In the wake of a heroin and opiate epidemic that garnered the attention of everyone from moms in Magnolia to Republicans in Congress, US cities are scrambling to figure out ways to reduce overdoses and get addicts into treatment or harm reduction programs. One very positive side effect of this discussion has been renewed discussion of safe injection spaces–places where injection drug users can come to inject under medical supervision, with access to sterile equipment, overdose reversal medication, and information about treatment, housing, and other services. Vancouver, BC remains the only city in North America with its own safe injection space, the decade-old facility on the city’s Downtown Eastside, but Ithaca, NY, San Francisco, Baltimore, and other cities have discussed replicating the program.
Of all the cities discussing safe injection spaces, though, Seattle has probably made the most progress, with the discussion evolving from a single safe-injection site, a kind of Mecca for injection-drug users across the city, to several sites not just for safe injection but for safe consumption of other drugs whose use is currently on the rise, like meth and crack (which are mostly smoked).
The movement is being led here by a grassroots group called VOCAL-WA, which itself came out of an older group in New York City called VOCAL-NY; both groups function as drug users’ unions and advocates for harm reduction in their respective cities. VOCAL-NY policy director Matt Curtis was in the Northwest recently to screen “Anywhere But Safe,” a short film directed by Curtis and his partner-collaborator Taeko Frost, executive director of the Washington Heights CORNER Project needle exchange, for VOCAL members in Portland and Seattle. I sat down with Curtis in VOCAL-WA’s office this week to talk about safe consumption, harm reduction, and the legal and political barriers to passing sane drug policies at the local level in America.
The C Is for Crank [ECB]: Your film “Everywhere But Safe” demonstrates the need for safe injection spaces by showing a harm-reduction agency restroom that’s been converted to make it a more comfortable place for clients to shoot up. Obviously, that’s a makeshift solution that isn’t technically legal. Can you talk about why agencies are allowing people to use in their bathrooms?
Matt Curtis [MC]: Harm reduction agencies in particular are seen by people who inject drugs as safe places, places where nobody wants to rat you out to the cops or whatever, places where people respect you, including the aspects of your life that have to do with drugs. So we’ve always had people injecting in our spaces and back in the day, agencies would do thing like put in backlights so that people couldn’t see their veins, or say, ‘OK, our policy is you can’t use the bathroom immediately after you used the exchange.’ And going way back, a lot of us in the movement have always thought, that’s insane bullshit, because your policy is basically, ‘you should go shoot up in the street.’
We all have to recognize that we can’t encourage or condone drug use going on in the the bathroom, but we’re also not going to pretend it’s not happening. And we also aren’t going to turn people away, knowing what the consequences are. So [the Heights CORNER Project] did make sure that staff were trained on overdose first aid and all that, but they really changed their physical infrastructure. You see some of that in the movie [which shows the] VOCAL bathroom. It’s a little more cobbled together—a stainless steel impermeable table, a chair. We put in a hand warmer because when it’s cold in the winter, it’s actually really nice to warm your arms, because it’ll help you get better veins. Multiple sharps containers. When we redesigned our space, we made it physically bigger. There’s an electronic door strike, so that if somebody is unresponsive and somebody needs to get in there quickly, there’s two different staff offices in the drop-in center where you can push a button and the door will pop open. There’s an intercom system, because people felt that was a little less jarring than having somebody knocking on the door, and a timing system, so people get checked on a regular basis and have a limit.
So, long story short, [the Heights CORNER Project] were doing that for a while and they reversed 60 overdoses-plus in their space and no one died.
ECB: What impact did that have on policy discussions around safe injection spaces?
MC: It sort of initiated this discussion with our state health officials, with our state service providers, just to kind of say, ‘Okay, let’s actually get all this stuff out on the table,; so from that, Taeko and I started convening a work group that included other harm reduction agencies, the Drug Policy Alliance, the New York Academy of Medicine, academic researchers, and city and state health officials, really to talk about drug injection policy and what do we do about this issue. This was about two years ago.
That work group eventually turned into kind of a campaign planning committee. We kicked the government people out and said, we love you. but you’re also our targets, so you have to sit back and wait for our phone call.
ECB: How do you measure success? Is it getting people to stop using, or start using less, or just stop dying?
MC: Our perspective on that is we’re all about people being well, and exactly how you’re using drugs is a little beside the point.
I think a lot of people think harm reduction is just syringe exchange, or they hear half the motto. Like, everyone says, ‘Meet people where they’re at.’ That’s not the motto. The motto is, ‘Meet people where they’re at and don’t leave them there.’ Good drug treatment providers do this too. They’re just not necessarily doing outreach and actively finding people. Offering people care and love and respect and dignity is a very different experience than what a lot of the rest of the media, politicians, general public and other kinds of service providers are offering you, where you’re kind of told day in and day out that you’re a mindless zombie with no personal agency, a criminal, a threat to society and children and whatever. And that there’s a sort of general loathing and fear of you because somehow you’re so bad that you might be contagious. That’s how most people have been taught to think about, certainly, people who inject drugs and who use lots of other kinds of drugs.
ECB: How far along are plans for a safe injection or safe consumption space in New York?
MC: Not as far as in Seattle. We started our campaign slightly earlier, and we’ve made way more progress than we anticipated. We want the intervention, we want the public health tool, but we also see this as a way of forcing people to contemplate drug users’ humanity and dignity in a different way. And we’re at that moment in the US in general where that’s happening more. I don’t know if everyone knows or remembers, but 10-ish years ago, there was a big push toward [safe injection facilities, or SIFs] in San Francisco and some real movement toward that, and a bunch of Republicans in Congress flipped out and were like, ‘San Francisco, you want a SIF, we’re ready to cut off all your education, transportation, whatever, funding,’ and the city very quickly blinked and nothing happened for 10 years–until now. It’s kind of starting up again and something seems different today. Like, we had Mitch McConnell standing on the floor of the United States Senate shouting out, ‘Harm reduction coalition.’
We’ve got one town in New York State that has stuck its neck way out, and the mayor has said we want SIFs, which is Ithaca, and did it as part of a broader municipal drug strategy that includes like 30 proposals. When the AP did a story really focusing on SIFs, instead of backing up and being like, ‘It’s just a proposal. We need to study it. What we really need right away is a methadone program,’ they said ‘Yes, of course we want that, it makes perfect sense.’ That has really helped focus people’s attention a lot. We’ve got a number of elected officials who’ve said they’re in favor. We’ve got members of our state assembly and senate who’s said they’re willing to sponsor authorizing legislation at the state level if we want to do that, which we might not.
ECB: Why not?
MC: Having a state law would be ideal. It might also be really hard to do in New York, because currently we have a Republican-controlled senate. So it’s not hard to do—it’s impossible to do. That may change in the fall. There’s maybe a two-thirds chance that it’ll flip.
It’s the more obvious route to go, but certainly the guys here in Seattle have a pretty good case that they’re making that this is feasible to authorize at the municipal level. That’s easier for us to do as well. We’ve got a really, really lefty progressive city council and a cautious but pretty lefty mayor and really progressive mayor’s staff who kind of get this stuff. We’ve already convinced them that this is a good idea, but there’s always somebody who can be like, ‘Well, all the drug control laws are state laws and part of NYPD’s duty is to enforce state law, so [they should] go and arrest everyone who’s using.’
The way we’re working a state law up is, the state health department gets to license a place to be a supervised injection facility. Inside that space, it is legal to possess and use drugs in the sense that you’re given a waiver from those laws. You get kind of a situation, ideally, where a bunch of places are doing it at roughly the same time and you have a kind of like a medical marijuana situation, where maybe the federal government isn’t approving of it, but they’re kind of confused and they don’t crush anybody. And it’s maybe a struggle for a while, but you get embedded in a way that you couldn’t otherwise.
But the flip side to the state thing is that I don’t want it to become where the narrative is, that we have to pass a state law in order to do this, because passing a state law is a heavier lift than getting municipal authorization. And so I don’t want it to be like, ‘Well, sorry, we can’t do it until Andrew Cuomo signs off on this, which I don’t think is likely.
ECB: Which city do you think is going to be first to open a safe consumption space?
MC: It’s not a race. In New York City, we created enough buzz that our city council just proposed doing an impact study to start sorting out what would this look like—where would we site it, what would we need to do to make it happen. So that got signed off by the speaker of our city council, who is, like, the second most powerful politician in the city. So that’s good.
But Seattle’s essentially already doing that with the heroin task force work on this. Ithaca is like a small neighborhood in Brooklyn in terms of population size. It’s so tiny. And they do have a serious problem that could be addressed by this. From talking to their mayor and DA and stuff, their position is, they’ve been very vocal about it, but they’ve also sort of punted to the state—like, ‘We want to do this and we think the state health commission should declare a public health emergency so that we can do this.’ It’s a nice notion, but I don’t think our state law allows for it. They’re rhetorically in a wonderful place and they’ve spoken about it just beautifully and brought something to the discussion, especially because it’s a small city and it’s easy to just sort smash them. They’ve been very brave about it and not shied away from the concept, so that’s amazing. There’s discussions happening in San Francisco, in Los Angeles, in Chicago, and I think they’re starting in New Mexico and some other places.
It’s sort of almost a question of who’s willing to be first. A lot of people are happy to say, ‘We’re really going to consider this as soon as there’s something to look at.’ People like me want to be first. I would like to see eight or 10 of them pop up over the course of eight weeks.
ECB: How many sites do you think New York City will need to make this work?
MC: Our general position is, we definitely don’t want a new, fancy standalone Insite-style thing. I mean, having an Insite in New York in some parts of city would be great, but we don’t have a Downtown Eastside. We don’t have a Belltown. We’ve got like 15 of those scattered around different parts of the city over a humongous geographic area, over a city of like nine million people. We already have 14 different agencies providing syringe exchange with 56 or 57 service locations. And so the first thing we want to do is just get authorization so that any of them who was to add this on as a natural extension of what they’re already doing, we can do that, because we’re already serving the exact right population. We’re serving injection drug users, and we have all the wraparound services that you would want. We’ve got all the sterile injection equipment. We’ve got linkages to all the primary care services and drug treatment and homeless housing. So that’s kind of the start, I think, because we need this in East Harlem, the South Bronx, Washington Heights and Inwood and Bed-Stuy and Coney Island and all over.
Having that opportunity to put stuff in places where there’s already services—it’s cheaper to do that by far, and it saves you some NIMBY headaches, because you’ve already dealt with the siting issues.
ECB: Do you think the reason safe injection, specifically, is getting some traction now is because the heroin epidemic is impacting white families, and the families of white lawmakers’ constituents?
MC: It’s not okay when it is a racialized thing, but it is certainly okay to be like, ‘Okay, I am going out for my constituency and my constituency is now having these issues.’ Certainly Indiana is overwhelmingly white, and it was a poor white county in the middle of the state that just had a crazy HIV outbreak and got this guy who for decades had been vociferously anti-syringe exchange to change his mind. And so, that’s fine for me. I mean, we should it have done it a long time ago, but whatever.
If you look at the stuff coming out of our Republican senate, it’s like, ‘Okay, we’re down with naloxone [a drug that can reverse overdoses], so everybody gets naloxone. Everybody gets as much damn rehab as they want. Then we’re going to damn sure make sure we punish those dealers that are preying on our kids, coming over from Brooklyn to Nassau County. We’re going to get a handle on that shit.’ Not recognizing that their own kids are the ones dealing to each other. It’s just shifting over the target of who needs to be punished for this, and now it’s the dealer or the person preying on everyone, the person tossing fentanyl into the water supply or whatever’s going on
ECB: Do you think there are any villains in this story, other than politicians?
MC: A lot of drug dealers are kind of like, fine, and they’re not evil people. The industry is really fucked up for super obvious reasons. I tend not to enjoy getting into parsing that out so much, because it’s like, if I lived in a neighborhood where the cops fucked with me every 5 minutes and there was, like, 50 percent unemployment among my friends and peers, and I care about my grandma, I’m probably going to do some extralegal things also. And yes, there are people that are violent and horrible. But with fentanyl [a synthetic opiate sometimes cut into heroin], for example—I haven’t done a survey of mid- and low-level drug dealers, but I find it really difficult to believe that they’re in any way involved in diluting the product. People figured out how to synthesize acetylated fentanyl in Mexico or whatever and they’re cutting it in because they don’t need to grow fields of poppies for opium. It’s happening way up the chain. I don’t think it’s people doing that at the distribution level.
ECB: Our LEAD [Law Enforcement Assisted Diversion] program here depends on arresting drug dealers, which is basically doing exactly what you say we shouldn’t do. What do you think of a framework like Seattle’s, which in a way declares that the dealers are the bad guys and the users are the victims?
MC: I don’t think that any of us think that LEAD is the end result that we want. Speaking for myself and for VOCAL New York, it’s not. It’s an interim step up that’s a major improvement from drug courts. It’s an in with law enforcement that we have not otherwise been able to figure out. I think for our members, we spent a year talking about LEAD inside VOCAL New York before our membership agreed that they were comfortable advocating for something like that in New York City. And the thing that convinced them was the opportunity for infiltrating law enforcement culture or helping change things from the inside to some extent. So I don’t know. Clearly, police all over America are already arresting drug dealers. The theory here is that there’s going to be some sort of distinction, at least, between subsistence dealing and people that are really profiting in a major way and that’s going to be the dividing line. I have no idea whether that plays out perfectly on a day-to-day basis, and it probably doesn’t.
ECB: Do you think there’s the political will to create safe consumption spaces for all drugs, not just injection drugs, in New York?
MC: I think the opioid injecting thing is the easiest hook for people, just because everyone is acutely aware of the overdose rate. As far as consumption spaces, honestly, in New York, we were just not on the ball, and I think we’re trying to figure out how to retrofit that into our discussion in New York now, because the Seattle folks did that in a more upfront way that was smart and that I wish we had done. We’ve got plenty of crack smoking, for sure, in New York. We’re New York, so we’ll always have heroin. We’re talking about it, but we haven’t pushed that idea yet. It’s something we need to work on more.
ECB: Given that crack and meth are generally smoked, and lawmakers may not
MC: Some of that stuff, I don’t think it’s a huge lift if you’ve already got somebody engaged. Unless you’ve done the world’s worst job of explaining a supervised injection facility, and you’ve explained it so narrowly that people are mono-focused on one little thing, I don’t think it’s that much more of a lift to walk people through why other kinds of consumption safe spaces are a good thing.
It makes it more sustainable and durable and more thought-out if you get beyond just opioids and overdoses anyway. And yes, there’s no pharmaceutical therapy for cocaine addiction, but you also have a lot less physical dependence that goes along with stimulants. Right now, we’re just not really doing much of anything for these folks. So engaging them in supportive services in a friendly environment so we can talk about what’s driving the chaotic or negative experiences that they may be having with their cocaine or crack use or meth use or whatever is probably a good thing.