LAUSR

In 2021, more than 107 000 people died from a drug overdose in the US,1 a 15% increase from 2020. Deaths involving cocaine increased 23%, and deaths involving methamphetamines or other stimulants increased 34%.1 Death rates are increasing the most rapidly among people experiencing homelessness2 and among American Indian or Native American, Black, and Latinx individuals.3 These staggering numbers demonstrate an urgent need for immediate action. In recent years, there has been expansion of proven harm reduction strategies to reduce overdose deaths. Harm reduction is a way of approaching and caring for people who use drugs that centers people’s dignity, humanity, and autonomy to reduce harms associated with substance use. It uses practical strategies to meet people where they are to improve individual and community well-being and health. Decades of robust research on harm reduction strategies, specifically syringe services and naloxone distribution, demonstrate that these strategies are associated with reduced morbidity, mortality, and transmission of infectious diseases and improved individual health outcomes and services engagement and that they have high cost-effectiveness. The use of overdose prevention centers (OPCs) is an evidence-based harm-reduction intervention that, until recently, has not been available in the US. OPCs, which are sometimes referred to as supervised consumption centers, are places where people can consume preobtained drugs in a monitored setting where staff can immediately intervene in the event of an overdose. People who use the centers can be provided or linked to wraparound services, including other harm reduction services, basic needs (eg, housing or food), medical services, and addiction treatment. There are more than 120 OPCs in 10 countries across Europe, Australia, and Canada. Models range from peer-run facilities to mobile units and medical models colocated with addiction treatment programs. Regardless of model type, all OPCs provide a safe, nonjudgmental setting with staff trained to intervene in the event of an overdose and provide individualized support and linkage to services.4,5 Research has found that OPCs are associated with benefits for individuals who use the centers and neighborhoods where the centers are located.4,5 OPCs have been found to be associated with reduced overdose deaths, substance use–related harms, and all-cause mortality among people who use drugs and to be cost-effective.4,5 OPCs have also been found to be associated with increased treatment engagement, with regular center use, but not with increased drug trafficking, initiation of substance use among people who did not previously use drugs, or resumed use among people in recovery. An evaluation of an unsanctioned US OPC that operated from 2014 to 2021 found high rates of center use without any overdose deaths.6 For surrounding neighborhoods, OPCs have been shown to be associated with reduced public drug consumption, litter of drug consumption equipment, and crime.4,5 In November 2021, OnPoint NYC opened the first government-sanctioned OPCs in the US. Harocopos et al7 describe patient encounters at OnPoint NYC’s 2 OPCs in the first 2 months of operation. There were nearly 6000 visits by more than 600 individuals. Among those who used the OPCs, more than one-third of participants were unhoused, a minority of participants (17.8%) had their own room or apartment, and three-quarters of participants reported that they would otherwise have used drugs in a public or semipublic location. Staff intervened 125 times to mitigate overdose risk, which included oxygen or naloxone administration for individuals using opioids, and hydration, + Related article