During his afternoons at work, Bryan Ortiz wraps tourniquets around the arms of intravenous drug users to help them find a good vein. If asked, he will even insert the needle, and pull the plunger back, before letting the user push the drug in.

Mr. Ortiz, 29, is the “responsible person in charge” — his official title — on the late shift at OnPoint NYC in East Harlem, one of only two openly operating supervised drug consumption sites in the country. He oversees the stuffing of the tips of crack pipes with copper filters, checks off paperwork that lists what illicit drug is being consumed, and cleans up used syringes while wearing a puncture proof glove.

And most days, at least once, he brings someone back from an overdose, administering oxygen or naloxone to a user who has passed out, working on them until their eyes flutter open.

Once an emergency medical technician on a city ambulance, Mr. Ortiz now works in a liminal legal space. OnPoint is officially sanctioned by the city, but threatened by federal authorities who say the services Mr. Ortiz and his colleagues provide are illegal.

OnPoint appears to run afoul of federal law — the so-called crack house statute makes it illegal to maintain a property where illicit drugs are consumed — and has also angered some of its neighbors, who fear the center has brought even more drug activity to an area where it was common long before OnPoint arrived.

“They don’t just do their drugs or get whatever they need there and then go,” said Hallia Baker, 64, a pastor who has lived on East 126th Street since 1976. “They just hang, and here they are.”

Supervised consumption centers have also drawn criticism for what opponents say is effectively enabling drug use. And yet, as more than 100,000 Americans a year continue to die in an opioid crisis that the nation has struggled to contain, some leaders have embraced a movement known as “harm reduction” to help users do drugs more safely.

Research on more than 100 safe injection sites in other countries has found that they reduce public drug use and lower mortality rates. A branch of the National Institutes of Health recently began funding a five-year study of New York City’s centers, which OnPoint’s leaders believed indicated at least tacit approval by the Biden administration.

For Mr. Ortiz, the calculus is simple: Compared to his job as an E.M.T., he feels he can save more lives here, teaching people about how to use more safely and watching over them as they get high.

“Here, I just feel like I’m helping everyone,” Mr. Ortiz said. “Some of them are in treatment, some of them have been to detox 10 times and come back. But we know that on the road to getting clean, there’s going to be falls and scrapes.”

While he tries to encourage his clients to start treatment, he also wants to help them stay alive when they stumble, he said. He and other workers at OnPoint’s two Manhattan facilities say they have intervened in more than 1,000 overdoses since opening in November 2021, with no fatalities — a record that has drawn praise from public health officials.

But it has also brought new scrutiny from federal law enforcement.

Local, state and federal officials have known about the center, which was authorized in 2021 by former Mayor Bill de Blasio, and it had been operating despite the illegality of the street drugs that people use there — heroin, crack, methamphetamine.

But a few weeks ago, the U.S. attorney for the Southern District issued a warning to OnPoint NYC, and the city and state policymakers who support the project, that caught them by surprise.

“Right now, without action from policymakers, supervised consumption sites in New York City are operating in violation of federal, state and local law,” Damian Williams, the U.S. attorney responsible for Manhattan, said in a statement to The Times on Aug. 7. “That is unacceptable. My office is prepared to exercise all options — including enforcement — if this situation does not change in short order.”

Since then, the staff members at OnPoint have been trying to make sense of Mr. Williams’s words, even as they have vowed to continue functioning. The federal prosecutor has not reached directly out to OnPoint, said Sam Rivera, the organization’s executive director. Mr. Williams declined to comment further.

Earlier this month, the administration of Mayor Eric Adams restated the city’s support for the center’s work, even after Mr. Williams’s statement. Some state lawmakers, who have been trying to pass a bill authorizing supervised consumption sites, have reached out to their federal government contacts to see if policy has changed. For now, the center is open as usual, though the mood is a bit more wary.

There are about 200 visits per day to the East Harlem supervised consumption room where Mr. Ortiz works, which is the busier of OnPoint’s two centers (the other is in Washington Heights). Hundreds of clients also come in for other reasons, such as to exchange needles, test their drugs, do laundry, get free food, massages or medical care, or just sit and watch television in a safe space.

On the blocks around OnPoint at Park Avenue and 126th Street, a concentration of drug treatment programs, drug users and drug dealers lead to use that can be remarkably out in the open.

This upsets the center’s neighbors, some of whom have lived in the area for decades.

While OnPoint didn’t bring the drug activity to the block, some insist it has made things worse. “If you don’t have the resources to make sure that people don’t spill out into community and make a nuisance of themselves, then you’re not helping,” Ms. Baker said.

The people at OnPoint say that the realistic choice is not between a drug free neighborhood and OnPoint, but between people doing their drugs outside, or inside, where someone is on hand to help if they overdose.

“We’re going to do it; we’re going to do it somewhere,” said Ann, 39, who attends support groups at the center and takes showers there. She asked not to use her last name because of family concerns. “So would you rather it be here or somewhere else?”

This is how Mr. Ortiz sees his job. He does it, he said, because he still remembers a day during EMT training when his ambulance got a call about an overdose in Central Park. An exact location wasn’t provided, making the response difficult, and when the ambulance arrived at the park, none of the workers got out to begin the search. That upset him.

Last Wednesday, Mr. Ortiz helped Marc, 65, a former carpenter, inject fentanyl in a vein in his hand. Marc is on suboxone, a drug that helps reduce opioid cravings, but he said it was not enough.

Baeya Harris, 36, was also in the consumption room, rolling joints in one of eight mirrored booths. She had just come from the women’s support group upstairs, and said she wanted to be able to smoke without being bothered on the street. She was also coloring a design that a staff member had given her as a way to stay calm.

Mr. Ortiz, born and raised in the Bronx, oversaw the action. He had become an E.M.T., he said, after witnessing a family member overdose when he was a teenager. Only the emergency responders knew what to do to save his relative, and he wished the person helping could have been him.

In his new job, he keeps in his mind that he’s not that different from the people whom he assists. One injury that leads to an addiction, a set of different choices, and he could be in their shoes.

He uses that sense of connection, he said, to bond with clients. Sometimes, he finds out they went to the same high school or are from the same neighborhood. He tries to teach them how to avoid infections and wounds and overdoses, even when OnPoint is closed.

“Even if you’re mean to me, I’m going to be the nicest, sweetest guy, and we’re going to build a relationship whether you like it or not,” he said. “And it always happens. It always works.”

He cleaned the mirrored booths, and kept the supply bins of free syringes, crack pipettes and alcohol swabs organized. Each pipe or needle someone uses and discards here, he reasons, is one less on the street.

Sharon Otterman covers health care and the pandemic for the Metro desk. A reporter at The Times since 2008, she has also covered religion and education, and won a Polk Award for Justice Reporting for her role in exposing a pattern of wrongful convictions in Brooklyn. More about Sharon Otterman

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