Drop on Albany Avenue where overdoses were common. People go to this drop-in center for syringe exchange, to get naloxone, or to find help with services if they are ready for that. The Drop is a safe place for people who often fall through the gaps. Mark installed a bathroom with a door that swings out instead of in so that it can be accessed from the outside. People can do whatever they want in the bathroom, but a Drop staff member sits at the desk across from the door and sets a timer. After three minutes, the person knocks on the door and asks if everything is okay. If someone overdoses in the bathroom, the staff revives them with naloxone. I have responded there for overdoses, and each time the person was alert and breathing by my arrival. No one has died in Mark鈥檚 bathroom; unlike the people we have found dead in the locked bathrooms of the fast-food restaurants on the avenue or in the Porta Potties in the nearby park.
In 2022, I spoke with Sam Rivera, the man who runs New York City鈥檚 two supervised injection sites. In just a few months of operation, the New York facilities served over a thousand people. Rivera described the camaraderie that has developed among the people who use drugs there. Instead of doing an extra bag, people talk with each other about the NBA finals. Women who avoided mirrors when they started coming there are now wearing makeup. The place is a community where people feel safe, respected for who they are, and yes, loved. People are called by their given names, not by generic slurs like 鈥渏unkie.鈥� They feel human. These supervised injection sites are not just a place where people can use drugs safely, but as the harm reduction activist Guy Felicella has said, they鈥檙e 鈥渁lso a place to stop using drugs.鈥� People are there to help get people who use drugs into detox and recovery when they are ready.
A study published in The Lancet in 2016 compared the overdose rate of a Vancouver neighborhood in the two years before the opening of the safe-injection site, Insite, with the rate in the two years after Insite opened and found that it had decreased by 35 percent. Other studies showed that the supervised injection site had led to a greater chance of users getting off drugs and to increased use of treatment services.
At the hospital I bring in an overdose patient whom we have resuscitated with naloxone. A security guard finds a package of syringes in the man鈥檚 backpack and throws them into the trash.
鈥淲hat are you doing?鈥� I say. 鈥淭hose are his.鈥�
鈥淚t鈥檚 against our policy,鈥� he replies.
鈥淵ou can鈥檛 throw his stuff away.鈥�
鈥淭he hell I can鈥檛.鈥�
鈥淗old on a minute,鈥� I tell him. I find an ED doctor. 鈥淲hen this guy gets out of the hospital and he鈥檚 going to need to use again, and he鈥檚 not going to have his clean syringes, he鈥檚 going to pick one off the ground or share one with someone and he鈥檚 going to get AIDS, hep C, or endocarditis. They give out clean syringes to prevent this from happening.鈥� The doctor then intervenes with the security guard, and the syringes along with the backpack are safely stored. I tell Mark about this encounter, and he later meets with hospital representatives and starts providing them with safe-use kits that they can give to people who are being discharged.
Harm reduction is concerned first and foremost with saving lives. Moral judgments are cast aside. The message is that people matter. Harm reduction enables people to use safely until they are ready to quit. Instead of promoting drug use, harm reduction ultimately results in less drug use and more people getting into treatment. It means less death. And less death is what we are about in EMS.
