As Local Opioid Fatalities Climb, Harm Reduction Advocates Push for Overdose Prevention Center

Colleen Grablick
April 11, 2023

For another year in a row, D.C. broke a deadly record, documenting more fatal overdoses than ever before.

“This is murder, this is absolutely murder,” said Shekita McBroom at a rally on Monday outside the Wilson Building to demand the declaration of a public health emergency over the crisis.

“My child should not be a poster child for fentanyl,” said McBroom, who found her 17-year-old daughter Jayla dead from an overdose when she went to wake her up for school almost two years ago. “She had other things she would like to have done, and she’s not here to do that. And anything we must do, I don’t care how many times I have to come out here to speak, I want people to understand that this is horrific for anybody to have to go through.”

In 2022, the city saw 448 documented overdose fatalities – up from 427 in 2021, and 411 in 2020, according to the city’s medical examiner. Black residents accounted for nearly 90% of all documented overdoses last year. D.C. is even topping national records, recently surpassing West Virginia to lead the country in fatal drug overdoses per 100,000 residents, according to the Centers for Disease Control and Prevention.

And while government officials tout their efforts to curb the crisis – including opening six vending machines stocked with supplies like the overdose reversal drug Naloxone and a sobering center this month – some say the city’s interventions are falling short by ignoring a crucial life-saving strategy: keeping people safe while they use.

Harm reduction advocates say the only way to address the crisis at scale is for the city to open a safe use center where people can use drugs with medical staff nearby and without fear of criminalization. It’s a model that’s already seen success  in New York and one that local advocates have pushed for years. But a program that essentially allows people to use drugs (even though proven to save lives) has been a difficult sell to government officials. During a recent Department of Health public oversight hearing, advocates spelled out the urgency of addressing this issue with a place where people can safely use drugs, and their frustration at the city’s reluctance to implement such a program.

“We’ve been in a sustained public health emergency for years, the only reason the city refuses to treat it as such is because 85% of those dying are Black,” testified Shane Sullivan, the outreach coordinator for D.C. harm reduction organization HIPS and an advocate of safe use centers. “I’ve lost track of how many friends, loved ones I’ve lost to this – and not just to overdose, but to the collateral consequences of locking people up, treating them like shit because they use drugs — and the city’s housing crisis has absolutely contributed to all of that loss as well.”

The city’s response to the surge in overdoses is managed by several agencies – including DC Health, the Department of Behavioral Health Services, and the fire department – and in partnership with community-based organizations like HIPS and Family and Medical Services. Through these partnerships, the city has run a needle exchange program and expanded the distribution and availability of Narcan, or naloxone. (According to DBH, last year the agency distributed 1,400 fentanyl test strips, and reversed 2,600 overdoses thanks to Narcan.) Last year, the D.C. Council passed an act establishing a commission that will decide how to use the millions of dollars the city received in settlements with pharmaceutical giants like the Sackler family and Purdue Pharma to support victims of the opioid crisis.

Advocates say that a major problem with the government’s response is that it mainly treats the aftermath of drug use, often relying on Narcan to save people post-overdose. These differing strategies were on display earlier this month when DC Health opened three of six vending machines stocked with Narcan, a pilot program to test their uptake. HIPS plans to open an additional three machines but theirs will also contain syringes to reduce disease transmission when people are using.

Later this summer, the Department of Behavioral Health plans to open another major component of the city’s opioid crisis response, and one that advocates are also frustrated by. D.C.’s first sobering center will be a 24-hour facility near Union Station where residents can get a bed and other wrap-around services like a mental health counselor and a peer support specialist. The center will also have medically-assisted treatment with buprenorphine, a drug used to treat opioid dependence. According to DC Health, the center will use the peer support specialists to keep in contact with people after they leave, if they’re not ready to stop using.

“One death is a death too many and harm reduction processes like the use of Narcan and fentanyl test strips is really essential,” Director of the Department of Behavioral Health Dr. Barbara Bazron said at a press event opening the vending machines. “We’ve got to keep people alive so that we can get them into recovery. And these harm reduction methods work and they will make a difference and it will allow us to reduce the deaths.”

But those who work in harm reduction spaces – including HIPS staff, who receive funding from the city and work closely with DBH, and other community advocates like those with the Health Alliance Network, also have concerns about this strategy, saying that as the crisis continues to escalate these methods aren’t sufficient.

Sullivan testified to Health Committee Chair Councilmember Christina Henderson in late March that no local organizations applied to partner with the city on the new sobering center because they don’t believe it’s an effective strategy by itself. The forthcoming sobering center will be run by an Arizona-based group, Community Bridges, Inc., which Sullivan says has no ties to the D.C. community. (Members of Community Bridges met with Sullivan and other harm reduction workers recently to discuss how they can best serve the community. Community Bridges did not return WAMU’s request for comment.)

“Absolutely [a sobering center] would probably create a place where people can go when they don’t have a safe place to go, if they aren’t living in a stable situation, if they need some support. However, the connotation of a sobering center is that it’s a place where someone is going to go to experience withdrawal,” says Dr. Sheila Vakharia, the Deputy Director of Research and Academic Engagement at the Drug Policy Alliance. “But the problem is, people need support where they’re actually using drugs, right?”

During a recent DBH budget oversight hearing, Ward 5 Councilmember Zachary Parker asked Director Barbara Bazron about advocates’ concerns that the sobering center won’t be managed by a local organization and that it won’t be located in any of the wardswith the highest reported fatal overdose rates.

Bazron denied that there were zero local providers who submitted a bid, saying it was a “competitive” process. She added that the location for that center, as well as a forthcoming Columbia Heights location proposed in Bowser’s budget, were determined by looking at overdose hotspots with D.C. Fire and EMS data.

“As the Ward 5 representative, I, too, had a raised eyebrow – not to say that there isn’t a need across the city, but we know that the highest deaths and usually the worst marks across any metric are usually in wards 5,7,8, so it was curious that these two centers are not being proposed in those areas,” Parker said during the hearing.

Safe-consumption sites have been slow to take off in much of the U.S., though they’re a significant part of drug policy in Europe, Canada, and Australia. Critics of the model often argue that it encourages or enables drug use and contributes to an increase in crime, although research has not found a link between safe-use sites and crime increases.

New York City opened its first overdose prevention centers in 2021 — one in Harlem, and one in Washington Heights. Run and funded by the nonprofit OnPoint NYC, they provide things like meals, showers, beds, harm reduction supplies like syringes, and a place where people can safely use drugs. People can bring their own drugs, use clean snorting, smoking, or injecting supplies, and administer the drugs with staff on standby in case of an emergency. The centers are funded completely independent of city dollars. In the first two months of operation, OnPoint served 613 people over 5,975 visits, and managed 125 overdoses. Over a year in, they’ve seen zero deaths. New York City Mayor Eric Adams laid out a plan earlier this year to expand the effort, opening five new overdose prevention centers by 2025.

But federal statutes make expansion difficult. A provision of the national Controlled Substances Act colloquially known as the “crack house statute” prevents individuals or organizations from maintaining or opening a place for the purpose of using a controlled substance. In New York, state officials vowed to not enforce the law on safe consumption sites. In Rhode Island, a similar program for a safe-use site has been approved for a two-year pilot. But in Philadelphia, an overdose prevention center called Safehouse has been in a years-long legal battle with the Justice Department. In California, Governor Gavin Newsom vetoed a bill for safe consumption sites last year.

“The Biden administration has not come out in support or opposition of OPCs [overdose prevention centers] so it’s kind of in a gray area from that perspective,” said Chelsea Boyd, a resident research fellow on harm reduction at R Street Institute, a D.C.-based think tank. “And really, what needs to happen is there needs to be some clarification from the federal government in order for OPCs to open and for states and localities, I believe, to be comfortable with opening OPCs.”

During last week’s oversight hearing, Parker asked Bazron about her stance on a harm reduction center, raising the concern that sobering centers emphasize abstinence, which will not keep people safe while theyre using drugs. Bazron said the data shows that sobering centers are effective at linking people to care, but admitted that “we have to do additional research to find out the pros and cons of [safe-use sites], and I don’t have enough information at this point to really have an opinion.” (In a statement to DCist/WAMU Parker said he’s open to such centers in D.C., and that criminalization of drug use has been an “ineffective approach.”)

An overdose prevention center with a space to safely use is favored by people living in D.C. who use drugs, according to a survey HIPS conducted of roughly 100 participants. The idea also has buy-in from Ward 4 Councilmember Janeese Lewis George, who visited OnPoint’s Harlem location last year. In her 2024  budget proposal to Mayor Bowser, she asked for $15 million to open two 24/7 harm reduction centers with safe consumption components, saying the city could save “hundreds of lives.” (A 2019 report from Live.Long.DC, the city’s comprehensive plan to reduce opioid deaths, included a budget item of $100,000 to “consider” safe injection sites, but it’s unclear what that money went toward.)

Opioid use remains criminalized in D.C., making both official and community buy-in difficult. Data released in 2022 showed that between 2017 and 2022, the most opioid-related arrests occurred in neighborhoods already recording high rates of overdose, suggesting that policing the problem isn’t saving lives. And while overdose arrests declined during that period, Black residents still make up an overwhelming majority of people arrested on opioid and drug-related charges in the city, as well as those dying from overdoses.

Research shows that criminalizing drug use perpetuates cultural stigma about users by placing blame on an individual rather than structural racism and poverty. It also makes voters less likely to favor harm reduction policies. And while the opioid epidemic’s impact on predominantly white communities has spurred on a more compassionate, public-health focused approach that treats addiction like a health issue rather than a personal failing, racism, classism, and criminalization continue to stigmatize solutions that involve helping people use drugs safely.

“We’re living at this very complicated time, where drug possession is still a crime but we are trying to say that drug addiction is a health issue, and that people who have substance use disorders have health issues that should receive treatment,” Vakharia with the Drug Policy Alliance said. “We have these two competing narratives: people should be able to get help, but also they’re criminals for possessing these drugs.”

At the rally this week, the Health Alliance Network called for the city to join Virginia and Maryland in declaring a public health emergency to free up financial resources. Among a long list of demands, the grassroots advocacy network called on the executive to designate sites for harm reduction centers East of the River, and for the council to step in and create an emergency fund to support the creation of more 24-hour and residential treatment centers, both for adults and youth.

“D.C. does not have an adequate infrastructure or ecosystem or workforce to seriously address substance and opioid use disorder, and we are losing the battle,” said Ambrose Lane Jr., the chair of the Health Alliance Network. “It’s not about the mayor. It’s not about the city council. It is about the District of Columbia. It is about our communities that are suffering because we have not put all of the resources that we can put in to address the opioid crisis.”

Amanda Michelle Gomez contributed reporting.