In 1985, the New York City Department of Health proposes a city-led pilot syringe exchange program. The memorandum is leaked to the police, who veto the proposal.

Another pilot program will be proposed by the city and adopted in 1988 despite strong opposition, producing positive results for helping people access long-term substance use treatment, but it is not comprehensive enough to reduce unsafe injections and the transmission of HIV. As such, this pilot program will be discontinued in 1989.

Community-led initiatives will last longer because they are woven into collective care, collective safety, and street economy-based strategies.