OnPoint Halves Overdose Deaths in East Harlem and Washington Heights as Mamdani Stalls Expansion

As New York City’s overdose crisis persists, a nonprofit’s discreet yet potent life-saving interventions highlight a hard policy question: should City Hall scale up a model that works—or hedge under political pressure?

In East Harlem’s faded tenements and under the shadow of the Washington Heights viaduct, a quiet revolution is underway. Since late 2021, OnPoint NYC, a nonprofit that operates the city’s first pair of sanctioned overdose prevention centers, has intervened nearly 2,000 times to halt drug poisonings that would likely have proved fatal. In a metropolis where accidental drug deaths now claim more than 3,000 lives annually—outpacing both homicide and motor vehicle fatalities—such numbers are anything but trifling.

OnPoint’s sites offer an unorthodox tableau: clients, often homeless or precariously housed, inject fentanyl or other illicit substances under the watchful eye of trained staff, just steps from a laundry, showers, and access to health care and counselling. Overdose is not left to fate; rarely does the clangor of ambulance sirens disturb these sites. City officials claim that more than nine out of ten overdoses at OnPoint are managed entirely in-house, forestalling costly emergency-room visits and saving New York an estimated $55 million in the last four years.

Yet this model, lauded by advocates and now cautiously praised by the Health Department’s acting commissioner, remains singular in the city. It exists, so far, as a boutique program—safe, modest, and politically ambiguous. Mayor Eric Adams, in 2023, announced intentions to quintuple these centers by 2025. That ambition has since evaporated in the ether of municipal promises: his designated successor, Mayor-elect Zohran Mamdani, has notably hedged, saying he would maintain the status quo and declining to answer repeated requests for clarification.

Meanwhile, local NGOs hoping to copy OnPoint’s blueprint have found themselves stymied by outer-borough politicos and pushback from neighborhood groups wary of “attracting crime” or “condoning addiction.” In the South Bronx—where overdoses cut down more residents per capita than anywhere else in the city—an effort to launch a similar site fizzled, undone by local resistance and, tellingly, an absence of dedicated funding.

OnPoint’s hands are tied not by lack of evidence, but by political skittishness. Its own direct supervision of illegal drug use remains pointedly unfunded by City Hall. Instead, the city doles out opioid lawsuit settlements for wraparound services: case management, therapy, showers. The nonprofit’s staff go about their work with patchwork financing and a refreshingly bureaucratic tolerance from local police. The limits of this arrangement are obvious: the model saves lives, but its growth is bottlenecked by political calculus.

This leaves New Yorkers in a peculiar position. The city leads, in raw numbers, the nation’s overdose toll; yet it also hosts America’s only functioning, officially permitted sites where users can inject drugs under medical supervision—paradoxically, an experiment neither fully embraced nor suppressed. Many find this ambiguity frustrating. Dr. Michelle Morse, the city’s health chief, announced enthusiastically that the city “values the partnership tremendously.” One suspects that a more robust alliance would be worth even more.

The broader impact for New Yorkers is at once fiscal and moral—if one is permitted to use that word within City Hall. Opioid-use disorder has drained the public purse, crowded hospitals, and ripped holes in working-class communities. Each prevented overdose not only spares a life but also saves the city, according to budget hawks, over $25,000 in emergency response and hospital costs. Yet NIMBY opposition, fears of spill-over disorder, and the perennial suspicion that such programs “enable” drug use have rendered expansion a fraught undertaking.

Nationally, New York’s experiment is watched (or ignored) with a studied caution. European cities, such as Zurich and Barcelona, have operated dozens of such centres for decades, garnering robust public-health dividends: lower HIV transmission, plummeting overdose mortality, and less visible street drug use. In the United States, however, federal law (the 1986 “crack house statute”) clouds the legal footing of these programs. President Donald Trump, in his curious nonchalance, has yet to move against New York’s sites, while State Governor Kathy Hochul has repeatedly declined to unleash the torrent of opioid settlement cash that could fund more.

Expansion meets inertia

The discord between data and policy endures. The state’s Opioid Settlement Fund Advisory Board has pleaded for more prevention centers, noting that New York’s overdose rate stubbornly exceeds the national average. Yet the statehouse dithers. City officials, their gaze flickering apprehensively toward Albany and Washington, keep their pockets buttoned and their statements vague. The fate of overdose prevention sites now hinges on the temperament of Mayor-elect Mamdani, whose shifting position bodes ill for quick progress.

One cannot blame local politicians for being circumspect. Harm-reduction is a field prone to moral panic and all-too-easy headlines. Yet the data are compelling: OnPoint’s sites have been tied neither to increased local crime nor to new waves of disorder. Instead, they quietly mop up a public health disaster others prefer not to witness. The city’s reluctance, therefore, reflects not a lack of evidence, but a surfeit of caution.

As overdose deaths nationwide reached a record 112,000 in 2024, New York’s experiment is at a critical juncture. The economic argument for scaling up supervised injection is robust. The political argument, less so. Other cities—Philadelphia and San Francisco among them—have eyed similar efforts only to blink in the face of federal warning letters and local uproar. OnPoint’s very existence, it seems, is evidence less of New York’s brash confidence than of its talent for bureaucratic compromise.

The “model” will be tested in the coming months, as advocates lobby for more sites and the new administration weighs the costs (and the optics) of growth. If data mattered more than symbolism, expansion would be a fait accompli. But in a city where governance is a spectator sport, informed by tabloids and animated by competing pressure groups, pragmatism still contends with lingering stigmas about what “help” should look like.

If New York wishes to claim leadership in public health—beyond press releases and pilot schemes—it will need to back up its words (and warm endorsements) with funding and political mettle. OnPoint’s experience makes clear that institutional inertia, not lack of evidence, is now the prime threat to lives saved. One expects better from a city that so often claims to lead. ■