Could overdose prevention centers work in the US? Let’s find out

Every day, in communities and families across the country, lives are being lost to the overdose crisis. 

Over 100,000 Americans die of a drug-related overdose each year — more than motor vehicle crashes and firearm-related deaths combined — making it a national public health emergency. This touches every corner of America, regardless of geography, age, or racial/ethnic identity. From states like West Virginia and Kentucky to cities like New York and San Francisco, people are dying. Over the past several years, stark racial disparities in overdose deaths are increasing among Black and Indigenous people.  

As the issue worsens, communities are urgently seeking solutions to help stem this tide of preventable deaths. One such strategy includes overdose prevention centers (or OPCs), which are places where people who use drugs can go and consume controlled substances — including by injection or inhalation —  in a safe, supervised environment.  

OPCs have health professionals and trained peers who can immediately recognize if an overdose is happening and administer oxygen and naloxone, an opioid overdose antidote. Overdose prevention centers also connect people on site with supportive and potentially lifesaving services such as healthcare, substance use disorder treatment and recovery services, housing assistance, employment counseling and more. 

The first two officially recognized OPCs in the United States opened in New York City in November 2021. Since then, the sites — operated by an organization known as OnPoint — have been used nearly 70,000 times, and staff has successfully reversed nearly 850 overdoses. Not a single person has died at either of the two NYC sites and only 14 have required an ambulance or emergency medical services personnel.  

Rhode Island became the first state to authorize overdose prevention centers through state legislation in 2021, and its first site is due to open in early 2024, with funding from the state’s opioid settlement agreement. 

While overdose prevention centers are a new concept in the United States, they have existed in other countries since the 1980s. Decades of research conducted internationally have shown that these sites save lives, prevent unnecessary emergency department visits and hospitalizations and increase the uptake of addiction treatment.  

Still, questions remain about their potential impact here in the U.S. Much of the existing research was conducted more than a decade ago, before the introduction of fentanyl into the illicit drug supply, and prior to the approval of medications now commonly prescribed for opioid use disorder, such as buprenorphine. Another major difference is that OPCs in other countries are implemented within the context of universal healthcare systems and strong social safety nets. While much progress has been made in expanding healthcare in the U.S., our delivery system is not yet universal. Certain populations, including people who use drugs, often remain on the margins and unable to access needed health and social services.  

To understand the impact of OPCs in the U.S. context, we are launching the nation’s first federally-funded study of these sites, thanks to funding from the National Institutes of Health. We will measure their impact on people who use these facilities, and the effect they have on the communities in which they are located — in both New York City and Rhode Island — over the next four years. 

We have assembled a team of experts with decades of collective experience researching overdose prevention centers, including those operating in other countries. We will explore whether and how overdose prevention centers lower the rate of fatal and non-fatal overdoses, and if using a center increases the uptake of addiction treatment and recovery services. To do so, we will enroll and track the outcomes of 1,000 participants in both New York and Providence over the age of 18 who use drugs and are already engaged with a harm reduction program. 

We will examine whether overdose prevention centers influence public drug use, drug-related litter, arrests and local economic activity in the neighborhoods in which they are located. 

We also have a critical opportunity to understand how these sites serve different communities and may scale to various contexts across the United States, or if there are adjustments that need to be made to make them more suitable for a U.S. context.   

Finally, we will examine their cost-effectiveness as a public health intervention to address the country’s overdose crisis.  

We understand that OPCs can provoke fierce debate, but whether you are a supporter or a skeptic, we can all agree that more data on how these sites work in the United States is needed. Let the data be collected and, in due time, we’ll have a clearer picture of the role OPCs can play to prevent the needless and heartbreaking loss of our loved ones to this epidemic.   

Brandon Marshall, Ph.D. is a professor of epidemiology at the Brown University School of Public Health, and the director of the People, Place & Health Collective at Brown University. Magdalena Cerdá, DrPH, is a professor in the Department of Population Health and director of the Center for Opioid Epidemiology and Policy at NYU Grossman School of Medicine.