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What’s the deal with Overdose Prevention Sites?

August 23, 2022

Principle 2 outlines that spending decisions should be based on programs and interventions that are evidence-based. But what about emerging interventions or novel programs? There may be instances where it makes sense to use litigation dollars to fund pilot programs for new or evidence-informed interventions.

Overdose Prevention Sites (sometimes referred to as supervised consumption spaces or safe injection sites) are one example that some places are excited to implement. Though not new interventions, they are novel to the US. But why have these sites divided politicians and the public? We breakdown some frequently asked questions about Overdose Prevention Sites and how they work to save lives.

What are overdose prevention sites?

Overdose prevention sites have long been a harm reduction strategy used to prevent overdoses. These spaces, which are supervised by medical professionals and other trained staff, provide a safe location for individuals to use drugs. Overdose prevention sites typically provide additional services such as fentanyl test strips, healthcare services, counseling, and referrals to health and social services, including drug treatment, as part of an integrated care model.

The first legal supervised consumption space opened in Berne, Switzerland in 1986 as a strategy to combat the spread of HIV/AIDS among people who use drugs by providing new, sterile drug use supplies. Currently, more than 120 overdose prevention centers operate in eleven countries around the world – Australia, Canada, Denmark, France, Germany, Luxembourg, the Netherlands, Norway, Spain, Switzerland, and now the United States.

What is going on here in the United States?

In December 2021, New York City opened the nation’s first two overdose prevention sites. In the first three months of operation, the sites have seen 10,470 visits by 857 individuals. According to OnPoint, the non-profit that manages these OPS, staff have been able to intervene in 300 overdoses across both sites. Additionally, the Sanitation Department collecting syringes in Highbridge Park in Washington Heights has estimated that discarded syringes have decreased from 13,000 per month to about 1,000.

Others are following suit. Rhode Island is preparing to start an overdose prevention site and Philadelphia, PA has been attempting to launch one for the last few years.

What about the legal issues?

The legal status of overdose prevention sites has been controversial in the United States, with some arguing that they violate the Controlled Substances Act. This has contributed to legal challenges that have kept Safehouse, a Philadelphia-based non-profit organization, from opening an overdose prevention site. The United States Department of Justice is currently in discussions with Safehouse and has agreed to weigh in on Safehouse’s stance that they are providing a vital public health service and are therefore not in violation of federal law.

Similar challenges have been seen in other jurisdictions. Recently, California’s governor vetoed a bill that would have allowed pilot overdose prevention sites in Los Angeles, San Francisco and Oakland.

Despite the legal barriers, OnPoint in New York, with support from state and local officials, has pushed forward, working with community partners to integrate into existing harm reduction infrastructure to pilot their operation.

But is the evidence there?

Outcomes from overdose prevention centers have been studied and published over the last 30 years and fall into three main buckets: health outcomes, cost-effectiveness, and public perceptions.

  • Health outcomes
    • Fatal overdose
      • No fatal overdoses have been reported at any overdose prevention site
      • Decreased fatal overdoses in areas immediately surrounding the sites
    • Quality of life for neighborhoods
      • Decrease in improper syringe disposal
      • No increase in crime, nuisance, or drug use in communities
    • Quality of life for people who use drugs
      • Increased access to drug treatment and mental health services
      • Decrease in HIV and Hepatitis C transmission
    • Reduction in high risk behaviors
  • Cost-effectiveness

A cost-effectiveness and cost-benefit analysis of an overdose prevention site in Vancouver, Canada, estimated that the site had prevented 35 cases of HIV and 3 overdose deaths each year, for an annual savings of $6 million in health costs.

Preventing overdoses can also alleviate burdens on local hospital emergency departments and emergency responders. One projection showed that if Baltimore, Maryland opened an overdose prevention site, the city would see a total net savings of almost $6 million per year.

  • Public perceptions

Opinion polling suggests that people who use drugs view overdose prevention sites as an opportunity to improve health outcomes and the relationship with the larger community. Local residents and business owners generally support the services the OPS provide, though they often have concerns about perceived risks of the sites, including safety and cleanliness.

Is this a good use of litigation funds?

Using funds from the opioid litigation to establish overdose prevention sites may make sense given the infrastructure costs associated with establishing such a site (see Rhode Island’s Strategic Plan as an example). Additionally, using other funding streams may not be feasible. As with all spending considerations, the decision for a locality to fund an overdose prevention site should depend on the needs of the community and the usefulness of the site to the individuals in that community.

Researchers conducted interviews with key informants in five jurisdictions that are considering establishing an overdose prevention site and found that building on existing harm reduction infrastructure and finding support from political champions was important to the successful implementation of a site. Other studies have found that community members are open to conversations about overdose prevention sites and that good data and political support help to improve community feelings about OPS.

For more information on Overdose Prevention Sites and using litigation dollars to fund them, see Chapter 3 of Evidence Based Strategies for Abatement of Harms and Strategy 8 of the Primer on Spending Funds from the Opioid Litigation.