OnPoint NYC offers a range of services that promote the health of drug users and the entire communities in which they are located. At its Manhattan locations in East Harlem and Washington Heights, OnPoint provides drop-in centers where people can eat, shower, and do laundry. They offer free syringes, plus additional supplies and trainings that reduce the spread of disease. They have an HIV and Hepatitis C testing clinic for those who may have been exposed.

Since November 2021, OnPoint has administered the United States’ first two sanctioned overdose prevention centers (OPCs), places where people can use drugs under the supervision of trained responders. They report reversing seven hundred overdoses in their first year of operation.

The organization has a total staff of around 120. In December, a supermajority of workers voted to form a union under the New England Joint Board of UNITE HERE. Their vote marks another first: the first union formed by workers at a harm reduction site. As more places like OnPoint open across the country, their campaign could not only improve their own working conditions but set a new standard of worker power across the field.

Organizing OnPoint

“OnPoint NYC’s workforce partners with the most marginalized populations often most harmed by the various exploitative systems in our society,” the union’s organizing committee wrote in a statement demanding recognition. “This makes it all the more crucial that the workforce has a union to ensure an increased level of job security and establish a mechanism for due process and protection for workers.”

The organizing committee also cites the need for better health care and a less hierarchical work environment. “We are unionizing to democratize the workplace and make decisions collectively in the best interest for workers and participants. Through this unionization we plan to build solidarity among workers and participants to make OnPoint NYC the best organization it can possibly be, while improving these life-saving services in New York City.”

Sam Rivera, the executive director of OnPoint NYC, told Jacobin that the organization plans to recognize the union pending the results of a card check. “I just want what’s best, and if that’s best then that’s wonderful,” he said of the union effort. “That’s the point of running this organization: to do what’s best for the participants and our staff. And if this is the best route, and if this is what the majority wants, then that’s wonderful, and we move forward.”

Brooke Alexandria Paine, a harm-reduction specialist at OnPoint, joined the union campaign a few months after she was hired in June. “I never really thought about unions until someone asked me, ‘Do you want a union?’” she says. “And I was like, ‘Yeah I kinda do!’”

Paine got involved in harm reduction as a teenager, after a friend died of an overdose. She started volunteering for an organization in San Francisco, doing outreach in the Tenderloin. She then moved to New York, working for the National Harm Reduction Coalition in both paid and unpaid positions while volunteering at different syringe exchanges around the city.

“The more I learned about the union, the more I was like, ‘This is the way to begin to address some of the concerns I’ve had from working in harm reduction nonprofits for the past five years.’”

Democratizing Harm Reduction

The National Harm Reduction Coalition describes harm reduction as a “set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.” In contrast to legal or abstinence-only approaches that punish or withhold services from drug users, harm reductionists intend to meet drug users “where they’re at,” offering products and services that make drug use safer. In comparative studies, these practices have been shown to dramatically reduce the risk of morbidity and transmission of diseases like HIV. The overdose prevention centers run by OnPoint immediately produced such results. In their first two months of operations, staff responded 125 times to mitigate overdose risk of people using drugs, and no fatal overdoses occurred on site.

Crucially, the harm reduction approach is based on — and in some ways a formalization of — the strategies that drug users have long employed to protect themselves and the people they use with. Harm reduction, that is to say, is something that is being practiced even without harm-reduction organizations. However, those organizations can provide resources that reduce harm even further.

At organizations like OnPoint, former and current drug users typically play key roles. These employees often work at an elevated personal risk, putting themselves in close contact with substances, people, and geographical areas that may have been connected to their dependency. They are also more likely to have been incarcerated, and they may need medical care that other workers don’t. The workers at OnPoint see unionization as a way to make those jobs less precarious.

“People with lived experience know what participants need because they used to be participants before they got hired,” Paine says. Yet in her experience, she’s found that harm reduction nonprofits often relegate these workers to “boots on the ground” jobs while excluding them from higher levels of decision-making:

The union just seemed like the most direct way to get those voices heard. Going to your boss as a single, individual person and saying, “Hey, I have this idea,” or “Hey, I think this could be better,” doesn’t really accomplish that much. When you have the whole organization signing cards and working together to build worker power, it’s a much more sustainable avenue to getting those changes to actually happen.

Putting OPCs in Every City

In December, Governor Kathy Hochul’s administration put a stop to funds from New York’s Opioid Settlement Fund being used to open more OPCs around the state. Hochul proceeded with the decision even though it ran counter to the recommendations of an advisory board convened to determine the best use for the money, as well as testimony given by staff from OnPoint. Meanwhile, the state’s Department of Health recently reported a 14 percent increase in opioid overdose deaths from 2020 to 2021. The data for 2022 is not yet public.

In California, Governor Gavin Newsom vetoed a bill that would allow for an OPC in San Francisco. Even so, across the country, the momentum behind OPCs seems to be increasing. One is set to open in Somerville, outside Boston, and another may follow in Providence. If union shops become the norm, organized labor could become a powerful ally for the harm-reduction movement, both by exerting lobbying pressure and normalizing OPCs among their large memberships.

One person I spoke to for this story told me that since the OnPoint union went public, he had already been in touch with harm-reduction workers in different states who were interested in unionizing their workplaces.

With solidarity at the heart of harm-reduction practice, this shouldn’t be surprising. And by forming unions, harm reductionists might be able to preserve the radical nature of their work. As state and federal governments inevitably become more involved in harm reduction, unionized OPCs could ensure that workers are able to drive the conversation, thereby preempting punitive regulation or other forms of opposition.

“We’re setting the standard of what we deserve as workers — not just as workers but as workers who are doing some really intense fucking shit,” Paine says. “We want an OPC in every city, so if the first one sets the bar high for how much workers are involved and have a voice, it sets the tone for the rest of this industry, whenever the powers that be allow it.”