Overdose Prevention Centers
The Takeaway
Addiction is a chronic illness. But it is treatable, and every person with a substance use disorder deserves the opportunity to recover. That’s why it’s important to protect people in active addiction from fatal overdoses, or infections that may harm their health. Overdose Prevention Centers (OPCs), also known as supervised drug consumption sites or facilities, are one potential intervention for doing that.
Although the literature is limited, it is thus far promising that supervised drug consumption sites could be a tool for reducing risks for people who use illegal drugs while also increasing access to treatment and other health care services. There is little to no evidence of adverse impacts from OPCs, and there are promising indications of positive effects. However, any new OPC implemented should be rigorously designed to ensure that it meets the needs of clients and the community, and regularly evaluated to ensure it is beneficial.
The Evidence
What Are OPCs? And where are they?
Injection drug use carries numerous risks, including overdose and infection. Smoking illegal drugs, such as methamphetamine and crack cocaine, carries similar risks. One approach to reducing these risks for individuals using drugs is an overdose prevention center. These facilities offer a safe, clean, medically supervised environment in which people can consume their drugs. At least 120 OPCs exist in Europe and Canada. The first OPC in the U.S. opened in New York City in 2021, and additional cities are considering implementing them.
OPCs provide a legally sanctioned space into which individuals can bring their own drugs and use them under the supervision of medical staff, who are always prepared to administer overdose reversal drugs if necessary. These facilities also offer sterile injection or smoking supplies and proper disposal containers for waste related to drug use. OPCs can take many forms, including both safe injection facilities (SIFs), solely for injecting drugs, and safe smoking facilities (SSFs), solely for smoking drugs. The world’s first OPC opened in 1986 in Bern, Switzerland, and the first OPC established in North America was Insite, which opened in Vancouver, Canada in 2003.
What Are The Impacts Of OPCs?
Several studies have indicated potential benefits from OPCs, both for those using the facility and for the surrounding community. Following the opening of the first OPC in Vancouver, fatal overdose rates in the immediate area dropped by 35%, and by 9.3% in the rest of the city. Following the opening of an SIF in Sydney, Australia, there was a 68% decrease in the monthly average number of ambulance attendances at opioid-related overdoses in the immediate vicinity and a 61% decrease in such attendances across the rest of the state.
Among those injecting drugs, use of an OPCs is associated with a significant decrease in syringe sharing, as well as an increase in safer injection practices, and a decrease in unsafe disposal of syringes. OPCs have been shown to reduce the risk of disease transmission.
Communities benefit from OPCs, too. OPCs have been shown to be associated with reduced public injection drug use and public syringe disposal, among other public improvements. Residents and business operators near one SIF in Sydney, Australia, saw significant community improvement, such as less drug use and syringe waste in public places over time following the opening of the facility.
While some believe that OPCs may increase drug use, studies have shown that using an OPC is associated with an increased likelihood of initiating addiction treatment, which is then associated with a decrease in, or complete cessation of, injection drug use. Similarly, OPCs have not been shown to increase crime, violence, or drug consumption in the surrounding areas.
Among individuals who inject drugs, OPC have been shown to be generally accepted, with between 68% and 85% of individuals interviewed across several cities noting that they would use an OPC if it opened nearby. Initial data from an unsanctioned SIF in the United States demonstrate potential for substantial risk reduction, as participants reported engaging in numerous high-risk behaviors (publicly injecting, using nonsterile syringes, having encounters with the police) when they did not have access to injecting at the facility.
Cost-effectiveness analysis of a hypothetical OPC in Baltimore show that such a facility would cost $1.8 million and generate $7.8 million in savings, predominantly from reduced transmission of infectious diseases. Analysis of a similar hypothetical SCF in Montreal, Canada showed a net savings of CDN$0.686 million from prevention of HIV cases, and CDN$0.8 million from prevention of Hepatitis C cases, for each new OPC each year.
There is still more room for the positive impacts of OPCs to grow. For example, currently those who require assistance injecting cannot use the Vancouver OPC, a limitation which enables many high risk behaviors to continue to occur. And as one comprehensive report notes, it will be important to rigorously evaluate any new OPCs that do open.
It is key to note that the causal effects of OPCs are still being evaluated. While there is promising indication of positive effects, there is still a need for rigorous studies, such as randomized control trials, to firmly understand how much the above listed positive impacts are due to the OPCs themselves, and not associated factors. However, it is important to highlight that evidence does not point to negative impacts from OPCs implementation, and therefore the potential for large benefits must be viewed in this context.
Overall
In conclusion, the existing evidence shows that OPCs could be a valuable tool to reduce harm, increase health, and improve communities. Design of an OPC should be carefully considered prior to implementation to ensure the facility meets the needs of community stakeholders and will serve its purpose in keeping clients and health workers safe. It must also be rigorously evaluated.
