Jeffrey A. Singer
On December 10, the country’s first state-sanctioned overdose prevention center (OPC) held a ribbon-cutting ceremony in Providence, Rhode Island. The center, located at 45 Willard Avenue, near the Rhode Island Hospital campus, was established and will be operated by the private non-profit harm reduction organization Project Weber/RENEW.
In July 2021, Rhode Island Governor Daniel McKee signed into law a bill authorizing two pilot OPCs in the state, which would receive no taxpayer funding and be regulated, inspected, and licensed by the Rhode Island Department of Health. Once it gets the final green light from the Department of Health, the center will open.
As I wrote in a 2023 Cato Policy Analysis, “OPCs have a more-than-30-year track record of preventing overdose deaths, HIV, hepatitis, and other diseases, and of helping people with substance use disorder find treatment. As of August 2022, 147 OPCs are providing services in 91 communities in 16 countries.” The first government-sanctioned OPC began operating in Bern, Switzerland, in 1986 and continues to operate.
Two city-sanctioned OPCs have been operating in New York City since the end of 2021. By the summer of 2023, they reversed more than 1,000 overdoses. A study reported earlier this year in The Lancet examined the overdose mortality rates in Toronto, Canada, between May 2017, when nine OPCs opened in the city, and December 2019. They found that overdose fatalities dropped significantly during that period in neighborhoods surrounding the OPCs but not in other neighborhoods.
The Providence OPC will have eight injection/us booths and two smoking rooms that can accommodate an additional eight people for smoking. As I mentioned in a previous blog post, an increasing number of people are smoking fentanyl rather than injecting it. With drug dealers increasingly offering fentanyl in pill form rather than as a powder, users are finding it more convenient to crush and smoke the substance instead of dissolving the powder for injection.
Advocates for public health have urged individuals who use drugs to transition to non-injection methods, as these are associated with a lower risk of skin infections, soft tissue damage, and blood-borne diseases. Smoking fentanyl may also decrease the risk of overdose because it enables users to adjust the dosage better to reach their intended effect, a process that is more challenging with injection. This switch to smoking might help explain the recent tapering of the drug overdose death rate.
Unfortunately, while the New York City and Providence OPCs are officially sanctioned in their local jurisdictions, they remain federally illegal because of 21 U.S.C. Section 856, the so-called “crack house statute,” which federally prohibits entities from knowingly permitting people to use federally illicit substances on their premises. Thus far, the Department of Justice has exercised prosecutorial discretion by not moving in to shut down these centers and arrest those who operate them. But that might change in the incoming administration. Congress should repeal or amend the law to allow OPCs to save lives in states and cities that sanction them.
