In late August, Governor Newsom vetoed SB57, a bill that would have allowed San Francisco, Oakland, and Los Angeles to open overdose prevention centers (OPCs). These centers offer indoor spaces where people can use drugs (that they have already obtained) safely, by providing safe supplies to limit infection along with response (e.g., naloxone, oxygen) to treat overdoses that occur onsite. They often provide basic medical care such as treating skin infections and wounds, and they also often offer access to primary care services and evidence-based treatment for drug addiction, like starting buprenorphine for opioid use disorder.
The veto occurred one week before International Overdose Awareness Day, a day mourning the hundreds of thousands of lives lost to overdose. Frustrated by the lackluster results of relying on criminal justice response to addiction and struggling with rising overdose deaths from an increasingly dangerous drug supply poisoned by illicitly manufactured fentanyl, many city governments are urging state and federal governments to allow these centers to open.
The Evidence for Overdose Prevention Centers
What may seem like a radical idea to some in the United States has been a practical intervention since 1986 in many countries across the Western world (including Australia, Belgium, Canada, France, Germany, Portugal, Spain, and Switzerland). In studies evaluating such centers, individuals who used OPCs were less likely to die from overdose and were more likely to reduce the amount and frequency of their drug use and increase use of drug treatment services.
In surrounding communities, OPCs help reduce public drug use. Studies show that by bringing people inside, syringe litter in neighboring areas decreases as do emergency calls and hospitalizations. Multiple studies have confirmed that crime does not increase in a neighborhood when OPCs are established.
With this evidence, in November 2021 New York City opened the nation’s first two OPCs, run by OnPoint NYC. In the first nine months of operation, OnPoint NYC reported more than 1,600 people used its sites, and the center intervened on more than 400 overdoses. In the same week that Governor Newsom vetoed SB57, San Francisco announced that it had counted 346 overdose deaths to date in 2022.
The evidence is clear that OPCs offer benefits for both the individuals who use them and the neighborhoods that house them, which prompted the California State and Assembly to pass this bill. What keeps individual cities or states potentially hesitant is perhaps the risk of federal prosecution. When Philadelphia tried to open an OPC in 2020, it was sued by the Trump Administration, and its case is still held up in the courts.
Many are looking to the Biden Administration to declare where it stands on OPCs. So far, the odds are in favor of OPCs, with the Biden Administration announcing it was “evaluating supervised consumption sites, including discussions with state and local regulators about appropriate guardrails for such sites, as part of an overall approach to harm reduction and public safety.”
Likely because the Biden Administration has not prosecuted OPCs in New York and signaled openness to these ideas and because of this strong evidence base, San Francisco has announced it is still moving forward with officially opening its own OPC soon. Less than 24 hours after the veto was announced, San Francisco’s City Attorney David Chiu announced said the city is considering pushing forward with opening an OPC despite the veto, in efforts to try to mimic the success in New York.
OPCs and Drug Addiction Treatment
The issue of harm reduction or treatment is not “either/or” but rather “yes, and.” We can focus on offering people both harm reduction tools and addiction treatment based on what they’re ready to receive. Treatment also is effective only when individuals are ready to accept it. People often ask why we cannot force people into addiction treatment. Forcing someone to go into a treatment program can even be more dangerous, as individuals returning to drug use after exiting months-long programs have reduced drug tolerance, and they can become even more susceptible to overdose because they misjudge how much their body can handle.
Our best tools to address opioid use disorder include medications like buprenorphine and methadone. Accessing them is not easy. State and federal governments are working tirelessly to improve drug treatment systems in the face of escalating overdoses, but fixing these systems take time. We need both harm reduction strategies like OPCs to keep people safe, and we need to work on making evidence-based, high quality drug treatment readily available to anyone who wants it.
Public Health Strategy
By no means are OPCs a panacea that will solve all the nation’s drug problems. OPCs are part of a public health strategy that treats drug use as a health issue rather than a criminal justice issue. This strategy includes elements like expanding access to drug treatment; providing access to safer drug use supplies to reduce complications and harms from drug use; and facilitating access to housing, food, and physical and mental health care—all the other stressors in life that can drive someone to using drugs to cope.
When it comes to drug overdose, many share common goals: fewer people using drugs in public, fewer syringes littering playgrounds, fewer 911 resources used to resuscitate unconscious individuals, and fewer deaths due to opioid overdoses. All these things can improve when we give people safer places to exist. We’ve tried almost everything else—maybe it’s time for something that has succeeded in much of the Western world.