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Brian Lehrer: Brian Lehrer on WNYC. Did you know that the pandemic era has actually seen an increase in overdose deaths by almost 30%, and yes, they are related. This is according to the national center for health statistics, more overdose deaths by almost 30% since the beginning of the pandemic. Now hoping to provide more outreach, two supervised injection sites opened in New York City last week, meant to reduce fatal overdoses.

This is over 2,000 fatal overdoses occurred in New York City during 2020 alone, 2,000, just in New York City. That's up from the last four years where totals hovered closer to 1,500. There were plenty before, but this is hundreds more lives lost last year in the pandemic. We'll talk about the relationship and these sites located in East Harlem and Washington Heights, which operated needle exchange programs before this, and now have staff trained to reverse overdoses.

They're providing spaces for people to consume drugs, still considered illegal, but there'll be monitored to avoid overdose deaths. Services also include opportunities for addiction treatment. Now, while these are the first supervised injection sites in the United States, the first to operate in North America was in Vancouver, British Columbia in Canada, Insight as it was called opened in 2003, in that city's downtown Eastside and operates on similar harm reduction policies.

A 2011 study found that overdose rates near the facility decreased 35% after it opened, compared to an almost 10% or only 10% decrease in the rest of the city. My next guests have experienced operating these supervised injection sites, one with many years under her belt. One just getting started on this type of harm reduction at the sites in New York. Sam Rivera is the executive director of OnPoint NYC, the nonprofit in charge of these new New York city sites.

Kailin See is OnPoint senior director of programs. Sarah Evans joins us as well. She's the former manager of Vancouver's Insight North America's first supervised injection space, as I said, and current director of the Open Society Foundations, International Harm Reduction Development Programs. Thanks to all of you for coming on. Welcome to WNYC.

Sam Rivera: Thank you very much

Kailin See: Thank you.

Sarah Evans: Hi, it's great to be here.

Brian Lehrer: Sam, you've been up and running for almost a week. How's it been so far?

Sam Rivera: It has been absolutely amazing. First I want to say hi to Sarah, who I haven't met, but it's cool to get on a call like this and receive multiple texts that Sarah's amazing. It's been a week, so thank you so much. It's been a week, it's been an amazing loving. It's just beautiful to have the opportunity to offer this option for folks and keep them alive.

Brian Lehrer: Kailin, you're involved in the New York sites too, give us some color, what drugs are meant to be used at these sites? What drugs are you most concerned about?

Kailin See: That's a great question. There's a lot of misinformation out there about what's allowed and what's not allowed. Our sites, the two sites in Harlem and Washington Heights are poly modality sites, they're not just injection sites. People can inject, smoke, sniff, swallow, or otherwise ingest their drugs because we're acknowledging that fentanyl is in all drugs, not just injectable drugs.

That's something that I think is really important when we understand the role that these sites will play in bringing those overdose fatality rates down. We're creating safety for drug users on a really broad spectrum here.

Brian Lehrer: Kailin, you're not just reversing overdoses, how are you monitoring the people at the sites, and what other services are offered?

Kailin See: So far these sites, just in their short week of operation, we've had 15 overdoses on site so far. That's 15 possible fatalities that were not fatalities. For us, that's huge, that's really powerful, that's a powerful testament to how effective these sites are at creating safety for not only drug users, but the larger community where our sites are located. When someone comes to our site--

Brian Lehrer: Can you tell us a story? Can you tell us obviously protecting people's privacies, not naming names, but can you tell us a story, how one of those went and why you thought the presence of your site, the presence of them on your site made a difference?

Sam Rivera: I think we should talk about the difference as well, Kailin, what makes them so different?

Kailin See: The one thing that we really want people to understand and Sarah will know this very well with all of her years of experience, is that an overdose is 100% reversible if someone is there to see it happen. That's why the fatality rate is so high, particularly in the US, if you're discovered to be a drug user, you're at risk of losing everything, you could lose your job, your house, your kids.

That stigma, that forcing people to conceal their use is why people use alone, and why there's so much overdose fatality. By acknowledging that people are using and that there is a risk of potential overdose and allowing them to use safely in front of us, our staff are intervening within the first five seconds of the onset of an overdose or another medical emergency.

They're resolved fairly quickly and fairly simply because of the timeliness of the response. Many of the overdose that we resolved so far on-site, out of the 15 I mentioned, we believe that many of those would have been fatal overdoses, very serious overdoses if the overdose had occurred in any other setting where there wasn't someone there to intervene really quickly.

One story that comes to mind is a gentleman who came in, he'd never used the site before, he was a long history of drug use, street entrenched individual houseless, he was very nervous to use the site, and he said, "I got to tell you I'm here because I'm afraid to overdose. I have a job interview this afternoon, I'm trying to get back on my feet and sure enough, he did overdose.

We were there and we were able to intervene, get him connected to other stabilization services like case management nursing, and he made his job interview. It's that chance at life, that chance at change, that chance to live a life with dignity and access to the care that people deserve, that these sites are really offering.

Brian Lehrer: Sarah, we'll bring you in a minute for the Vancouver experience since you have years of experience running a site like this, that the guests from New York City, where these sites just opened might be able to learn from, but Sam, a couple of questions of pushback that are coming up. One, does the permissive nature of the sites make it more likely that people will overdose and then have to be reversed.

Second, I know there's been criticism about the locations of the sites, some question why they're concentrated in poor communities, why not more in wealthy communities, people in all kinds of places use opioids, so there's stigma, and some in East Harlem, in particular, have expressed concern that the site there is in close proximity to a daycare center. What would you say about any of these things?

Sam Rivera: The first thing I'll say, the sites are located where the issues exist. We've been here. We didn't just come here now, I think that's some of the other misinformation where people were believing we are new. We aren't new, we are improved. We are improving an already existing program. We are improving an already existing need, addressing a major need into communities that need them.

I agree when some of these neighborhoods get saturated with additional services, I think part of it is to check or measure the existing services. Again, we're in the right place at the right time. As far as people using an outside, they're using, folks are using drugs. We are creating a safe space to keep them alive, and that's the reality. If you hear the numbers already in one week, these are the 15 people we would have lost, 15. I think Kailin is being very modest because-- and even the staff who become very surprised and feel like what they're experiencing isn't truly an overdose, because we're getting in so early.

By being there as early as we are, we also prevent other onsets, other illnesses. We're addressing fentanyl, and almost every drug out folks are using. The last thing I'll say about the communities, as I agree, I grew up on the lower east side in the '70s. You can't tell me how about a pandemic of drug use. I grew up walking the streets of Avenue B and Avenue C and walking over bodies that time. I totally agree with these communities. Unfortunately, it's an issue that exists in these communities, we're here to be a participant and support the folks who live here. The last thing I'll say is we had an amazing meeting with Community Board 11 in Harlem, and it was great for them to come and see the site, watch what we do see the people, and many of them have changed their view regarding what we're doing and how we're saving lives.

Brian Lehrer: Listeners, we can take a few phone calls, what are your questions on the new safe injection sites in the city. As our guests have described, it's not just for injections, it's for any kind of taking in illegal drugs to prevent overdose deaths when they've been so much on the rise in the pandemic era in New York City. For the two guests from that, or from the former manager of similar sites in Vancouver, who we will get to in a minute, anyone from East Harlem or Washington Heights wondering what to expect now that these sites are open in your neighborhoods, as the first two in the city to (212)-433 WNYC or anyone with experience using opioids or reversing opioid overdoses to share your stories if you would like to publicly (212)-433 WNYC 433-9692, or tweet at Brian Lehrer.

Sarah Evans, former manager of Vancouver's Insight, North America's first supervised injection space, and current director of the Open Society Foundation, International Harm Reduction Development Program. Sarah, as you have past experience running sites like this, do you have any advice on the specific challenges of running a safe injection site now that this is a new thing for New York?

Sarah Evans: Thank you, Brian. It's so great to be here. I really love your show and also really love talking about this topic. I don't know that I have any advice for Sam and Kailin and these folks. They really know what they're doing. What I think that is important for people to understand, and Brian, for your listeners to understand is that these sites are not really anything new. They've been around, in fact, globally for 35 years.

Today, there are about 100 of them in operation in many countries around the world. I best know that the site in Canada, but I've been involved in some other sites as well around the world and these are the first two public legally sanctioned ones in the USA. There are many other cities in the USA who are poised to do the same thing. Fortunately, because of the wealth of experience that we have, from the other countries around the world, we know what these sites do. We already understand their benefits in terms of improved public health and safety.

To your questions about whether they permit drug use and or too permissive or what does it mean about how they're located we know that these sites work to save lives, to prevent disease, to help people into other forms of care, including addictions treatment. They do this while improving public order and safety around the site and not having any negative impact on crime.

Brian Lehrer: Sarah as you're accompanied, ironically, by the sound of an ambulance going by it sounds like let me just ask you to speak as close to your microphone as you can, so the listeners can hear you as well as possible, siren or no. Sarah, put this into larger context of the pandemic, for our listeners, and especially with your international perspective, at the Open Society Foundation. Why are overdose deaths going up during the COVID pandemic?

Sarah Evans: Well, indeed, they are going up. I'm not sure if this was mentioned in your preamble but New York City, for example, had 2,000 fatal overdoses last year, and almost 600 just in the first quarter of 2021. That's a lot of preventable overdose deaths that are affecting our community. It's across socio-economic boundaries. It affects every race and ethnicity, although the highest rate of overdose in New York is amongst African Americans. This is basically unacceptable and we need to take action.

Overdose rates have been increasing over the years and many people have been tracking this for the past 10 years. They've been going up. There are many reasons for that. They have also skyrocketed under COVID and there are reasons for that as well. COVID provided interruptions in care, more social isolation for people using so where people are at risk of fatally overdosing if they use alone and in a context of social distancing, people are more likely to use alone.

People may be also more likely to use in general, because of the pressures they're feeling coping with social isolation and the dynamic. I think there's really a link between COVID and overdose death rates and the same communities are affected. We know that communities of color, and especially African American communities are particularly at risk of contracting COVID and dying from it. The same goes for overdose, which is why Samsa a year ago, called this a dual-threat for communities of color in America.

Brian Lehrer: With Sarah Evans, from the Open Society Foundation, International Harm Reduction Development Program, and Kailin See and Sam Rivera, the leaders of OnPoint, NYC, the nonprofit in charge of the two new New York City safe injection or safe opioid, or other drug use sites in New York City, one in East Harlem, one in Washington Heights, the first two of their kind in the nation. Dan in Huntington, you're on WNYC. Hi, Dan. Thanks for calling in.

Dan: Thank you so much, longtime listener, first-time caller. Thank you so much. I just wanted to say, as a resident of Washington Heights for many years, and I use some of the services probably 10 years ago for safe needle exchange. Only because of that program, did I ever even know about the healing properties or the community properties of getting clean and staying clean. Because of programs like the ones you're talking about, I was able to get clean, stay clean for like eight-plus years now, able to reintegrate into society hold like a solid job.

I just want to say thank you. I know it's a thankless job a lot of the time and it's tough. It really is tough and you get a lot of negative comments coming from the community. I hear people saying things basically like not in my backyard. You're right, you say you are where the need is most.

Brian Lehrer: Dan, thank you so much for that. Thank you. There's the progression from Dan, who felt like it saved his life just to have the needle exchange program to walk away with a needle. Now you've got the on-site premises, where people can use their drugs controversial, is that is. Craig in Queens, you're on WNYC. Hi, Craig.

Craig: Hey, Brian. Good morning to you and your guests. I wanted to talk about Nicole Malliotakis and her objection to the sites, even though she doesn't represent those who come to communities. It's ironic because before the pandemic, The Daily News, I believe run a story on opioids, and how one graduating high school class in Staten Island lost so many kids or young persons to overdose.

Brian Lehrer: I guess I should remind people who don't know the name that Nicole Malliotakis is the congresswoman from Staten Island and a little bit of Brooklyn across the Verizon Bridge. Go ahead, Craig.

Craig: In this tough crime, when the guest said, it affects all color streams. I understand that not in my backyard. When you drive through the city, and you see the morphine sites or I don't know exactly correct sites, but sites, and you see the conjugation of the people, and then the community with the homeless shelter, and I understand is being put on but these are people, family members. These are people's mothers and fathers.

This is where to save lives. Like that guy with a testimony, he's not even from the city, but he was in the city living in Washington now. People got to open their minds and see, I'm not with drugs, selling and just use but if this could bring one-two people out in the dark, and maybe, give somebody back their mother or father, sister or brother, I think is, work that we need to do.

I just wanted the guest to comment on this tough one crime these people might-- I'm not going to say, Congresswoman but Ms. Malliotakis who used this. We got so much stuff going on in the city, and she used her platform to bully something that's helping people.

Brian Lehrer: Craig, thank you very much. I know you said morphine sites before. I'm sure you meant methadone sites for previous heroin users, but just to make that clear, but it makes the point. Kailin, you want to respond to that at all?

Kailin See: Yes, I'd love to and I also just want to say that I recognize the voice of the caller who used to use the services in Washington Heights and I am so thrilled for you. I'm going to let the team know that you're doing really well. I recognize your voice and thank you, Craig, for your comments as well. Sam and I would like to invite Nicole Malliotakis to come and see the site. They really speak for themselves. They're well-designed thoughtful programs that meet a need in the communities where they exist.

They're not just for people who use drugs they're also for the communities where they're located. The community asked for less public injection. They asked for less improperly discarded syringes on the streets and in playgrounds, they asked for less overdose death. They asked for less crime in their neighborhoods as Sarah mentioned. They asked for less of a burden on emergency services and enforcement services. These sites tick all of those boxes.

I know that Sarah will agree with this and this has been my experience and Sam's experience in our short week, running these sites here. We've had some tough conversations with the community and we've opened our sites to people who would normally be considered detractors. We've said, come, come and see it, come and understand it, come and learn about it. We find that's a really powerful mechanism for bringing people on-site and changing their perception of these services. If you're listening, Nicole Malliotakis, this is an open invitation from Sam and I to please come down and learn about these sites anytime.

Brian Lehrer: Sam, we're getting a question-- oh, go ahead. You can say whatever you want, but I also want to ask, in a certain respect, unless you live in her district, it doesn't matter what Nicole Malliotakis thinks she's a member of Congress. This is a city policy. It's up to the mayor and city council, but I do want to know how much support you have from the NYPD from at the moment commissioner Shea, I know he's outgoing, and why is that a funny question?

Sam Rivera: This is a great question. I'll start with that. I want to also circle back to what, let me start from what Kailin said. It's very clear that one of the services we offer is this program. We offer medical services, we offered holistic health services, acupuncture, acupressure other elements of body treatment, and sound therapy. We offer case management. We're truly a part of the community just last week and this week we're offering COVID vaccines, like, so it's important that folks understand that we are much more than what's the focused on right now. We are much more than that.

As far as the police, the reason why we all Kailin and I had a laugh, it's a really good laugh, and it's great because it was a concern. I have to tell you, we are partnering, listen to that carefully, partnering with the NYPD. They are supporting us. They are here at our sites, not for our participants. They are here to support us and make sure that there are no disrupt to what we're offering. Wonderful and beautiful people. We have a hard time keeping them out because they want to keep coming in and seeing the site and spending time. We've met with chiefs. We've met with many, many of what we call white shirts, throughout the police department and both the three, four, and the two five.

It's just something that makes us have an internal in this case, external giggle, because it was a concern and to have partners, to have police officers say to me, wow, I can refer, refer someone I see using drugs. They already have, they are asking us for paperwork so they can share with the folks they're meeting in the parks and in the streets, et cetera. That's exciting and that's why we had that reaction.

Brian Lehrer: We're going to run out of time soon. Let me get a few more callers in here. Ellen in Manhattan, I think has a really great point to make. Ellen, you're on WNYC. Hi.

Ellen: Hi, thanks for taking my call. I am an ER nurse in the city and I just wanted to make the point, if you've been to an emergency department in New York you know that in many cases they're overrun and the staff is exhausted. I think anything we can do to decrease the burden on emergency services is really important.

I've personally tried to resuscitate patients who even though emergency services got to them, and gave them Narcan it was too late. We've lost those patients. If you love someone and know someone who's struggling with addiction, that people do recover, but you can't recover if you're dead. The fact that the service exists and it allows people to connect them to resources, which you guys do a way better job of than we do in the emergency department, by the way, despite the fact that we try, it's hard to argue against it. It really is.

Brian Lehrer: Ellen, thank you so much.

Sam Rivera: Can I respond very quickly?

Brian Lehrer: Let get another call. Go ahead, Sarah. You haven't spoken a while. So go ahead. Real quick though.

Sarah Evans: Well, I was just going to say thank you for that comment. What I know from my experience working at the safe injection site in Vancouver is that there have been hundreds of thousands of overdoses since that site opened in 2003, and zero overdose deaths. In fact, zero overdose deaths in any site anywhere in the world, and there are hundreds of sites. I think that is really one of the most important things for people to take away.

We are saving people's lives, but as the ER nurse just mentioned, once you've done that everything remains possible. Even though the sites are a place for people to use drugs, they're also a place for people to get into detox, access methadone, start addictions treatment. At the site that I used to run in Vancouver, users of that site are twice as likely to access addictions treatment as non-users of that site.

In the years after we opened, there was a 30% uptake into addictions treatment services. We're not forcing people into treatment or requiring abstinence as a precursor to care, but we are providing an OnRamp for people. First of all, by saving people's lives and secondly, by facilitating their access.

Brian Lehrer: One more call, Chris in Heights town you're on WNYC. Hi, Chris.

Chris: Hello. Can you hear me?

Brian Lehrer: I can hear you. Everybody can hear you.

Chris: Oh, I'm on speaker. My question is, isn't there a means to test for fentanyl levels in whatever drugs before they're actually used at a center, such as the centers you're talking about?

Brian Lehrer: That's a great question and it's going to be our last one. Kailin, do you want to take that, if fentanyl-laced opioids are a reason for so many overdoses. Can you test the drugs since you're supervising a site where people come to take them for fentanyl before they even use them?

Kailin See: Yes, that's a great question. Thank you. First off we're operating from the understanding that all opiates in New York city are positive for fentanyl. We do have fentanyl testing strips available for free at our sites, but we have not tested a batch of opiates in New York City that came back negative for fentanyl since 2017. Just let that sink in for a second. Our fentanyl testing program becomes very important for opiate naïve drug users.

That's people using cocaine, crack, benzodiazepines or street-based acquired pills that may be contaminated for fentanyl. We also offer benzodiazepine testing strips, methamphetamine testing strips, amphetamine testing strips, cocaine testing strips, and morphine testing strips at our sites. We really strongly encourage pretesting, and we have these sites available for anyone using our overdose prevention centers, but also people who may be the participants of our syringe exchange programs.

We're also working with the department of health who has recently acquired three mass spectrometers, and we are ourselves acquiring a mass spectrometer very soon to have available for people for more immediate testing when they present at our overdose prevention programs. We're working towards it as quickly as we can. I do want to tell Ellen our very tired ER nurse, that of the 15 overdoses we've intervened in we did not call 911, all were resolved in-house.

We agree with you. We're trying very hard to relieve the burden on the emergency services and to let you guys get some rest after what's been a very, very challenging couple of years.

Brian Lehrer: Yes, and we talked on Friday about the nurses' shortage currently. So that's good news in that context too. We've been speaking with the executive director of on-point NYC, Sam Rivera and their senior director of programs, Kailin See, plus Sarah Evans, former manager of Vancouver's Insight North America's first supervised injection space and current director of the Open Society Foundation's International Harm Reduction Development Program.

These two spaces in New York City are the first in the nation. Sam, do you want to give the addresses? Is that something you want to do on the air, the East Harlem one or the Washington Heights one?

Sam Rivera: Sure. East Harlem is 106 East 126 Street and the Washington Heights address is 500 West 180 Street of the corner of Amsterdam Avenue.

Brian Lehrer: Thank you all for coming on with us. Good luck with the sites.

Kailin See: Thanks a lot.

Sam Rivera: Thank you.

Sarah Evans: Thank you, Brian Lehrer. Have a great day.

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