On May 23, 2017, the City of New York Police Department, commonly known as the NYPD, led a massive, multi-agency operation to clear “The Hole.” This stretch of abandoned railway tracks in the South Bronx had become ground zero for the borough’s often-intertwined crises of opioid addiction and homelessness. Just across the street from the area’s largest green space, the 35-acre St. Mary’s Park, the encampment had been cleared before, but this would be the last time. The NYPD announced plans to build a new headquarters for its 40th precinct on the site, in a district with an opioid overdose death rate twice that of the rest of the city and increasing five times as fast.
Tipping Point
The closure of “The Hole,” coming just at the beginning of NYC Parks’ peak operating season, sent shock waves through the area. The borough’s maintenance and operations staff went from regularly picking up hundreds of syringes each week to collecting thousands.
While St. Mary’s Park and a smaller neighborhood park, Patterson Playground, bore the brunt of the influx, more than a dozen parks across the South Bronx saw a dramatic increase in public drug use and discarded syringes littering lawns, play equipment, benches, basketball courts and athletic fields. It was affecting nearly every aspect of park maintenance, as staff was removing syringes from horticultural beds, leaves and vegetation, clearing them from sewer lines and emptying trash bins to pick through the contents before re-bagging them.
Every syringe collected represented a risk not just to the public and staff, but also to those individuals suffering from addiction and possibly at risk of a fatal overdose in a secluded area of a park or a restroom. As an agency that prides itself on improving the quality of life of all New Yorkers, especially those for whom parks are perhaps the only safe space they have or their only opportunity to enjoy the physical and mental health benefits of green space, NYC Parks staff felt increasingly unable to fulfill its basic mission.
Crisis Intervention
NYC Parks had partnered with other agencies and community-based organizations specializing in harm reduction (often referred to as syringe exchange programs — a misnomer that belies their commitment to meeting all the immediate and long-term needs of those suffering from addiction) to address drug use in parks. However, the South Bronx was in crisis on a scale no one had ever seen.
Armed with an internal audit that revealed staff was picking up close to 5,000 syringes a week over the course of the summer, NYC Parks contacted the city’s Department of Health and Mental Hygiene (DOHMH). Field researchers immediately toured the parks most affected and were alarmed by what they found — many people, who had been evicted from The Hole, were crowding neighborhood parks, openly injecting drugs amid park patrons and staff, with some desperately asking for the encampment to be reopened.
NYC Parks and DOHMH immediately held a series of meetings to define the scope of the intervention required to ensure the public’s safety, reduce syringe litter and address the needs of a vulnerable and suffering population, and convened a task force to implement each aspect of the response. The monthly meetings of more than 75 individuals brought together city agencies, such as the health, homeless services and police departments, harm reduction organizations, healthcare and treatment providers, housing advocates and community residents.
Syringe Disposal and Working with Vulnerable Communities
DOHMH researchers spent six months conducting field observations and interviews with people who use drugs in parks, assessing factors regarding park utilization and drug use, along with service needs and barriers. They also met with community stakeholders, service providers and area residents, and distributed more than 250 naloxone (overdose reversal) kits. This work would inform the task force’s efforts to develop and focus outreach capacity. Respondents also indicated high levels of support for syringe collection kiosks, which were central to reducing syringe litter.
The New York Harm Reduction Educators (NYHRE), a harm reduction organization, proposed an innovative solution to both address syringe litter and provide outreach to those using drugs in the parks. NYC Parks would purchase, install and maintain 47 kiosks in 16 parks throughout the South Bronx, while NYHRE staff would empty the kiosks and assist with picking up syringes at the parks where the boxes were located. NYHRE would also distribute personal sharps containers and naloxone, promote safe disposal and provide a variety of services, including treatment and housing referrals, HIV/HCV testing, basic medical care, overdose reversal, Medicaid application assistance and referrals to local drop-in centers where these and other services are always accessible. “Syringe disposal kiosks are simply one tiny practical step in a different direction toward building a comprehensive solution grounded in reality,” explains Liz Evans, NYHRE’s executive director.
Kiosk locations were determined by long-term, persistent syringe litter — the 16 sites represented more than 99 percent of syringes discarded in Bronx parks — but also by direct engagement with the drug-using population. In addition to interviews conducted by DOHMH, NYHRE surveyed program participants about where they were injecting and seeing the most syringes. Outreach teams also canvassed surrounding neighborhoods to assess syringe litter, so kiosks might improve these conditions for area residents. Highly unstable behavior patterns also had to be factored into the process, influenced by a range of factors, including weather, geography, proximity to services and the frequency of NYPD patrols.
Concurrent with the rollout of the kiosks and additional outreach, Parks Enforcement Patrol (PEP) officers partnered with NYPD to increase patrols at all playgrounds where kiosks were installed, and within larger parks receiving kiosks. Both agencies agreed that patrolling all the area’s parks at all times was impossible and would only displace those using drugs to other parks and public facilities. However, the playgrounds would be patrolled as frequently as possible while children were present, notably before and after school and during recess. NYC Parks issued naloxone to all PEP officers and education-focused Urban Park Rangers and trained them in overdose reversal. After two lives were saved in the parks, Parks Commissioner Mitchell J. Silver made the practice standard procedure citywide for these employees.
A Work in Progress
Just as there are no easy or immediate solutions to the opioid epidemic, the issues of public drug use and discarded syringes will not be solved overnight. However, over the first six months of the program, encouraging signs of progress were visible. While slightly more than 10 percent of syringes collected in the parks were deposited in kiosks, this represents a staggering 7,314 syringes to which both members of the public and NYC Parks staff were not exposed. Some kiosks were used 100 percent of the time, while others remained empty, even though syringes still littered the ground nearby.
Working in close consultation with NYHRE and with input from those using the drugs, NYC Parks relocated several of the sharps disposal units and, in some cases, installed additional units to sites where public injection surpassed expectations. These changes led to an immediate reduction in syringe litter in those locations as kiosk use increased. NYHRE also had teams of outreach workers in the parks every day promoting the use of the kiosks and educating people on safe sharps disposal, recording an astounding 31,697 individual interactions — connections made with people who use drugs that offer the full array of services the organization provides. During this time, they also distributed more than 500 naloxone kits, connected more than 100 people with treatment or other care, and intervened in scores of overdoses in area public spaces.*
NYC Parks’ partnership with the NYPD led to a marked decrease in drug use and discarded syringes at Patterson Playground, but displacement did occur, with an increase in syringe litter at nearby parks, public housing complexes and in the surrounding streets. This brought the issue of displacement to the forefront of the discussion surrounding how to address public injection, highlighting the need for better information sharing and coordination of resources. It also underscores the importance of the city’s commitment to combatting this crisis by bringing help to people wherever they are.
“The actions around The Hole demonstrated that displacing people doesn’t solve anything. People who are vulnerable, mentally ill, addicted and experiencing homelessness just get forced into more precarious situations and some die. Shifting them is simply about optics, rather than about creating real solutions that are better for all of us and our communities,” says Clara Cardelle, Washington Heights Corner Project outreach specialist who worked extensively in The Hole.
This commitment was the basis for Mayor Bill de Blasio’s November 26, 2018 announcement of the Bronx Action Plan, an investment of $8 million to combat the opioid epidemic specifically in the South Bronx. This allocation of funds is in part due to the successful efforts of NYC Parks and Health, as well as NYHRE, to address public injection and discarded syringes in a comprehensive and lasting way. It has provided all three organizations with the ability to devote additional resources to these efforts and ensures that early successes can be sustained and expanded. For the first time, many people are cautiously optimistic they may be witnessing a turning point in one of the nation’s communities hardest hit by the opioid crisis.
*NY State does not require location specifics for overdose interventions, only an outdoor/public space designation. Most of these locations would have been parks, but not all.
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Julien Scott is NYC Parks Bronx Operations Manager.