ABSTRACT
More than one million people have died from accidental drug overdose in the United States (US) in the past
twenty years. In response to this unabating crisis, New York City implemented the first two publicly recognized
overdose prevention centers (OPCs) in the nation in November 2021. Rhode Island became the first state to
authorize OPCs through state legislation and they are expected to open in late 2022. OPCs are community-
based facilities that permit clients to consume pre-obtained controlled substances under the supervision of
personnel who are trained to intervene in the event of an overdose. Staff at OPCs also provide safer drug
consumption education, access to sterile drug use supplies, offer health and ancillary services, and provide
referrals to other treatment, health, and recovery services. While research from other countries and from an
unsanctioned site in the US suggest that OPCs produce individual health and community benefits, no evaluations
exist of sanctioned OPCs in the US. The proposed study has extraordinarily high policy significance, as it will
evaluate the public health, public safety, and community benefits—and potential unintended effects—of the first
sanctioned OPCs in the US. We propose to conduct a rigorous, multi-site, multi-component evaluation of OPCs
in New York City and Rhode Island in 2023-2027. At the individual level, we aim to evaluate whether a
prospective cohort of 500 persons attending OPCs experience lower rates of overdose, other health problems,
and emergency department use, and a higher rate of substance use disorder treatment initiation, compared to a
cohort of 500 persons who do not attend OPCs (Aim 1). At the community level, we will examine whether
neighborhoods surrounding the OPCs experience a greater change in overdose, measures of drug-related public
disorder, and acute economic conditions following the opening of OPCs, compared to neighborhoods unexposed
to OPCs (Aim 2). Third, we aim to delve into the role that the operational context, including neighborhood
location, program models, and operating procedures, plays in shaping the effectiveness of OPCs using
qualitative and ethnographic approaches (Aim 3). Finally, we will estimate additional costs and cost savings to
the healthcare and criminal justice systems associated with OPC use, to support future cost-effectiveness
analyses of OPCs (Aim 4). To accomplish these aims, we have assembled an internationally renowned
investigative team and established strong, community-engaged research partnerships with harm reduction
organizations in New York City and Rhode Island. As more jurisdictions throughout the US consider opening
OPCs, findings from the proposed research will have critical implications for US drug policy. The study’s results
will have powerful, lasting implications for communities that wish to offer OPCs, generate critical data to optimize
their effectiveness, and provide models for sustainability and expansion of these interventions.