In a back room behind a colorful facade in northern Manhattan, drug users are smoking crack while nearby cubicles stand ready for heroin users to wrap tourniquets around their arms and inject themselves with new, sterilized needles.
It's all part of a 5-year-old experiment sanctioned by the city of New York, but not by the federal government, which has long-standing anti-"crack house" laws criminalizing facilities that allow for drug use.
Supporters say the supervised drug-use sites reduce overdose deaths and street drug use, and serve as a model for the rest of the country. But critics say the centers are magnets for hard drug users and dealers, leaving the local community feeling less safe.
"It's scary for the kids walking into school in the morning, seeing people in that state," said an educator at a nearby school who spoke on condition of anonymity because they were not authorized to speak to the media.
New York City has two facilities like this, known as overdose prevention centers, or OPCs. By supervising the use of addictive, illegal drugs, proponents say the sites remove barriers to healthcare and can lead to people getting off drugs or transitioning to less risky behaviors.
In a recent interview with CBS News, OnPoint NYC Executive Director Sam Rivera said his team has intervened in more than 2,100 overdoses with no fatalities, and has more than 7,000 registered participants who have used the facility's services 250,000 times since it opened in 2021.
"250,000 times people used inside with us, not in the parks, not in the street, not in the playgrounds, not in bathrooms," said Rivera.
Rivera gave CBS News a tour of OnPoint's facility in East Harlem, a neighborhood where problems with drug use have persisted for decades.
In addition to the smoking room and injection cubicles, OnPoint offers services such as primary medical care, addiction medication, art therapy, sleep rooms and laundry, as well as perks like massage, acupuncture, aromatherapy and, soon, hair styling.
They are amenities that might seem more at home in an upscale wellness center than a place where people can inject heroin just a few steps from the massage tables. But Rivera said the wellness therapies serve a purpose.
"Those things are medicine. Those things are reducing drug use, introducing people into an environment that loves them," he told CBS News. "Many of our folks haven't experienced that."
In the massage room, an OnPoint participant-turned-part-time employee said, "I did the acupuncture, for the first time my back feels better. I didn't believe it but it really works."
Outside of OnPoint's walls, however, some residents say they're not happy about what it means for their neighborhood.
"You couldn't pay me to walk down that street anymore," said Syderia Asberry-Chresfield, co-founder of the Greater Harlem Coalition. "The dealers don't even have to look for clients. Drugs are being sold in front of everyone's faces. It's a slap in the face."
CBS News met Led Black, founder of the local media organization Uptown Collective, who lives a few blocks away from another OnPoint location in Washington Heights.
"I have three daughters. They're not little, but they're still young, they still shouldn't have to deal with this," he said. "You don't want the kids downtown to see it. Why is it OK for the kids up here to see it?"
Political controversy
In a campaign ad, New York state attorney general candidate Saritha Komatireddy, a former federal prosecutor running as a Republican, singled out OnPoint as an example of bad policy.
"The problem here is these sites take people in, they give them deadly drugs, and then they turn them right back out on the street and into the subways. That's not a solution," Komatireddy told CBS News. "I think it's unethical. I think it's cruel, and it's definitely illegal." (OnPoint has a space for users to stay indoors and be monitored while they are under the influence of drugs.)
She notes that the East Harlem location is directly across the street from an early childhood development center and two blocks down from a school with students in kindergarten through grade 12.
Last year, Rep. Nicole Malliotakis, a New York Republican, publicly asked then-Attorney General Pam Bondi to shut down the facility, citing federal law prohibiting illegal drugs.
"They're enabling addiction instead of actually getting people the treatment they need to get off drugs," Malliotakis told CBS News. "They're also letting dealers know where their clients are."
Harm reduction
In the 1970s, amid rising drug use in America, a movement began that would evolve into what's known today as "harm reduction" policy, with a core principle of removing any judgment or coercion from drug treatment.
Providing clean needles and testing drugs for contaminants that can cause sudden death seemed like the humane way to address painful-to-kick addictions, keep people alive, and reduce infectious diseases.
Despite the compassion behind the policies, they were no match for the nation's growing addiction crisis or increasingly lethal drug supply in recent years. Federal data show the rate of drug overdose deaths quadrupled in the U.S. between 2002 and 2022, a problem largely driven by prescription opioid pills before ballooning into a full-blown opioid epidemic.
Overdose deaths climbed to a peak of almost 108,000 in 2022 before to decline, according to the Centers for Disease Control and Prevention.
Overdose prevention centers that supervise drug use in-house are an extension of the harm reduction approach. While still unfamiliar to most Americans, they've existed internationally for two decades, with one report finding more than 100 such facilities worldwide, including many across Europe.
The one in Vancouver, Canada, is probably the most well known and has been in operation since 2003. Vancouver saw a steady rise in overdose deaths until a peak in 2022.
Support from the city
Just two months after taking office, New York City Mayor Zohran Mamdani visited OnPoint to show support for the program.
"This weekend, the team at OnPoint NYC kept their doors open 24/7 so vulnerable New Yorkers had somewhere safe to go," Mamdani posted on X in March, alongside photos of himself with Rivera and other staff.
OnPoint operates with about $19 million in annual funding from a mixture of city, state and private funds, including some opioid settlement money. The city of New York funds a lot of it through multi-year contracts worth about $17 million in total. However, city rules prohibit using any of those funds for the direct supervision of drug use, so the organization has to rely on other sources for that work.
OnPoint once had more than $2 million in grants from SAMHSA, the federal Substance Abuse and Mental Health Services Administration, which it lost after President Trump issued an executive order in July 2025 explicitly barring federal taxpayer dollars from funding "drug injection sites" or "illicit drug use."
Despite the belief among many city officials, public health practitioners and researchers studying the programs that overdose prevention facilities are effective and necessary, their future in America is far from certain.
Efforts to open similar facilities in Seattle, Portland, San Francisco and Chicago have all failed. (Those cities have other harm reduction programs, such as needle exchange programs and social services for drug users.) Only Rhode Island has been able to move forward providing supervised drug consumption since OnPoint opened in 2021.
Rivera said he still wants to expand and has a community of city officials who support the notion.
OPC impact on overdose deaths
The NIH's National Institute on Drug Abuse writes that after 20 years of international experience, "it is unclear whether such facilities reduce overdose death rates overall."
Existing studies tend to show some reduced death rates near the facilities that become hard to detect in larger populations. One systematic study from 2021 of existing international research concluded that OPCs "may help reduce overdose morbidity" while another study of Canadian programs across British Columbia found "no evidence that they reduce local hospitalization or mortality rates."
New York City's experiment with supervised drug use has been running for nearly five years — enough to start drawing conclusions about its impact.
Over the past two years, overdose deaths citywide have been decreasing rapidly from the highest recorded year ever in 2023, which tracks with the national trend. The city's Department of Health did not name OnPoint directly, but in a press release touting harm-reduction programs, it credited the change to "several years of increased investment in evidence-based overdose prevention strategies in NYC."
The NIH is now funding a team of researchers to evaluate America's three supervised injection sites: the two OnPoint NYC facilities and a newer one in Providence, Rhode Island, called Project Weber/RENEW. The multi-year study is still ongoing, and while they have not drawn conclusions on mortality rates, one of the lead authors said in an interview with CBS News that he believes overdose prevention centers have had a positive effect on public health.
Charles Fain Lehman looks at the very same data and sees a net negative. He is a senior fellow at the Manhattan Institute for Policy Research, a conservative think tank that has been a vocal critic of Mamdani's policies.
"There is a lot of evidence that interventions of this type generally do not have an appreciable effect on overdose deaths," Lehman told CBS News. "There's a fixed pool of resources available for helping people who are dealing with substance use disorder. If you're spending the dollars on an intervention that doesn't work, like supervised consumption sites … you're not spending dollars on [addiction medication] and evidence-based treatment."
The evidence on crime
A CBS News analysis of available crime data told two different stories between the two neighborhoods where OnPoint operates.
Felony crime complaints have risen steadily in the 34th Precinct, where the Washington Heights facility is located, since OnPoint opened in 2021. The precinct includes multiple city blocks, so the increase in felony crime complaints cannot be tied directly to OnPoint. Citywide complaints have also increased over most of that time, but more slowly than in the 34th.
In the 25th Precinct, where the East Harlem facility is located, felony complaints rose after 2019 and peaked in 2023. By 2025, felony complaints fell substantially but remained 10% above their pre-pandemic levels. The rest of the city fared worse, with felony complaints remaining near 2024 levels last year.
A CBS News review of 911 call data from the New York City Police Department showed most of the calls made from the OnPoint addresses were for ambulance services; relatively few calls required police response.
So far this year there have been 124 calls from the East Harlem location and 84 calls from the Washington Heights address.
A study in 2023 found no significant changes near the sites in "crime or disorder," which included 911 calls for trespass and 311 complaints.
Another study in the Journal for Experimental Criminology found a significant increase in property crimes near the Washington Heights location, where a Target store had recently opened. The study authors reasoned that placing the safe injection facility so near a location with easily shoplifted products created an environment ripe for theft. Notably, the study found no similar increase near the East Harlem facility and no increase in violent crimes in either location.
"This is our major conclusion, is that your location matters," said the study's co-author John Hall, a retired NYPD officer who is currently a PhD candidate at the Institute of Criminology at Cambridge University in England.
The NIH study's initial findings show that the sites seem to have a largely neutral effect on local business activity and drug-related criminal activity in their neighborhoods.
Brandon Marshall, one of the researchers on the NIH team evaluating America's overdose prevention centers, said, "OPCs can do many things. They can reduce public drug use, they can reduce 911 calls. They can help people access healthcare and treatment. They are not a panacea to all social problems in a neighborhood."
When the multi-year evaluation comes in from the NIH, it may move the debate about supervised drug consumption forward — or it may not.
Johns Hopkins bioethicist Travis Rieder argues that support for places like OnPoint will never be decided solely by the empirical data.
"I don't actually think it's why anyone believes what they believe," he said. "They have a view about what we should actually be helping people to do or not do, and then they find the evidence that best supports their view."
Rieder said he knows where he stands. "Here's what an overdose prevention site does: It says, 'You are welcome here, and I will watch over you so that you don't die today, and you're worth that. You deserve that because you're a human being and you have dignity.' And I think that's a really beautiful thing."
Black, the community activist, says he wants the researchers at universities studying OnPoint to spend a day in his shoes.
"Why should it be an addict-focused approach?" Black said. "I wish it were a community- focused approach."
–Jamie Korenblat and Max Moore contributed reporting.