Overdose prevention centers OPCs are safe spaces where people can consume pre-obtained substances and be supervised post-consumption by personnel trained to identify and respond to the earliest signs of overdose. Such supervision is often just one part of the harm-reduction and wellness services made available to participants. Often behavioral-health support, drug treatment, minor medical assistance, showers, laundry and other assistance are available to those who need and want such supports.

OPCs have been implemented throughout the world with significant success for decades. Currently, more than 200 overdose prevention centers operate in at least 14 countries around the world, often staffed by peer mentors and/or medical professionals. OPCs are operating in dozens of sites throughout Canada (click here for a map of existing facilities.)

Overdose Prevention Centers (OPCs) reduce drug-related loss of life. Instead of a person using a substance alone or with someone else who may not be qualified to properly assist in the event of an overdose, OPCs allow trained personnel to immediately respond with appropriate care. That training and proximity to the individual experiencing the crisis prevents overdoses from becoming fatal. OPCs also prevent many more overdoses by encouraging safer use practices such as reducing dosage and providing on-site drug checking services.

See e.g.:

• Brandon DL Marshall PhD, M-J Milloy MSc, Evan Wood PhD, Prof Julio SG Montaner MD, Thomas Kerr PhD, Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study. Lancet. 2011;377(9775):1429-1437. (reporting a 35% decrease in overdose deaths in the community surrounding an OPC).

• Semaan, S., Fleming, P., Worrell, C., Stolp, H., Baack, B., & Miller, M. (2011). Potential role of safer injection facilities in reducing HIV and hepatitis C infections and overdose mortality in the United States. Drug and alcohol dependence, 118(2-3), 100–110. https://doi.org/10.1016/j.drugalcdep.2011.03.00

• Yoon, G. H., Levengood, T. W., Davoust, M. J., Ogden, S. N., Kral, A. H., Cahill, S. R., & Bazzi, A. R. (2022). Implementation and sustainability of safe consumption sites: a qualitative systematic review and thematic synthesis. Harm Reduction Journal, 19, 73. https://doi.org/10.1186/s12954-022-00655-z.

• Oudshoorn, A., Sangster Bouck, M., McCann, M., Zendo, S., Berman, H., Banninga, J., Le Ber, M. J., & Zendo, Z. (2021). A critical narrative inquiry to understand the impacts of an overdose prevention site on the lives of site users. Harm Reduction Journal, 18(1), 6. https://doi.org/10.1186/s12954-020-00458-0

• Kral AH, Lambdin BH, Wenger LD, Davidson PJ. Evaluation of an Unsanctioned Safe Consumption Site in the United States. The New England journal of medicine. 2020;383(6):589-590. DOI: 10.1056/NEJMc2015435

For decades OPCs have been implemented throughout the world with significant success. Currently, more than 200 overdose prevention centers operate in at least 14 countries, often staffed by peer mentors and/or medical professionals. OPCs are operating in dozens of sites throughout Canada (click here for a map of existing facilities.)

States in the US are also beginning to move forward with the implementation of OPCs. In December 2021, OnPoint NYC opened the nation's first-ever Overdose Prevention Centers in Harlem and Washington Heights. Since opening, the sites have helped intervene in over 1,200 overdoses and served several thousand individual clients, while providing a wide array of other supportive services. OnPoint has demonstrated that the operation of overdose prevention programs in the United States can be highly successful and beneficial. The New York City Health Department has developed guidelines for operating OPCs in the city.

Rhode Island has also passed a law to authorize “harm reduction centers,” which will include supervised consumption services. The first such center is expected to open in 2024. (For more information see See Rhode Island’s Harm Reduction Pilot Program fact sheet.)

OPCs help provide treatment and build connections to treatment. Many such programs also provide screening, prescribing and treatment with buprenorphine (the gold standard of medication-assisted treatment (MAT). Programs frequently offer connections to supervised withdrawal providers and other addiction treatment programs.

A major report prepared by the National Institutes of Health highlighted a 2017 systematic review of literature “that concluded there is consistent evidence to demonstrate that OPCs are cost-effective, based on their ability to mitigate overdose-related harms and unsafe drug use behaviors, as well as facilitate uptake of addiction treatment and other health services among persons who use drugs, without increasing drug-related crime.”

National Institutes of Health / National Institute on Drug Abuse report on Overdose Prevention Centers (available at: https://nida.nih.gov/sites/default/files/NIH-RTC-Overdose-Prevention-Centers.pdf) citing Kennedy MC, Karamouzian M, Kerr T. Public Health and Public Order Outcomes Associated with Supervised Drug Consumption Facilities: a Systematic Review. Current HIV/AIDS reports. 2017;14(5):161-183.

OPCs benefit the communities where they’re located in many ways, including by reducing public drug use and syringe litter in public spaces. Studies have documented significant reductions in public injection drug use and publicly discarded syringes in the communities surrounding such facilities. See e.g. Wood E, Tyndall MW, Montaner JS, Kerr T. Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2006;175(11):1399-1404.

In just its first year of operation in New York, OnPoint found that, in 81 percent of visits to facilities, its its OPC participants would have otherwise used the substance in a public space.” (See Dr. Brent Gibson, PhD, Kailin See, Brittney Vargas Estrella, Sam Rivera, Baseline Report on the Operation of the First Recognized Overdose Prevention Centers in the United States (December 2023). Available at: https://onpointnyc.org/wp-content/uploads/2023/12/ONPOINTNYC_OPCREPORT_small-web1.pdf

Studies have shown no increases in drug use or crime in the areas surrounding OPCs. A recent study published in November 2023 found no significant changes in the volume of violent or property crimes reported by police, 911 calls for crime or medical incidents, or 311 calls for public drug use or unsanitary conditions around the OnPoint OPC locations in New York City. Chalfin A, del Pozo B, Mitre-Becerril D. Overdose Prevention Centers, Crime, and Disorder in New York City. JAMA Netw Open. 2023;6(11):e2342228. doi:10.1001/jamanetworkopen.2023.42228

See also:

• Potier C, Laprevote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug and alcohol dependence. 2014;145:48-68.

• Kerr T, Stoltz JA, Tyndall M, et al. Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study. Bmj. 2006;332(7535):220-222.

Some who oppose harm reduction strategies like OPCs argue that federal law prohibits them. The argument relies on a minor part of the Controlled Substance Act intended to criminalize selling of drugs from homes or other properties - a law passed before OPCs had been established widely throughout the world.

The federal law in question, often referred to as the “crackhouse statute” (21 USC 856), makes it unlawful to “knowingly lease, rent, use, or maintain any place, whether permanently or temporarily, for the purpose of manufacturing, distributing, or using any controlled substance.”

Many legal scholars and law enforcement leaders (including many state attorney generals, prosecutors, and former Department of Justice officials) believe that federal law does not prohibit interventions like OPCs - particularly when they are authorized by states. See e.g. Amicus brief by the District of Columbia and nine states in U.S. v. Safehouse, July 6, 2020 (Indeed, unlike crack houses or raves, (OPCs) do not distribute, manufacture, or encourage drug possession, but rather “serve a medical purpose by providing counseling to people with a substance use disorder, preventing overdoses, and stopping the use of dirty needles. . . SISs thus do not present the identified dangers that Congress feared when Section 856 was enacted.)

An attempt to use the statute to prohibit the opening of an OPC has only been raised in one federal district court in Philadelphia. Despite a finding by the Third Circuit Court of Appeals that the federal statute could be interpreted to prohibit OPCs, there has been no finding by a federal court with authority over Vermont that the law would prohibit OPCs.

No federal agency has attempted to intervene in other states that are moving forward on OPCs. There has been no enforcement action to halt the operation of OnPoint NYC’s two OPC locations in New York City, and no federal objections have been made to the statute passed in Rhode Island to establish an OPC, which is expected to launch this year. Notably, a spokesperson for the Department of Justice reportedly has said “that supervised consumption sites were being evaluated on a district by district basis, in discussion with local leaders, to determine ‘appropriate regulatory guardrails.’”

Even if more federal courts interpret the disputed federal statute to at least permit federal intervention, the federal law should not serve as a barrier to opening OPCs any more than federal drug laws have impeded establishing legal, regulated access to cannabis in the states. Despite federal cannabis prohibition a large majority of states provide medical access to the substance and nearly half regulate access to cannabis for non-medical adult use.

States retain broad power to legislate protection for their citizens in matters of public health. Most states, including Vermont, have “Good Samaritan” laws that eliminate the threat of arrest for drug possession by those who call for emergency help during a medical emergency. Last year Vermont passed a law providing criminal and civil immunity to those participating in or providing “drug checking” services, and permanently decriminalized unauthorized possession of the treatment medication, Buprenorphine. The continued existence of federal laws prohibiting possession of drugs did not prevent Vermont or other states from passing such laws that prioritize saving lives over criminalization.

Attorney Generals from around the country, including former Vermont Attorney General T.J. Donovan, former U.S. Attorney Jerome O’Neill, and former Attorney General Kimberly B. Cheney have joined legal briefs supporting states’ rights to establish OPCs.

Any unresolved and unlikely conflict with federal law should not stop Vermont from passing laws that help protect lives and better care for those needing wrap-around services in the state.

In addition to the live-saving benefits of OPCs, such facilities provide a cost savings for local governments. Such facilities reduce calls for emergency services and admissions to hospital emergency departments, not only for overdose-related incidents, but also medical responses resulting from infectious disease transmission, skin and soft tissue infections, other conditions that may be addressed with minor care that can be provided in connection with OPCs.

One study focused on San Francisco found that “each dollar spent on a (supervised injection facility) would generate $2.33 in savings, for total annual net savings of $3.5 million for a single 13-booth (facility.)” Another study estimating the benefits focused on Baltimore estimated an annual net savings of $7.8 million. Yet another study conducted to estimate the costs and benefits of a potential OPC in Providence, Rhode Island, found that it would prevent approximately “261 ambulance runs, 244 ED visits, and 117 inpatient hospitalizations for emergency overdose care annually compared to a scenario that includes a syringe service program only” for an estimated savings of over $1.1 million annually compared to the syringe service program only.

See e.g.:

• Irwin, A., Jozaghi, E., Bluthenthal, R. N., & Kral, A. H. (2017). A cost-benefit analysis of a potential supervised injection facility in San Francisco, California, USA. Journal of Drug Issues, 47(2), 164–184. https://doi.org/10.1177/0022042616679829

• Irwin, A., Jozaghi, E., Weir, B. W., Allen, S. T., Lindsay, A., & Sherman, S. G. (2017). Mitigating the heroin crisis in Baltimore, MD, USA: A cost-benefit analysis of a hypothetical supervised injection facility. Harm Reduction Journal, 14, 29. https://doi.org/10.1186/s12954-017-0153-2

• Chambers, L. C., Hallowell, B. D., Zang, X., Rind, D. M., Guzauskas, G. F., Hansen, R. N., Fuchs, N., Scagos, R. P., & Marshall, B. D. L. (2022). The estimated costs and benefits of a hypothetical supervised consumption site in Providence, Rhode Island. International Journal of Drug Policy, 108. https://doi.org/10.1016/j.drugpo.2022.103820

• Institute for Clinical and Economic Review. (2020). A Look at Supervised Injection Facilities. https://icer.org/wp-content/uploads/2020/10/SIF-RAAG-010521.pdf

OPCs have been extensively researched over the past two decades and found to be beneficial for the health, safety and well-being of people who use drugs and surrounding communities. The 2021 National Institutes of Health report reviewing the available literature found that the “preponderance of the evidence suggests these sites are able to provide sterile equipment, overdose reversal, and linkage to medical care for addiction, in the virtual absence of significant direct risks like increases in drug use, drug sales, or crime.”

Several states have conducted their own studies of OPCs. The Massachusetts Department of Public Health concluded in a December 2023 report that “(t)he success, cost effectiveness, and life-saving ability of OPCs has been proven in Europe, Canada, and now in New York City” and recommended that the Commonwealth “should support harm reduction agencies to expand harm reduction drop-in centers to include OPCs, including funding for clinical staff and supplies.”

A more extensive federal study of OPC pilot projects in the United States is underway. In May of 2023, the National Institute on Drug Abuse (NIDA) announced it would provide funding to Brown University School of Public Health and New York University Langone Health to study the impacts of the operating OPCs in New York City and forthcoming OPC in Rhode Island.

Alongside the ongoing research, sufficient and clear evidence supports the establishment of further projects around the United States, particularly in states like Vermont that have experienced high rates of fatal overdose.

In 2024, Vermont passed bill H.72, which provides legal structure for OPCs and uses settlements from pharmaceutical companies to fund one pilot site. The bill had tri-partisan support and was backed by hundreds of Vermonters and over 50 Vermont organizations, including treatment providers, medical professionals, harm reduction service providers, people who use drugs, people who have lost loved ones, and more.

Now that the bill is law, Vermont is ready to move forward with OPCs. Implementation will involve establishing state guidelines, identifying providers, engaging the local community, and reporting on the success of the center.

While the bill only provides funding for one pilot site, it allows for centers throughout the state.