A comprehensive review of the literature and evidence behind overdose prevention centers compiled by the Vermont Department of Health. (VDH, April 2024)

A guide to the best practices and key considerations for establishing an overdose prevention center, based on findings from focus groups across the USA. (DPA, 2024)

Compilation of evidence relating to overdose prevention centers. “Scientific Update on Overdose Prevention Centers: Annotated Bibliography 2022-2023. People Place & Health Collective and Drug Policy Alliance (2023)

This paper explored the impact of safer supply programs on injection practices from the perspective of clients and providers in Ontario, Canada. Authors concluded that “Safer supply programs can contribute to reducing injection-related health risks in addition to overdose risks. More specifically, they have the potential to address disease prevention and health promotion gaps that stand-alone downstream harm reduction interventions cannot address, by working upstream and providing a safer alternative to fentanyl.” Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada. Marilou Gagnon, Katherine Rudzinski, Adrian Guta, Rose A. Schmidt, David T. Kryszajtys, Gillian Kolla & Carol Strike. Harm Reduction Journal volume 20, Article number: 81 (2023)

“Accumulating evidence has indicated that cannabis substitution is often used as a harm reduction strategy among people who use unregulated opioids (PWUO) and people living with chronic pain. (The study) sought to investigate the association between cannabis use to manage opioid cravings and self-reported changes in opioid use among structurally marginalized PWUO. . . (The) findings indicate that cannabis use to manage opioid cravings is a prevalent motivation for cannabis use among PWUO and is associated with self-assessed reductions in opioid use during periods of cannabis use. Increasing the accessibility of cannabis products for therapeutic use may be a useful supplementary strategy to mitigate exposure to unregulated opioids and associated harm during the ongoing drug toxicity crisis. ” Cannabis use to manage opioid cravings among people who use unregulated opioids during a drug toxicity crisis. Hudson Reddon, Stephanie Lake, Maria Eugenia Socias, Kanna Hayashi, Kora DeBeck, Zach Walsh, M-J Milloy. International Journal of Drug Policy, Volume 119, September 2023

Project focused on increasing education and awareness around xylazine in opioid user populations and primary care providers who work with these patients.

Patlak, David J., "Xylazine as an Emerging Risk in Vermont: Harm Reduction for Primary Care Providers and Patients" (2023). Family Medicine Clerkship Student Projects. 862.

Opinion article with summary of evidence in support of Overdose Prevention Centers: “Supervised injection sites improve health outcomes. One study found a 26% net reduction in overdose deaths in the area surrounding a supervised injection site in Vancouver, Canada, compared with the rest of the city. A supervised injection site in Barcelona, Spain, was associated with a 50% reduction in overdose mortality from 1991 to 2008.”

Jorge Finke, MD, Jie Chan, MD. The Case for Supervised Injection Sites in the United States. Am Fam Physician. (May 2022);105(5):454-455.

Harocopos Alex, Brent E. Gibson, Nilova Sahal, Michael T. McRae, Kailin See, Sam Rivera, and Dave A. Chokshi. “First 2 Months of Operation at First Publicly Recognized Overdose Prevention Centers in US.” JAMA Network Open 5 (July 2022)

Research brief finding that “while overdose death rates have increased in every major demographic group in recent years, no group has seen a bigger increase than Black men. As a result, Black men have overtaken White men and are now on par with American Indian or Alaska Native men as the demographic groups most likely to die from overdoses.” (John Gramlich, Pew Research Institute, January 2022)

Study of an SCS, finding that each overdose that is managed at the SCS produced a benefit of $1622. The benefit of averting the cost of ambulance and emergency department care ranges between $39,739 and $74,612 per month, from November 2017 to January 2020, and that overall, there were $2,364,876 cost savings produced from the overdoses that were managed at the SCS site, by avoiding the need for ambulance and emergency department services. Also in 10% of clients were not coming to use drugs, many utilizing resources for other types of care and referrals. The number of people who frequent the SCS has increased, but the need for ambulance responses to overdoses have decreased. (Khair, Shahreen, Cathy A. Eastwood, Mingshan Lu, and Jennifer Jackson. 2022. “Supervised Consumption Site Enables Cost Savings by Avoiding Emergency Services: A Cost Analysis Study.” Harm Reduction Journal 19 (1): 32.)

Study finding that “People using the SCS were 27% less likely to visit the emergency department, had 54% fewer emergency department visits, were 32% less likely to be hospitalized, and spent 50% fewer nights in hospital.” (Lambdin, B.H., Davidson, P.J., Browne, E.N. et al. Reduced Emergency Department Visits and Hospitalisation with Use of an Unsanctioned Safe Consumption Site for Injection Drug Use in the United States. J GEN INTERN MED 37, 3853–3860 (2022))

Study finding that drug consumption rooms minimize skin and soft tissue infections among people who inject drugs because they provide sterile equipment, thus preventing reuse of materials. Also finding decreased emergency department visits. (Roux, P, M Jauffret-Roustide, C Donadille, L Briand Madrid, C Denis, I Célérier, C Chauvin, et al. 2022. “Impact of Drug Consumption Rooms on Non-Fatal Overdoses, Abscesses and Emergency Department Visits in People Who Inject Drugs in France: Results from the COSINUS Cohort.” International Journal of Epidemiology, June, 2022)

In July 2021, the Rhode Island government passed legislation supporting a two-year pilot program authorizing supervised consumption sites (SCSs) in response to the overdose crisis. This study estimated the costs and benefits of a hypothetical SCS in Providence, Rhode Island and found that SCS in would result in substantial cost savings due to prevention of costly emergency overdose care. (Laura C. Chambers, Benjamin D. Hallowell, Xiao Zang, David M. Rind, Greg F. Guzauskas, Ryan N. Hansen, Nathaniel Fuchs, Rachel P. Scagos, Brandon D.L. Marshall, “The estimated costs and benefits of a hypothetical supervised consumption site in Providence, Rhode Island,” International Journal of Drug Policy, Volume 108, 2022)

Study on barriers to implementing drug checking programs with additional evidence for use of such programs to prevent overdose (“Drug checking, or the use of technology to provide insight into the contents of illicit drug products, is an evidence-based strategy for overdose prevention.”) The Bronze Age of drug checking: barriers and facilitators to implementing advanced drug checking amidst police violence and COVID-19. Jennifer J. Carroll, Sarah Mackin, Clare Schmidt, Michelle McKenzie & Traci C. Green, Harm Reduction Journal volume 19, Article number: 9 (2022)

Journal article considering the “barriers to equitable drug checking services that impede population reach and distribution of services according to population need. Participants reported major barriers to access for themselves and others due to structural determinants including geography, criminalization, and stigma. Barriers also included lack of knowledge and cultural appropriateness of drug checking within certain communities, and individuals’ attitudes and behaviours around substance use and drug checking.”

Wallace, B., van Roode, T., Burek, P. et al. Everywhere and for everyone: proportionate universalism as a framework for equitable access to community drug checking. Harm Reduct J 19, 143 (2022)

This paper reviewed 22 studies about the impacts of SCSs on health and community outcomes, like overdose and crime rates. It found that “The strongest evidence suggests that SIFs may help reduce overdose morbidity and mortality and improve access to addiction treatment. An increase in crime, an often-cited concern of SIF opponents, was not observed to be associated with SIFs in most included studies, and crime was actually found to decrease in 2 studies.” (Levengood, Timothy W., Grace H. Yoon, Melissa J. Davoust, Shannon N. Ogden, Brandon D. L. Marshall, Sean R. Cahill, and Angela R. Bazzi. "Supervised Injection Facilities as Harm Reduction: A Systematic Review." American Journal of Preventive Medicine 61, no. 5 (2021): 738-749

Systematic review, which found that “monitoring of drug markets by drug checking services is well established in Europe and increasingly in North America; there is an emerging evidence base on the capacity of drug checking services to influence behavioural intention and, to a lesser extent, enacted behaviour, among people who use drugs.” (Maghsoudi, N, Tanguay, J, Scarfone, K, Rammohan, I, Ziegler, C, Werb, D, et al. Drug checking services for people who use drugs: a systematic review. Addiction. 2022; 117: 532– 544.)

Researchers “sought the perspectives of people involved in the unregulated drug market on how drug checking could be implemented as a market intervention within the current context of a highly unpredictable drug supply and unprecedented rates of overdose.” Findings suggest the need to prioritize trust and safety in the program design. (Bruce Wallace, Thea van Roode, Piotr Burek, Bernadette Pauly & Dennis Hore, Implementing drug checking as an illicit drug market intervention within the supply chain in a Canadian setting, Drugs: Education, Prevention and Policy (2022))

In response to a dramatic rise in overdose deaths due to injection drug use, there was a rapid scale-up of low-threshold supervised injection services (SIS), termed ‘overdose prevention sites’ (OPS), in Vancouver, Canada in December 2016. Researchers measured the potential impact of this intervention on SIS use and related health outcomes among people who inject drugs, and found that scaling up overdose prevention sites in Vancouver was associated with immediate and continued gradual increases in supervised injection service engagement and immediate increases in related health benefits. (Kennedy MC, Hayashi K, Milloy MJ, Compton M, Kerr T. Health impacts of a scale-up of supervised injection services in a Canadian setting: an interrupted time series analysis. Addiction. 2022 Apr;117(4):986-997.)

Kral, Alex H., Barrot H. Lambdin, Lynn D. Wenger, Erica N. Browne, Leslie W. Suen, and Peter J. Davidson. 2021. “Improved Syringe Disposal Practices Associated with Unsanctioned Safe Consumption Site Use: A Cohort Study of People Who Inject Drugs in the United States.” Drug and Alcohol Dependence. Available via Science Direct.

“Harm reduction services, which typically provide overdose education and prevention with distribution of naloxone and other supplies related to safer drug use, help reduce opioid-related overdose and infectious disease transmission. However, structural stigma and the ongoing criminalization of drug use have limited the expansion of harm reduction services into many non-urban communities in the United States that have been increasingly affected by the health consequences of opioid and polysubstance use.” Authors of the study “conducted qualitative interviews with 22 professionals working with people who use drugs in cities and towns across Rhode Island and Massachusetts to understand challenges and strategies for engaging communities in accepting harm reduction perspectives and services.” Implementing harm reduction in non-urban communities affected by opioids and polysubstance use: A qualitative study exploring challenges and mitigating strategies. E. Childs, K.B. Biello, P.K. Valente, P. Salhaney, D.L. Biancarelli, J. Olson, J.J. Earlywine, B.D.L. Marshall, A.R. Bazzi. International Journal of Drug Policy, Volume 90, April 2021.

Department of Health Report to explore the potential impact of incorporating overdose prevention centers into the City’s opioid response strategy. Based upon a literature review to summarize the international experience with OPCs and was developed in consultation with an Expert Advisory Panel comprised of national and international drug policy experts, scientists, and advocates was assembled to guide the study. NYC Health, 2018.

A review of literature pertaining to techniques, implementation models, and the benefits and risks associated with drug checking as a harm reduction intervention, with particular focus on existing drug checking services in other jurisdictions such as Western Europe. (British Columbia Centre on Substance Use, 2017)

A review by the Ontario Rapid Response Service of evidence about the effectiveness of safe injection sites (overdose prevention centers). (OHTN, 2014)