“This Site Saves Lives,” reads the sign at the entrance of OnPointNYC in East Harlem. It’s a typical Monday morning, and the atmosphere is welcoming: people drift in and out, greeting one another by name, pausing to chat in the doorway. By the door, before the curtains open into the main room, a wall display is stocked with free syringes, condoms, and other supplies.
OnPointNYC is one of three overdose prevention centers (OPCs) in the U.S. where people who use drugs can come in for clean supplies, a safe space to use, and judgment-free support. Since opening in 2021, the center has intervened in 1,008 overdoses, and during their first year, they collected and disposed of 435,078 units of used needles and other hazardous waste.
Places like these have operated quietly for years, and they are a crucial part of New York City’s public health strategy. To keep their doors open, they rely on the support of elected officials for stable funding and political cover. Mayor Zohran Mamdani’s recent decision not to expand these centers has left harm reduction advocates underwhelmed, though many remain cautiously hopeful about future progress, even among legal uncertainty.
A central component of Mayor Zohran Mamdani’s agenda is the creation of the Department of Community Safety (DCS), which promises to handle crises through civilian-led teams and expand community-based programs to “prevent violence before it happens.” Mamdani has pledged to address root causes of addiction such as poverty, mental illness, and housing instability, and has met with organizations promoting less punishment and greater access to life-saving harm reduction services.
Given his commitment to treat public safety as a public health issue rather than a policing one, harm reduction workers expected Mamdani to champion OPC expansion. But in the final mayoral debate, he surprised supporters by aligning himself with former New York Gov. Andrew Cuomo’s position to maintain the two existing sites without adding more. (As of press time, Mamdani’s team has not returned a request for comment.)
“Would I have liked for him to say that he’s going to expand them? Yes. But he did not retreat from support of OPCs. And that’s important,” says Gabriel Sayegh, the Co-Founder and Executive Director of the Katal Center for Health, Equity, and Justice.
Sayegh emphasizes that the landscape under Mayor Adams had been a “terrible situation,” describing the administration as having a “jails-first orientation” that ballooned the incarcerated population and dismantled much of the city’s diversion infrastructure. Against that backdrop, Sayegh views Mamdani’s position on OPCs as a low bar, but still meaningful. “He didn’t walk it back from where we currently are,” says Sayegh. But there is still a lot of work needed to integrate OPCs into a comprehensive public health approach and expand services beyond the two sites in upper Manhattan.
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From September 2024 to September 2025, there were 3,870 overdose deaths in New York State, with 77 percent involving opioids such as heroin and fentanyl, according to the New York State Overdose Death Dashboard. That’s a quarter less than the previous 12-month span—a drop coinciding with broader access to naloxone (Narcan), medication-assisted treatment, and other harm reduction initiatives. A 2025 New York Epi Data Brief shows that overdose deaths remain highest for residents of high-poverty neighborhoods in the Bronx and among the older Black population.
There are no federal laws in the United States that explicitly authorize supervised consumption sites. Instead, they exist within a complex legal gray area and rely on a series of local, state, and sometimes private strategies to bypass federal prohibition. The primary legal obstacle is the “Crack House Statue” (21 U.S.C. § 856), which makes it a federal felony to knowingly manage, control, or make available any place for the purpose of manufacturing, distributing, or using controlled substances. Despite this, the first authorized U.S. sites in NYC have operated since 2021 in part because the Department of Justice under Biden showed a willingness to discuss “appropriate regulatory guardrails” rather than pursue immediate enforcement.
Perhaps that’s because OPCs work. A 2024 report from the International Drug Policy Consortium shows that, during the first year of operation, the two OPCs operated by OnPointNYC saw 2,841 individuals visit 48,533 times while staff intervened in 636 overdoses. During this period, emergency medical services (EMS) were called only 23 times, and no overdose deaths occurred in the centers. Results also show that the OPCs diverted up to 39,000 instances of public drug use and played a critical role in connecting participants to care, with 75% of participants accessing other harm-reduction, social, and medical services through OnPointNYC.
The success of the country’s three publicly recognized OPCs is cited by harm-reduction advocates as “proof of concept” for expanding safe-consumption interventions throughout the country. It’s what makes Mamdani’s backpedaling particularly frustrating for those involved with OPCs. Tracie Gardner, executive director of the National Black Harm Reduction Network and a member of the state Opioid Settlement Fund Advisory Board, is among those who view Mamdani’s opposition to OPC expansion as “disappointing,” even as she remains hopeful that the mayor’s Department of Community Safety can address the same needs. She suspects NIMBY politics are to blame for Mamdani’s reluctance, with the mayor seeking to avoid conflict with residents and community groups who oppose OPCs opening near where they live.
Evidence suggests OPCs reduce syringe litter and public drug use by bringing people indoors, but unsupported concerns about safety, public disorder, and increased drug use surrounding OPCs persist, shaping the public narrative and influencing political decisions.
Despite proven success, efforts to open supervised consumption sites are consistently met with legal and political resistance. Harm reduction nonprofit Philadelphia Safehouse has been trying to open an OPC for years, but litigation has repeatedly thwarted their efforts. Federal courts ruled that supervised consumption sites violate the Controlled Substances Act, and the Philadelphia city council later passed zoning laws effectively banning them. This experience serves as a cautionary tale, demonstrating that even well-organized, well-funded proposals can be obstructed. The remaining safe-consumption experiments must either rely on the discretion of local governments and councils or hope for legislative change.
“We have already drastically reduced rates of HIV, Hep C, and overdose in the past couple of decades,” says Graciela Razo, Director of the Drop-In & Syringe Service Program at VOCAL-NY, a grassroots organization focused on harm reduction and community health. Without harm reduction sites, people are pushed back into using public bathrooms, streets, or unsafe housing situations, increasing the risk of overdose and disease contraction and funneling people into the carceral system, which disproportionately affects poor people of color. Harm reduction extends beyond safe drug use by also addressing “overall health, mental health, housing, education, employment, community connection, and artistic expression,” says Razo. These sites provide participants with much-needed connection, “because stigma can be so isolating for folks.”
Back at the East Harlem site, the morning proceeds as usual. But the terrain beneath their feet is increasingly unstable. In July of 2025, President Trump issued an executive order stating that safe consumption efforts only “facilitate illegal drug use and its attendant harm.” This reflects a broader stance in even the most liberal cities, such as San Francisco and Philadelphia, which are turning to a “recovery first” approach. Even as governmental priorities shift, groups like VOCAL-NY remain determined to keep their doors open, continuing the decades-long fight to support the New Yorkers who need it the most.