New Empirical Evidence That Overdose Prevention Centers Save Lives

Jeffrey A. Singer

As I explained in a Cato briefing paper last year, overdose prevention centers (OPCs) are a proven harm‐​reduction strategy, begun in Switzerland in 1986. There are 147 sanctioned OPCs in 16 countries and 91 locations, including two in New York City, which announced they had reversed more than 1000 overdoses a year and a half after they opened. This saved the city millions of dollars in ambulance and emergency services.

The two OPCs in New York City are operating in defiance of federal law. A law passed in the 1980s, 21 U.S.C Section 856, or the “Crack House statute,” makes it a federal felony for organizations to allow people to use illicit drugs on their premises knowingly. So far, the US Justice Department has not taken action against OnPointNYC, the harm reduction organization operating the two OPCs, or the City of New York, which sanctions them.

Now comes more evidence to support harm reduction advocates’ claims that OPCs save lives. A study published in the February 2024 issue of The Lancet provides clear evidence that OPCs reduce overdose mortality in surrounding neighborhoods.

The researchers 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. Referring to the OPCs as “safe consumption services” (SCS), the authors concluded:

We found that the period during which SCS were implemented in Toronto was associated with a reduced overdose mortality in surrounding neighbourhoods. The magnitude of this inverse association increased from 2018 to 2019, equalling approximately two overdose fatalities per 100,000 people averted in the square mile surrounding SCS in 2019. Policy makers should consider implementing and sustaining SCS across neighbourhoods where overdose mortality is high.

Also in February, the Providence, RI City Council permitted a non‐​profit harm‐​reduction partnership, Project Weber/​RENEW, to open the state’s first OPC later this year. The organization is working with VICTA, a private substance abuse and mental health treatment program, which will offer services to OPC clients who want them. The Rhode Island legislature authorized privately funded OPCs in the state two years ago, provided they received local government approval.

And last May, Minnesota lawmakers authorized OPCs in that state.

Critics of OPCs voice concerns that they may attract drug‐​related crime in surrounding areas. But a study published in the Journal of the American Medical Association last November found “no significant increases in crimes recorded by the police or calls for emergency service in NYC neighborhoods where 2 OPCs were located” and concluded:

These findings suggest that concerns about crime and disorder remain substantial barriers to the expansion of OPCs in US cities, and initial data from NYC do not support these concerns.

As overdose fatalities mount, more states and municipalities are willing to give this proven harm‐​reduction strategy a try. Congress should adopt federalist principles by either repealing the Crack House statute or, if that is not feasible, amending it to allow state and local governments to permit OPCs within their jurisdictions, free from federal interference.