It’s 9 a.m. and already the corner in front of the Washington Heights Corner Project is starting to fill up. The doors won’t open for another hour, but the people here — some homeless, all eager for their next hit — know it’s worth the wait.

Once inside, they sign up and get in line to use one of two bathrooms. The people, called participants here, are given 15 minutes inside, no questions asked. Many will inject heroin. If they don’t have their own needles, they’ll be given clean supplies.

Every five minutes there will be a knock on the door and an outreach worker will check if they’re OK. If there’s no response, the outreach worker will burst in with life-saving equipment and overdose-reversing medication like naloxone at the ready.

The facility, which operates a syringe exchange program, also provides counselling and other services. But the project has generated some controversy because if you take away the door and the toilet, what you’re essentially left with is a supervised injection site — something that’s still illegal in the U.S.

“I think it’s barbaric that we have to pretend this is a bathroom in order to do service provision, but you know, we have to do what we have to do,” said Jesse Reid, a Canadian who moved to New York in October and now works at the New York project.

Reid used to work at Insite, the first supervised injection facility in North America which started in Vancouver in 2003.

“I left a battle zone and I came into another one.”

Familiar fight

Reid’s boss is another Canadian who is intimately familiar with Vancouver’s fight to get a supervised injection site. For Mark Townsend, the challenges that come with working in a city facing an increase in overdose deaths, a federal government critical of their approach and a community searching for answers is all too familiar.

Along with his wife Liz Evans, Townsend was part of a group of housing advocates that pushed in the 1990s for the creation of a site to help deal with the soaring HIV rates and overdose deaths that were hitting Vancouver’s Downtown Eastside.

Townsend and Evans left Vancouver after a 2014 spending controversy at the non-profit Portland Hotel Society, where the pair served as co-executive directors.

An internal audit commissioned by the B.C. government found questionable expenses and a weak financial position. Townsend said at the time that none of the expenses in question, which included costly hotels and limo rides, were paid for with government or program money. There were no charges but the couple was forced out, with Townsend saying managers at the organization faced a choice of either stepping down or watching the organization lose contracts.

“I think when you try and change things and when you have political battles, you know, you get lots of scars. So I mean really those, to me, they’re just like kind of badges of honour,” said Townsend, who now works as the director of harm reduction at the Washington Heights project.

He said the issues from Vancouver don’t appear to have followed them to New York, where they have found an audience eager to hear the gospel of harm reduction.

Overdose deaths on the rise

The overdose issue is a pressing one in America’s largest city.

A study says 1,441 people died of drug overdoses in New York last year —  more than the number of people who died by suicides, murders and car accidents combined.

Evans, now executive director of New York Harm Reduction Educators, said when she and her husband arrived two years ago the conversation about supervised injection sites was already underway but still in the early stages.

When New York Mayor Bill de Blasio championed the idea of supervised injection sites last month, calling them overdose prevention centres, backers of harm reduction saw it as a big step forward.

But whether these sites will actually open in the sprawling city is still uncertain. While some in law enforcement have expressed support for the centres, it’s far from unanimous. Michael McMahon, district attorney for Staten Island, has argued supervised injection is the wrong approach.

“While thinking outside the box is necessary to finding solutions for the heroin and opioid epidemic, I believe creating supervised injection sites undermines prevention and treatment efforts, and only serves to normalize the use of these deadly drugs,” said McMahon in a statement to CBC News.