PROVIDENCE, R.I. — Cristina Ramsey, frail but defiant, arrived at the headquarters of Project Weber/Renew to say her goodbyes to people who had watched out for her for nearly two decades.
She embraced staff members at the group, which helps drug users in one of this city’s poorest neighborhoods, convinced they had prolonged her life with clean needles, treatment, housing and friendship. She told them that she was going into hospice care and that the organization “really did help me — a lot.”
Ten days later, she was dead, a victim of multiple drug-related illnesses. Ms. Ramsey, 50, a longtime drug user, was infected with H.I.V. and had liver disease and heart problems, a complicated case that left Project Weber’s staff wondering what else could have been done to save her.
By the middle of next year, the group hopes to have at least a part of the answer. It is preparing to open the first supervised drug consumption site legalized by a state — one of the most daring experiments in “harm reduction” in America to date.
By letting people use drugs on site and under the supervision of social and medical workers, rather than alone, Project Weber hopes to curb overdose deaths and infectious diseases and coax more users like Ms. Ramsey into using medication and supplies for safer drug use.
Many public health experts see this strategy as a possible template for transforming how the United States addresses drug use. The concept has drawn considerable interest in recent years: New York City allowed two sites to open last year, and some state legislatures have considered following suit. Rhode Island has authorized a two-year trial that Project Weber and a partner treatment organization anticipate leading.
Top Biden administration officials have also signaled openness to the idea. In 2019, the Trump administration sued a Philadelphia group that aimed to open a site, but under Mr. Biden, the Justice Department is weighing whether to drop the lawsuit. If it decides to do so, that could serve as a tacit endorsement of the strategy.
Brandon Marshall, an epidemiologist at the Brown University School of Public Health who studies the strategy, said the sites “require us to shift our thinking in how we treat people who use drugs and how we address health issues they face, and how as a society we want to provide care to people, or not.”
“So much of the history of the drug war in the U.S. is pushing people into the shadows, criminalizing their drug use,” he added. “These facilities do the opposite. They say, ‘We want to bring you in and give you a safe environment where you will be respected.’”
But the idea of government-sanctioned infrastructure for drug use has not yet attracted broad political support. Conservatives and even some Democratic leaders remain wary: Citing “a world of unintended consequences,” Gov. Gavin Newsom of California, a Democrat, recently vetoed a bill that would have legalized supervised consumption in some cities there.
Critics of the sites see them as not helping users like Ms. Ramsey but hurting those users by facilitating the use of drugs that can lead to quick and fatal overdoses. Some who live near proposed sites have said they fear loitering and drug use outside them. “Supervised injection sites have led to an increase in crime, discarded needles and social disorder in the surrounding neighborhoods,” a group of Republicans in the U.S. Senate wrote to President Biden this year.
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Rhode Island has mirrored the nation’s record-shattering tally of overdose deaths. More people in the state died of accidental overdoses in 2021 than any other year on record; roughly three-quarters of the 435 deaths involved fentanyl, an extremely potent class of synthetic opioid that is often found mixed into other drugs.
To open the site, Rhode Island has a novel source of funding: $2 million in legal settlement money from litigation against prescription opioid manufacturers and distributors that has been earmarked for supervised consumption by a state committee. Project Weber and Victa, a partner treatment clinic, still have to submit a more detailed application to the state before they can receive funding. The Providence City Council also has to approve the site’s location before the state can license it.
Rhode Island’s everyone-knows-everyone culture helps to explain its role as the first state to clear the way for supervised drug use, residents and lawmakers said. But some cities and legislators have still expressed discomfort.
Arthur J. Corvese, a Democratic state representative who opposed supervised consumption, said last year that “we set rules, regulations, laws and parameters for our people to conduct themselves, to comport themselves.” He continued, “But yet we will say, ‘You want to chase the dragon or shoot up? There’s the place to do it.’”
State lawmakers say that the pervasiveness of fentanyl has sped up acceptance of helping people use drugs safely. Among its services, Project Weber distributes test strips that show if a drug contains fentanyl, a tool it would distribute at the supervised site.
One lawmaker who helped push state legislation authorizing the sites, John G. Edwards, said that even some of the more conservative law enforcement officials he knew were supporting them.
“This is not some drug haven,” Mr. Edwards, a Democratic state representative, said. “When you understand the whole issue, you understand that this means whether people live or die.”
Ashley Perry, a recovered user and Project Weber employee, has spent years delivering many of the services of the future site on her own. As she drove around the neighborhood surrounding Project Weber one recent morning, residents ran up to her van to say hello and to seek clean needles.
Ms. Perry serves as the emergency contact for nearly two dozen users; she has picked up some of them from the hospital when they were discharged after an overdose. She shows up in court with them, then works to expunge their records.
Supervised consumption is not just about dispensing supplies and preventing overdoses and infections, said Colleen Daley Ndoye, Project Weber’s executive director. The location, she said, will allow the group’s staff to work with users, earning their trust and linking them to other services. Ms. Daley Ndoye said that as with other harm reduction programs, the site would not aim to force people to enter treatment, nor would it expect that they do so, but it would offer the option if participants were interested.
The program will offer H.I.V. and hepatitis C testing, supplies for safer drug use, syringe disposal and drug checking tools. Representatives from Victa plan to offer initial doses of buprenorphine, a medication that eases withdrawal symptoms and cravings, to interested clients. Medical staff members will treat wounds from injecting drugs and help manage hepatitis C.
For years, Nicole P., a sex worker who said she used drugs at least once a day, would not reveal her name to Ms. Perry. Ms. Perry took to calling her “Star,” learning her real name only when she retrieved her from a hospital after an overdose.
Nicole, who declined to provide her last name, is now a regular at Project Weber. She uses cocaine and fentanyl and takes methadone, a heavily regulated opioid used to treat addiction by controlling cravings and withdrawal symptoms. With Project Weber’s help, she moved into an apartment late last year, devouring design magazines, fantasizing about acquiring her own furnishings and dreaming of a more settled life.
Nicole said she was interested in trying the supervised consumption site but was anxious about it, too, in part because it might feel invasive. “I don’t like people watching me do it,” she said. But Ms. Perry said that watching over clients at their most vulnerable moments — when they could easily, abruptly stop breathing — would prevent some of the many deaths that occur when people use drugs alone in the era of omnipresent fentanyl.
“The No. 1 thing we teach people is: Don’t use alone,” Ms. Perry said.
Ms. Ramsey, the longtime drug user, worked for Project Weber during a period of sobriety, counseling users and helping with harm reduction programs such as naloxone distribution and needle exchanges. Days before she died in August, she attributed her poor health to a contaminated needle. She grew sicker in recent years, even as she sought more help: treatment from medical staff members at Project Weber’s busy Pawtucket site and sterile supplies for drug use.
She said she worried about how successful supervised consumption would be, given that for some users it may not curtail cravings, impulses and withdrawal symptoms. Still, she said it would be an important step in stopping fatal accidents.
The supervised consumption site is set to be located on a bus line, close to a hospital and far from schools and Providence’s downtown, factors that Project Weber and Victa staff members believe will head off opposition.
Project Weber has spoken with law enforcement about how to handle activity around the site, to prevent confrontation and arrests. “Their sense is this is a lifesaving thing and this will make their jobs easier and there will be fewer overdoses to attend to,” Ms. Daley Ndoye said of the local police.
A spokeswoman for the Providence Police Department did not respond to a request for comment.
Dr. Marshall, the Brown epidemiologist, conducted some of the earliest research into supervised consumption in Canada, where sites have operated since 2003. He now oversees a team of researchers studying the concept, advises the groups opening the Rhode Island site and sits on the committee that earmarked the money for supervised consumption.
“After moving to the U.S. in 2012, I left this topic aside because we were so far from this being a reality here,” he said. Criticism that the sites are unproven, he added, “only demonstrates the need to open them here in the U.S.”
Not everyone who might benefit from the site is in favor of it yet. Desiree Lafreniere, who has the names of friends who died from fentanyl overdoses tattooed on her arm, relies on medication and Project Weber’s syringe exchange. Her desperation to get clean makes her frown on the idea of a supervised drug use site.
“I think it’s just an easy way for us to get high without getting in trouble,” she said. “And I don’t think that’s the way to get us off drugs.”
Ms. Daley Ndoye said those concerns reminded her that some users had internalized the stigmas around their drug use, thinking that “you have to be punished out of it or criminalized out of it.”
Nicole, the user who picks up harm reduction tools from Project Weber, recalled not knowing how to ask for help, using needles she had found on the ground at a nearby cemetery. Ms. Perry once found her alone on Thanksgiving in the car she lived in and delivered a holiday meal to her.
“She was actually thinking about me,” Nicole said.
Asked whether she ever feared dying from a fentanyl overdose, Nicole turned away, fighting back tears.