, mostly in Europe, but also in Canada, Australia, and a few other places. You can even find a few in other cities in the US, but they're sort of underground, with local police and other city officials quietly looking the other way, but not allowing them to operate openly with official approval, mostly because the federal government regards them as violations of federal law. What makes this center special is that it's now operating openly with legal and

political approval by city government. Our former mayor Built A. Blasio gave is okay just before leaving office at the end of last year. The current mayor, Eric Adams, is supportive and new York's Governor, Kathy Hokel, has said nothing but seems okay with it. When I turned the corner onto Under twenty six Street, I was a little surprised to see over a dozen people standing outside two doors, one for the harm Reduction program and a few feet

away the door of the overdose Prevention Center. I walked in and was even more surprised, I guess because the streets had been so empty, to see about fifty people sitting around in a large room about half the size of a basketball court, on chairs and couches, chatting, reading, napping, working on computers. One of the first people I met was Bryant, the staff person who had previously worked as an e m T, an emergency medical technician. This is

actually my first week before be doing this. I was an e m T. And the reason why I came over here because it's really hard, especially trying to harm reduction being in that area. It's really hard. You know, if you're a MT, you get a call at Central Park that you have a possible overdose. You know have big Central carkets, but one person, yeah, and then you know nobody knows who this person is. John doe Um could be a d O A and it's you know, it's here is more controlled. You know, it's uh I

mean yeah ye. When someone arrives for the first time, the staff person greeting them at the door collects information about them, including about their drug gets. This is the first time they ever came, so this out. You know, if they whether they're going to be doing today, if they're not coming to our facility where they will be using, if they're going to be doing it alone, you know, if they were any troubles with cops and stuff like that. How many times have they use in the past, and

you keep he explained to me. They also give out over those prevention kids containing the antidote and the lock zone, which many people call by its most popular brand name, Narcan. If they do want to take a Narcan kid, will give him a card it looks like this sublieve. Yeah, but they're basically like cars, saying that they know how to use narcomunication, will train them on it and send

them home if they do want to pick. After getting a brief tour of both the overdose Prevention center and the harm reduction center right next door, I chatted with the clinic manager my name is Susan Spratt. I'm a clinic manager. Mrs Gary the sound guy. Hi, you're not You're not trying to pull people in or or people from there saying maybe you should go over there. Um, we definitely make sure that everybody knows all the services

that are being offered in the building. So everybody, all our staff, whether it's our harm reduction specialists who are really like on the front lines in the drop in center and and here, that everybody knows the entire array of services. So whenever somebody joins us, if there's a new intake, we absolutely will give them a rundown of everything and so they know what they can find here, which I think is like making the health insurance you

help with things like that. Yeah, absolutely, And why don't you have relationships to the methan on programs in the area, and so we refer to method on programs. But also a big thing that we do here in our clinic as we prescribe our doctors prescribed to box Zone, Peop and Marphine and so obviously some people prefer to be on methodone and then but for some people methodone can

be kind of restrictive. The nice thing about Buke we call it is that you know, it's something once you're stable on it, you can see the doctor WinCE a month as opposed to coming in daily or weekly to get a bottle, you know. And are some of the staff here are the current users or in the methanon programs or anything like that. So you got both both current users and people in methan on Boukmarpine working here as well as people in recovery. Yes, yeah, it okay,

that's great, that's fantastic. This is we're hoping to put a pharmacy and that would obviously serve the community, but also it would be something we could swear, providers could prescribe and then the participant can come and get their medication right here. And you have things like at the puncture the second floor. It we have an amazing the holistics room. You're going to see that and and um and it's yeah, it's a it's a really quiet, calm space.

It smells amazing. We have a lot of really amazing volunteers, people doing acupuncture and everything's free to use, right yeah, I mean these are coin operated, but we just keep quarters. Like when we finished this conversation, I headed up to the third floor to chat with the executive director of on Point, Sam Rivera, and his colleague Kalen c the

senior director of Programs. They're in charge of the harm reduction programs and over those prevention centers both here in East tar On and also a few miles northwest up in Washington Heights. So Sam and Calin, thank you so much, so much for joining me. Thank you. He was a pleasure just to be and it's a pleasure to see you again. It's been a long time. I know, I know. So listen, this thing just got the official go ahead a few months ago for Mayor de Blasio, just before

he was leaving office. And you know, his successor, Eric Adams, the new mayor, says he's in favor. But nine months ago, did you think you were going to be first in America to do this? So I'll say this is good, it's perfect. I'll say no, but you heard that, yes, that that's Klin right. Like so, I always always talking about this in that way where no matter what we talked about in our work, there was always Calin. That

That's why I thought it was perfect going reception. One day, we're gonna open I'm like, she does not give this a break. And it's a blessing. It really is a blessing that that she that you kept bringing it up because whatever we did, it was like just remember when we opened, we need to have this. I'd be like okay, and then we all bought in. We were like okay when we open, and it was the way to do it.

So when we expanded our dropping center, when we got the you know, we were able to acquire a larger drop in space. When we got the new space in Washington Heights, every conversation was when we opened our OPC, this is what we need, so make sure it looks like this. And I'm like, she just won't stop, like she won't stop. And so nine months ago, no for me, no, but it was there always in the conversation. Caitlin definitely

believed it because I mean, you think about it. Rhode Island last year became the first state, the state, not just the city, to say let's do it. San Francisco has had a kind of quiet underground site going forever, and the mayor has been in favor. Other mayors. You had the mayor of Ithaca, New York, think Myrak who has been behind it. So you know a few years ago you start seeing not just the public health people, but the mayors around the country saying, let's do it.

And then it seems like they talked to their chief legal council who says to them, you know, I mean the Trump administration, they can actually put you in jail, and the mayor saying, well, let's hold off. And then you on New York, You've got other organizations are looking at this, so, I mean, kill, what made you confident you're going to be number one? We we were just ready and this has been um a goal, uh for not only our organization but the entire harm reduction community

in New York for for decades. It's a shame that it's still controversial to open these sites in America. I mean in some ways in terms of harm reduction and what we could be doing over those prevention sites or safe consumption rooms or old news right, because they've been up and running in all all kinds of you know,

all over the world, as you mentioned earlier. But as as as an organization, with our Washington Heights site and our East Harlem site, we have been tiptoeing up to this and preparing for this in a variety of ways for years. I think it's fairly common knowledge that we were operating unsanctioned sites of both of our program arms for six years prior to opening, and that was that was strategic unctioned. These were basically kind of bathrooms that were set up so that people could use in a

safe place. But so let was it that that kind of set up, Yes, But what I think is important to make really clear about about the unsanctioned program was that it acknowledged that people were using, in overdosing and dying in public bathrooms all over New York City alone, in their homes, subway stations, underpasses, overpasses, and they were

using and overdosing in our bathrooms too. So I really want to applaud the New York State Department of Health, the Office of Drug User Health in particular for putting guidelines in place to allow for the safe operation of a bathroom program and a harm reduction setting. What we did is what we're very good at doing and we do all the time, which is pushed those guidelines to the max. This is our approach to harm reduction service is we have to remember that the War on drugs

was born and raised in the United States. Everything about practicing harm reduction authentically is kind of illegal here, So you've got to find ways through. And that's what these

two agencies have been so good at doing. And our unsanctioned program, built off of those guidelines that the New York State Department of Health put in place, was really the platform that enabled us operationally to do this when the moment came to be super ready to seize that moment when it presented itself, UM, which I reminded Sam every day since he started was going to come. And then also just for our staff, UM, it's a big lift to ask your staff to sit in that kind

of witnessing with people consuming drugs every day. But we were ready because we've been doing it. We were ready philosophically, we were ready programmatically. Sam and I often say we we met at the at the right time. UM, that it was a combination of what I bring to the table and what he brings to the table. And I really I think he's right, Well, you're doing this in

New York City. We were. It's a complicated place, right, I mean, first of all, we have there's city city regulations, there's state law, and there's federal law, and all of this is still illegal under federal law and in some ambiguous or illegal state under state law. So a lot of this is like kind of link linked not not then in New York right where New York City has actually made up of five boroughs, right, five independent cities

that unified a hundred twenty five years ago. Right, So you know, it's been a process of getting the buy in where now you've got four of the five district attorneys in New York City saying we want to do this. But I want to ask you specifically about a few players. First of all, when it comes sam to the cops, right, I mean, this thing goes way back, and obviously you know local cops must have been aware. So what's the relationship like with the cops and how is that evolved?

This is this is exciting and that's why I think we're both laughing. The police, and in specifically to the opening of and operating operations of our opr O PC safe consumption sites, have been our partners have been beyond amazing, have been extremely supportive. You know, New York City police, you just never know, just never know. So, um, we

brought them in. We brought them into the fold. And then being the local people, the previou commanders, three cops or local commanders, conversations weekly at least it was daily for a while, but weekly with captains and lieutenants from local piecings often also sending me text I said, with the kleb, but who's this guy again? Texting asking if we need anything? The local police asking if we need anything.

They asked us to did we need anything. We had to keep reminding them we've been doing this for six years. We haven't called you. We haven't had any issues for six years. They came in, We met with them, We invited them in. Uh, they came in and took a tour. And that's the thing we keep telling people, especially if you don't believe, if you don't understand what we're doing, come visit. You know, come visit. So they came in.

We offered them a tour where they all came and we were getting calls like Kyle and the team would be like, there are four cops here. What are we doing. We're like, Oh, they came for a tour. We give them a tour. People don't know, they don't know what they don't know, right, and people fear what they don't understand. So we very much see it as our role to have an open door, particularly for people who are in opposition or don't don't understand or have misperceptions about the program.

It's our job to nip those in the bud quick because that spreads faster than the positive message in some ways. So we went to roll call at both precincts, all of them, including the late night one, and everybody's there, you know, standing at attention, very stiff. I'm sweating because I'm just like, this is gonna be a hard sell.

And then you explain how it works, and you explain how it's a benefit to the police, and you explain how you want them to work with you, right you you sort of you check all their boxes around anxiety and their misperceptions about the site, and you just can visibly see the shoulders relax. And at the end of this we always say open invitation to all of you to come fully expecting that none of them would none

of them, and that's what Sam's talking about. They would just show up, you know, in groups of like four or six and come in and look at the site, and you can see you can see the deep breasts, and you can see the slow pans and the eyebrows go up. But they're thinking and they're trying to understand,

and they're asking really thoughtful questions. And when they came in, what was really an unspect and really unexpected benefit was our participants of staff for the police are here and some you know, they were hesitant, and then they some come in they saw us talking with them. We showed them around. Part of that created a safe sort of interaction between our participants and the police because the police, they are talking to us, they know we're all doing.

They felt more comfortable about walking in knowing that drugs on their possession, in their possession. Uh. Walking into one of our our sites knowing that the police know, they know now here we go. Everybody knows what we're doing here. It is loud and proud um. And then you know, we would have to talk to them often because they were so happy, interesting enough, happy to be here outside.

Sometimes they were in front of the building, literally five six of them would be like can you go cross the street, and the other thing would happen um uh is like I would drive in and I see one of them parked at the corner with their lights on. A text the captain that's wild text to lieutenant. Can you tell you guys turn the lights off? It looks you know, the scaring people away. Oh sorry about that. They get right on. We'll be talking more after we hear this ad. It were the first you know, the

safe and Jake's as I ever visited. It was one of a couple of sites in Zurich, Switzerland, back twenty five years ago. You know it was located. It was on the second floor of the building. The first flour was the police station and the second floor it was the safe injection site. And the cops were cool with it and any injectors. And this congresswoman, Rights Nicole Malio tiki, it's one of the few, I believe it is. And she's one of the few Republican members of Congress from

New York State left. She represents stating on in South Brooklyn, and she's one of the knuckleheads, and she has no direct control, but she's pushing legislation in Congress to try to ban any federal funding not just for these programs, but for any programs related to these programs. Right now you've invited her in and she won't. She won't, So you're still dealing with that mentality. But there's another type of opposition you're dealing with, right, which is from the locals. Right.

It's when the famous civil rights leader Al Sharpton, Reverend Al Sharpton gets up with locals and say, what are you putting this here for? How do you respond to that? No, No, it's a good point, because that's that's that's what's been out there right. Um, So I reached out to his staff directly, who have visited us, who we have walked the site and visited the site. I am asking out for for a comment. It's coming, It's coming. I believe

it's coming. I always thinking he tends to layd up in the right place, but on the drug issue, he's always taking this time together. This issue. It was I think reflecting some of the black church resistance to drug stuff, but his other set of values brings them in the right area. You mentioned earlier misinformation. They were they're upset about their view of the over saturation of programs at hall and Trump programs at home. They are clearly not

upset about what we're doing. Part of the misinformation that kind of moved them back and go, oh my god. Is for some of them. Some of them didn't know we've been doing this un sanctioned for six years. So when they heard it, they were like, we're bringing syrens to this neighborhood. And we're like, well, most of you we were talking to, we've been here longer than you,

So it's not your neighborhood, it's our neighborhood. What we tell people as we improved what we were doing, we had an unsanctioned program where we would if someone overdose it was later any overdose it was. It was a very dangerous time for the for the individual, and what we did was improved that. The other thing I've been saying since the beginning is these programs are response to the community. Community doesn't want people using drugs of the street.

We don't either. They don't want syringes and paraphernalia industreet we don't either. Like all of the things they're asking for, we were entering. The differences were courageous. I used to say, crazy, We're courageous enough to bring them into our side and manage them ourselves. So the other piece we'll see in time is this neighborhood seeing the difference they're going to see. They've already seen a difference in in in paraphernalia, surrageous

and stuff. We already know that we that the programs are a great success. But one I'll tell you about, Highbridge Park up in Washington Heights is a very well known open their drug consumption in drug market public park that the public doesn't use because it's quote unquote overrun by drug use. So Highbridge has been a big problem for us, and we've lost a lot of people in Highbridge. You know, our our team attended nine bodies in Highbridge Park over the last couple of years of participants that

we know and love. And then there's was syringe letter everywhere. It was absolutely an issue. Sam and I are making all of these pronouncements to the media about how this is going to have an impact on syringes, and we're secretly like it's going to have an impact on the syringes, right, and we get this email from the Parks Department just a couple of days ago saying, have you guys increased

your outreach and public safety team? That's those are outward facing teams that do community engagement and syringe cleanup and work with people that are in the camps, are in the subway stations. Because in November our team collected thirteen thousand syringes from Highbridge Park and this month there's only been a thousand, Like what have you added more people? Like what's happened? Like how that's so stark. I was

so excited for the opportunity to build. I don't know if this is dorky to say, but like the consumption side of my dreams, like they you know, this was a real cool opportunity, right. We had we had support, a big support, and they were they were going to allow us to build the site that we wanted to build. And I and I don't want to minimize what a great privilege and honor that was. So these are polymodality sites.

They're not injection sites. You can snort, smoke, sniff, inject, swallow or otherwise ingest your junks of choice, and you can do it by dose as determined by the participant. So you can smoke, inject, smoke, sniff if you want to, all in one visit, because that's how you decide that your doses. But I want all of that to happen in front of us, because that's how I'm going to keep you safe if I only let you do one thing and then you got to go and sign back

up again, et cetera. So our Washington Heights site is our peer or consumer lead model, So most of the folks working up there are active in their use currently we're former participants and are now on staff or have very recent UM drug use experience. And then the East Harlem site is the more traditional medical model with a higher threshold of staff, the more traditional stainless steel boost with the big mirrors that you would expect to see.

So the Washington Heights site is meant to be cheaper, really really cost effective, UH, using para professional staff and active consumers UM. So that sort of gets that if you're in a jurisdiction where there's no way you're going to be able to get around the licensing for a nurse or a doctor, this is a model that might work for you. All the way up to the other end, which is the big fancy dancy design build UM supported

by clinicians and care coordinators. And then UM, as I'm sure you've seen downstairs, are nine drug user Health Hub is right on the other side, I being the name of the Starlem site. You are karmaduction educators and HRV of the mirror. Then that's so that you can observe somebody. Why why the mirror is there? The mirrors are hotly contested item in a in a safe consumption space, but

but we really believe in them. The mirrors are twofold one. Uh. It allows the participant agency and control over their setting. They can see what's happening around them. So often, Uh, drug consumption, particularly in the States, happens quickly and I'm checking over my shoulder. Am I gonna get robbed arrested? If I'm a woman, am I going to get raped? So no safe for use practices are employed because it's about getting the shot in as quickly as you can

and then moving. The mirrors allow them to see what's going on around them. Really relaxed decreases anxiety, lets people take their time. They're also for our team UM to see the onset of a medical emergency the second it starts to happen without having to get up into people's business. Right, drug consumption is ritualized in private and intimate for people, and we want we want to reserve that space unless we have to go into that bubble and do something. UM.

So it's it's a relationship right between the practice. Do you see differences like are they they using different drugs in Washington Heights compared to East Harlem is a younger versus older incting to be fascinating any drug policy nerve which is just going to like have a field day with our dad. It's so fascinating some of the early stuff that we've seen. Um, the Washington Heights population is significantly younger than the East Harlem population. UM. And all

Speedball injectors, so they're touching down with us. Really. So Speedball just explained that's the heroin cocaine or fenyyl cocaine or stimulant opioid. Oh yeah, exactly. I love how drug literate you are, because the heroin and cocaine are by and large constructs in the poor neighborhoods, right, It's usually the synthetic analogs that are staying here. So it's fentanyl and meth usually, um, and you know the good drugs

are in Tribeca, Bushwick. Harlem is an older population. UM. A lot of veterans in Harlem too, and lots of smoking. So where Harlem is getting a dedicated smoking room to accommodate the all of the smoking. What are they smoking? Is it still crack or is it K two cocaine, meth all even heroin K two being a kind of synthetic Canadas cannabinoid. Yeah yeah, um, and that they're smoking.

You can smoke at both locations, but here we just really saw a need for the larger smoking room because of course, once you start to get big, long weights, you start to work against your objectives, right, We don't want people to bounce away from the service, So there's no time limits on people, but if they take too long, you encourage them to try to move into the waiting areas. Like here's the great thing. Um, no official time limits,

but you're absolutely right. We start to do a little bit of sheep hurting if we've got a big lineup, But that just means transferring here to our drop in center, Like they don't have to leave the building, they don't. We We have co located everything here, food, nutrition, laundry, showers, medical care groups, holistic care, free acupuncture all at both sites, so we we really can engage and keep people for

so we'll be through. Right. So somebody hears about this place and they show up for the first time because some friends told them. Whatever, how does it work? They walk in, they give their name, first name, last name, they tell off to talk about their drug preference. I mean, what, how does it just walk me through the thing you kind of did? Yeah? So are our services are confidential and anonymous um, which which means you know, we're not checking I D. But that doesn't mean that we're not

making an effort to get to know people. So you come in, you do an enrollment where you're asked U like some very simple questions, um, but you are asked to acknowledge that you have presented at the site with the purpose of consuming drugs and that you are dependent on drugs, right, And that's sort of our little waiver

and release. There's a couple other questions in there as well, and you're asked what you're going to be using, how you're going to be using if you weren't here using, where would you be have you had an overdose in the last twenty four hours or thirty days? What's your housing status? Where do you hang out the most in the city, buy zip code where do you buy most

of your drugs in the city? Buy zip code? Have you had an interaction with the police in the last twenty four hours or since we last saw you, and in the last thirty days, and that's it. Key check for guns or weapons or anything like. No, there's no metal detector or nothing like that. Oh no, and no security, no metal detector, no padding people down. I want to go back quickly about the mirrors because there's another unintended benefit that I love watching people start to look at

themselves in the mirror. People in pain and I've been in pain. People in pain and people who are struggling. You really don't want to look at mirrors, you know. I remember I should do this this support group and we talked about how many mirrors you have. I don't want any merrors in my house. I'm a man, you know. But watching people come in and one of my girlfriends, she she she came in the beginning and she would

be like, oh, I don't look at me. And now she's like, actually one time two times instead of she actually said I'm not gonna use again, like she you know, because I want to look at myself. I came in the room and she's like, I want to look pretty for my boyfriend, and she's doing her makeup in the mirror. She didn't want to look at herself the first day. Then like she didn't want to look at herself. She was she the light came on because they there's there's

also these really amazing lights. They control themselves, and when she put them on, she was like, oh, like she pulled, she had like a wolf. She put her hat down. She didn't want to look at herself. So she went from that to seeing how beautiful she is and and now joking around and flirting with you know, feeling confident about the woman in the mirror. Like that just touches.

It touches for me because you know, I've seen her here for him since like hey, since I've gotten here, and just to see that in other people and starting to look at themselves when I know they wouldn't and talk about different thing things you know, uh, and identifying and building that relationship itself, and simply because we have a mirror there. Um as far as safety, this is the space right. We've created the safe space. So we

engage our people in protecting the space right. So the blessing and sometimes we have to manage it is people start having a disagreement, which happens really not as much as you would think. Someone else usually steps in and says, hey, you know it says, do you know what you're doing here? Like this is creative for us, we cannot do this. Plus it's important and for me, you know, a personal lived experience who comes from the inner City, from the Lower east Side, you know, I want to talk to

them about that, Like, this is your space. I know it's ours, but this is this is really your space. We built this for you. So what you do here it really matters, and how you show up really matters. This is sacred ground. This is sacred ground. This is the church. This is sacred ground. That's the that's the the Church of Safety. Sure, it's what we were calling in. We have a story about that. But this is a sacred ground. And for Native people. I'm a Native American.

Indigenous people sacred grounds with things change and things are blast and people people are honored in a certain way. And we have two spaces in the city of Many, this in the Lenape land, but in the city, we have two spaces that are sacred ground for people who are who are oftentimes, you know, treated as disposable and mistreated and unloved. So the blessing here, and I'm telling you, is I go down to that room and I going to drop it center three or four or five times

a day. And people tend to think I'm going down there to be the boss. I'm going down there for medicine, for good medicine, to watch people be loved in a way that they're not used to, and it really does something for me. We've had some people come up here and I talked to them and they go, I go, why are you here because I'm in trouble. You're here because I love you and I care about you, And they don't know what to do. They're like, what do

you mean? That's what I mean? Another thing? And I don't remember everyone's name, but believe me, Ethan, I will turn around quickly said what's the first name was? Because if I called them by their name, it is a

beautiful moment. Man. One of the places where the whole twelve step, you know, recovery movement intersect with harm reduction, is that both of them, deep down are about enabling people to uncover and recover their basic sense of dignity right, and that when people get called by their own name or when they get approached in a kind of non judgmental wave because we don't judge people because about what the drug they're putting their body. That's fundamental to people

is coming home and think about our buddy. Howard Joseph fer taught me a lot. Just Howard Joseph's again. He's they who founded Exponents, which was really a pioneering program in New York that integrated harm reduction, drug treat and helping people coming out of jail to get their lives together. So many of the harm reduction leaders in the city

are graduates at howard Us program. I graduated Howard did a thing once and many things, but I was in one of his trainings and he and he does this thing that I've been doing now for years, which is having a conversation with people who are using and identifying the read the root cause and telling people, do you understand why you used? You have Obama, I'm a junkie, I don't know, I'm a loser. You use because you're

self medicating pain traumatic experience of mental health condition. And I would watch people go what because that's not what they've been taught, that's not what they believe. So you know, I've taken that piece Howard has given me many years ago and expanded on it and have conversations, individual conversations, even in the OPR while someone's there. It's not my thing like it was Howard's. Right, we just let's keep

carrying it forward. It's really about the person receiving the message and watching their reaction a like goes off like not all these things people told me I am and a person who uses drugs is one part of who they are. Like I've been saying for years, I've committed crime, but other identified Let's take a break here and go to an ad because there's another thing about this is one of them. Remember the key selling points a needle exchange programs back years ago in the US I think

was one of those early programs. Dave purchased Tacoma and what he showed that the needle exchange program was the number one point of referral into abstinence based drug treatment programs. And my understanding is here too, you have people right, you're referring people to methand on uperneour freen recovery. Right. Yeah, I'll say something real quick about that. There's also this perception,

this perception that none of them tried treatment before. And we know that my interactions, they've all tried it, They tried some some part of it. Right. How they there matter? Right? Because too many people who are just send under treatment. What you're doing is enabling. It's not true because we know they've tried, that means they won't try again. But you just want to be clear, We want to be really really clear that our folks have tried, sometimes numerous times.

There's this perception that the absence based world and the harm reduction world are at odds, and I just think that they're they're in a slightly dysfunctional marriage, and but they're married. And there are a few things that both worlds really agree on. You know, the number one predictor of an overdose fitality is a previous overdose. And we also know that most people who are as entrenched in

their addiction is the folks that we work with. Our there's a chance of a return to use after leaving an absinence based program, it might as well be so if if the likelihood of a return to us is that high. You better hope there's a harm reduction program nearby to catch that person when they returned to use, because you know they when you return to use after a period of accidence, you have no tolerance and you're in such a high risk of overdose fatality. But you

know you're preaching to the choir. I gotta say, because what was right on top of Insight in Vancouver a detox and treatment program literally operated by Insight, one staircase above the consumption facility. And you know, I just know that Sam is so excited for that to be the next thing that we tackled together, because that's where we gotta go. But she let me ask you about this because you know, even when I was runing Drug Policy Alliance,

always advocating for the safe injection size overcerenction centers. But this other thing that I would never let go of was moving forward on heroin prescribing, having a site where you can get legal heroin pharmaci And these things also start in Switzerland back in the nineties. You now have been Switzerland and Germany, the Netherlands and UK. You have in Canada. I think they're about to open up in Norway. You know, and but we can't seem to get it

going in the US. And I've been in places in Geneva or other places where you have there's a safe injection program, there's a heroin prescribing program, you know, but the people complain about a safe injection program because people are still buying their drugs illegally. They're still using drugs that they don't exactly know what's in it. They don't know how much fentinel is in it, they don't know

what it's cut, whether there's all those risks. And here's the heroin prescription program where you're getting a prescribed dose legal, you can't take it home with you, And so I mean, I I'm immensely frustrated that this is not moving forward

as well. And in fact, that sometimes seemed to me that the cops would be more comfortable with her own prescription programs and safe injection because heroin prescription is all legal, like a method on program, we're safe injection still involves people buying their drugs on the streets, buying them illegally, and all this sort of stuff. So is there some movement of foot to try to get these things going,

and whether it's with a university or something. I see Kel is nodding here, so say a little something about that. I mean, I don't I don't mean to be evasive, but we we are working with one of the hospitals in New York City and some of the doctors there on several different research applications around around heroin maintenance and safe supply. These are New York based doctors who have all visited some of the locations that you've mentioned, who came roaring back to the US saying, we got to

do this. Um, so it is happening. It's just it's just you know what happens when we submit the proposals. You know, you know, I really I forgot to ask you a detail about the overdose stuff because here you are called an overdose prevention center, and I think it's important for our listeners understand that not not every overdose results in death, and not every overdose reversal is saving

a life. So it just explain a little more about that detail, right, So explain about you know, like, what percent of overdose is actually my result in a fatality? And how do you intervene when you see something happening. It's it's hard to say to to your question of how many of the what are we at a hundred and twenty eight overdoses in two months that we've intervened in, and the vast majority are depression opiate involved overdoses, It's hard to say how many of those would have resulted

in fatalities. What we can say is that, thank god, we don't know, right because because the staff is there at the second of on site of the overdose, um, we're preventing the loss of consciousness. It's a kind of overdose response very unique to this environment. If you can keep the brain firing, if you can keep oxygen to the brain and prevent the loss of consciousness, you essentially stop the progression of the overdose. If you overdose but you're not going to die, is there still some damage

that happens to the brain, even absolutely so. So a couple of things about that, there's this real reliance on the lock zone, and we're very grateful to n lock zone. It absolutely is a miracle drug. It does. It does what it's supposed to do very beautifully, which is intervened in these really mostly fental involved overdoses. But long before in a lock zone existed people were intervening in overdoses with just oxygen, right, Like, overdose responses really really fundamentally

about oxygenation. And as long as we can keep the brain healthy and keep the brain firing, the brain then doesn't shut down the rest of the body. UM. So we choose to approach our overdose response from that perspective oxygen first, and a lock zone only when necessary, and just enough to pull the opiate off the receptor so that respiration can resume. We don't want to be making people dope sick or putting them into withdrawal, because that's a negative experience. UM and who knows what they had

to do. Zone is more likely to result in some dope sickness because they'll have them are rapid withdrawal from the opioid of failure. Yes, anyone who's dependent on opiates UM is put into some degree of withdrawal with n lock zone. The higher dose of naloxone, the more severe the withdrawal. And that's not a pleasant experience for anyone. And that's that's not the that's not what we want

to be offering to our participants in these settings. But are absolutely right about this emerging landscape of people who are surviving their overdoses UM or years of being in a kind of a heavier opiate nod having long term cognition problems. Right, harm reduction works and drug users are living longer. Like used to be if you were forty and you were a drug user, you're a senior citizen. That's not true anymore. But when I was downstairs, look

like your average age was probably around four. I mean, we got some gray hairs down there, and hallelujah for that. UM. But we are seeing this other you know, this new kind of landscape and our work which is um you know, long term brain damage from ongoing overdose occurrence in long periods of being in a knot. It's something that the

harm reduction community is looking at. But oxygen, oxygen oxygen, and it's the best practice in safe consumption in other parts of the world, UM, to intervene with oxygen before you Before that, you have these drug test strips to write to check for sent and all other drugs, and you're think data and so what are you finding? Generally speaking? Is sentinel in almost everything from opioids to stimulants and

also people. Is there meth amphetamine in New York Now, um you know, or is cocaine still around or are the synthetic K two cannebinois things where people don't really know. I mean, what are you finding and what's what do you see? Trend lines? Yeah, it's the party pack. Everything

is here. The one thing that we don't have yet, thank god, knock knock knock, as we're not seeing car fentanyl or any of the other Um, really really potent and just explained car fentinels another analog of fentonel, even more potent of fentel, And it showed up in Ohio a couple of years ago, and all of a sudden the overdose fatality rate went up. Like so we are lucky in New York, very lucky to not see that.

But just just as relates to fentanyl. Um, you know, us, like many of the other harm reduction providers in New York have been testing with the fentanel testing strips for years and years. We've been testing since we haven't had a negative bag of heroin since, so we don't even use our fentanyl test strips for opiates anymore. We operate from the basis the presumption of positive. So anyone who's

using opiates. That's our campaign. Assume it's positive. Where the fentanyl test trips become really useful for us is for opiate naive people or people who aren't using opiates, who are just going to get blown over guy a fentanyl positive dose of a stimulant or a party pillar, research chemical or whatever else. And it takes me back to your previous question. And you know I said this, I

don't know the other day of something. The last seven weeks, I haven't gotten the calls we would get every morning, and we felt like every morning, but we will get calls like who did we lose? Now, even if it was someone we didn't know, we would get a call that there was another person. That to me is a complete and clear connection to the services we're running and the fact that we're allowing folks to come in and you safely because we're not seeing it the way we were.

The hardest part right now for me is be closed every night. And that hurts Ethan hurts man, Like when I drive off I see the gate going down, it hits you. You're you're aiminite aim all way way. Oh yeah, it's going it's going to happen. It's going to happen. Just is not fast enough. I mean, do you foresee mobile units like mobile vans also going out You're reading out stuff? Man, you've been No, I'm just I'm just wondering, definitely, you know. Okay, okay, and elsewhere in the city Brooklyn

coming up other organizations. I will say something very quickly. You asked, because you were starting to talk about earlier, why us, Why were we selected? Because I'm going to a call with Nevada to help them get there. So okay, thank you very much, Sam, the almost penultimate question here. I was very pleased when I walked in. I saw a little sign saying, if you smoke, join our nicotine vaping group here, which I'm a huge fan of. And I see Helen Redman, who has been a real champion

in this stuff. So as real effort being made here to get people are smoking, to encourage them to switch to the from cigarettes to the yes for sure, especially through our holistic treatment program. You know. I I'm also a regular acupuncturists since nine and I've been treating people for years who want to stop smoking, you know, and it's worked. We have a really good approach to it. So yeah, overall, if we get people to stay alive, now, how do we keep them alive in other ways? Right?

Because most of our folks also have other chronic conditions, so how do we manage those? So we're always looking at other ways to expand what we're doing. Um. We also know that a lot of organizations don't aren't too comfortable working with our people. Uh you know, we send them places and they go, oh man, you know the way they showed up. So the more we see that, the more we expand and want to be the organization that provides more services to them. Our next big one

coming up is food and nutrition. We're very close to opening a very very robust food nutrition program. You know, just answering gaps you have to conduct think gaps analysis. It's a holistic health approcess everything. Damn okay, it's great here, you're doing. Great to see you here. Something. Listen to one of the guys. It's the way you've grown into

this thing. Would you do? And you played a pioneering role, not just for the city of the country, So so thank you and you know, and also thank you to Callen as well. Right before I left, I wanted to chat with at least one of the clients who would come that day. The staff asked around and a young fellow named Kat agreed to talk with me. So your name is Kat Chasm. Yeah, where do you live the bronx time? And so you've come down? How often you

come down here? One again? Yeah? Once or twice to leave? Yeah? Yeah? And were you coming here? Even before it became a legal open place, they had a mobile unit on the corner doing Hepatitis C and HIV testing and you know, they had two trunks and given up the plot stuff like that. So I had I wanted took a hepatitis the test and the HIV test, and you know they filled me in on the you know, the workings of the place. So you already started coming here back then, Yeah,

that's when I started coming. It was more like different, it was different bathrooms. Yeah, yeah, basically use um heroin heroin but to heroin. Heroin's got fitting on it now, I believe so. But you know, if you get without fitting on and it is, it's quite useless because everything, like you said, almost everything has it in there. So if something doesn't have it in there, being a just

so accustomed to it already, it's like useless. Yeah, yeah, I know it's amazing to change, you know, and basically injecting it injecting as well. I injected, but I used to just sniff. Then why did you transition from from steffing it's injecting. I have absolutely no idea. If you if you slip for whatever like that, you know you have to just you don't have to really worry about anything. Just sniffict. But you gotta make sure you don't get

wet or any you know, and stuff like that. But if um, if you inject, you know, it doesn't really matter. You can be putting it in water anyway. So I don't know, you like the sensation of the injecting more than the sniff the stuff. I actually did like the sniffing better because it lasted longer to me, the high end the stuff like about one bag and it probably lost back a day or two. I think that's the

best thing you do. You still go in that program here, so you go to the net round the corner right here. So but you live in the Bronx, but you go to the best program at Harlem and uh and this place. Yeah, so you're going to mess. You're going there every day basically, you messing on day every other day to give you one day take home. Get with those messing on your So it's a low dope. So when you do the heroine, you can still get high supposed to. But I don't.

I don't know. Yeah, I don't know. I don't know why, but I just don't you worry about overdose in at all. I mean the one time I overdose one time, and I think that was like when the jet got around because I wasn't familiar with a year. I was at my mother's house and somebody else was there, so she had hit me with the um the knock game twice and I didn't get back up. Then um my friend had told her put ice on my testical or whatever

like that. I guess that that woke me up. Put the nar can innotually did not wake you up at the moment, That's yeah, that's what they said. Looks like you gave it to me twice and I didn't get up. That scare you when that happened, or not so much, because I mean, yeah, yeah did because you know, I was like dead, you know, but I didn't. I didn't. I didn't realize it. I didn't feel anything until after when the knock is the knock came pushes everything else.

So you just like you feel like shit. I mean you feel like, oh my god, what do you think of the quick? What do you think about it? Someone to go? You know, it's like going to a program, but not going to a program, Like it's just a place where you know, it's like a break all the time. You know, if you go out, like if you have a class and you get a fifteen minute recess and everybody's like a smoke area, that's like this is hours.

So when you come here, you hang and then you're able to go into the back room and inject there. And you've never had an over the situation here everything here? And do you ever use the testing trips to see what's in the drugs you're bringing here? Yeah? And is it always the same like heroin Sentinel convo basic very once in a while you'll see um without without without So for you a lot about this place, it's not even so much as having it's not so much having

a safe place to inject. It's just a nice place to hang out in date, right, because you have other places you could inject myself. Yeah, you're a long but you'd like to be around people somewhere, and this is the place pretty much appreciate. Okay, good media. I felt exhilarated after spending my afternoon at on Point. What inspired me was that here, at last was an outpost of decency and pragmatism, and not just my own country but

my own city. Drug consumption sites like these have saved tens of thousands of lives around the world, and tens, maybe hundreds of thousands of people living really difficult lives have found a place where they can chill out safely use the drugs they would otherwise be using alone or on the streets, find a little community, talk to a health professional or social worker, get some care, have a cup of coffee, wash their laundry, and just be treated

like a human being. It matters. Of course, the programs like these don't just help the people they serve. They also reduced the public nuisance associated with drug users hanging on the streets, including you syringes lying around, and they save taxpayers money by reducing police and emergency medical costs. Moreover, those prevention centers will soon open other parts of New York City, and hopefully in other cities as well. I must admit that I don't fully understand what the Biden

administration is waiting for. All they need to do is give a qualified green light, just like the Obama administration did ten years ago when Colorado and Washington legalized marijuana, even though it was and still is illegal under federal law.

I know the politics of this issue can be tough, not least because even as more and more Republicans have come around to joining Democrats and supporting harm reduction and marijuana legalization and reducing prison populations, the issue of over those prevention centers is one on which Republicans can't resist

reverting to old drug war rhetoric. But the bottom line is that these sites save lives and money, and are all the more crucial when more people than ever are dying from using illegal and unregulated drugs of unknown potency and purity. We need hundreds of programs like this around the country. They won't solve the overdose epidemic, but they will save the lives of thousands and improve the lives

of many more. If you're enjoying Psychoactive, please tell your friends about it, or you can write us a review at Apple podcasts or wherever you get your podcasts. We love to hear from our listeners. If you'd like to share your own stories, comments and ideas, then leave us a message at one eight three three seven seven nine sixty that's eight three three psycho zero, or you can email us at Psychoactive at protozoa dot com or find me on Twitter at Ethan Natalman. You can also find

contact information in our show notes. Psychoactive is a production of I Heart Radio and Protozoa Pictures. It's hosted by me Ethan Naedelman. It's produced by Noam Osband and Josh Stain. The executive producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren Aronofsky from Protozoa Pictures, Alex Williams and Matt Frederick from my Heart Radio and me Ethan Edelman. Our music is by Ari Blucien and a special thanks to

A Brios f, Bianca Grimshaw and Robert bb. Next week we'll be talking about Mexico's century long experience with drug prohibition with two of Mexico's leading drug specialists, Alejandro Madrasso and Catalina Paris m Subscribe to Cycoactive. Now see it, don't miss it.