Overdose prevention sites save lives

Despite their success in saving lives and other documented public health benefits, there are no sanctioned overdose prevention sites in the United States. Why?

Site coordinator Josh Ledesma displayed safe injection supplies with outreach specialist Rachel Bolton outside the Access Drug User Health Program drop-in center in Cambridge in March, 2020. The pair uses bicycles to deliver safe injection supplies, NARCAN® (naloxone) and hygiene kits to people with substance use disorder.Craig F. Walker/Globe Staff

The COVID-19 pandemic has exposed gaping deficiencies in the country’s public health infrastructure. But it’s also laid bare our extraordinarily tenuous handle on other health crises. Health officials and lawmakers should take stock of current approaches and push for strategies that we know will save lives.

In no realm of public health is this clearer than the country’s overdose epidemic. By the time the national tally is finalized, 2020 will be the deadliest year on record, with more than 81,000 drug overdose deaths, according to the Centers for Disease Control and Prevention. In Massachusetts, following steady declines between 2016 and 2019, opioid-related overdose deaths have been increasing steadily since January 2020. In Rhode Island, the state is on track to record more than 400 overdose deaths in 2020, surpassing the state’s previous record (in 2016) by almost 20 percent. Every death in this crisis is a tragedy, particularly since overdoses can be reversible — and death entirely preventable — with the right tools in place.

Overdose prevention sites, also known as supervised consumption facilities or safe injection sites, are environments where people can use pre-obtained substances under medical supervision. If an opioid overdose occurs, staff provide first aid and administer naloxone, an opioid overdose antidote, and often oxygen. More than 120 facilities operate in 10 countries (many have been for several decades): There has never been an overdose death recorded in such a facility.

Despite their success in saving lives — and providing access to treatment options and health care — there are no sanctioned overdose prevention sites in the United States. The approach is widely supported by the medical and public health community (including the American Medical Association), civic officials in several US cities, and by people who use drugs. Why haven’t any yet opened? The reasons are manifold, but the nation’s troubled history of racialized and punitive responses to drug-related problems plays a major role.

Ongoing stigma experienced by people who use drugs and misperceptions about substance use disorders (including the false narrative that people need to hit “rock bottom” before recovering) also impede progress. Finally, myths that overdose prevention sites somehow increase drug use (they don’t) and crime (which actually goes down) are pervasive and often repeated by politicians who haven’t read, or who choose to ignore, the science on overdose prevention sites: They save lives, prevent infectious diseases, and increase access to treatment and recovery services.

With overdose deaths skyrocketing in more than 40 states, we urgently need a more compassionate, science-based approach to the crisis. On this front, the Biden administration can take several important steps.

First, the president should order the Department of Justice to drop the Trump-era lawsuit against Safehouse, an organization planning to open an overdose prevention site in Philadelphia. Second, the administration can clarify that it will not take enforcement action against states or cities that wish to open such sites, just as the Department of Justice does with recreational cannabis. Third, although Xavier Becerra, Biden’s pick to lead the Department of Health and Human Services, has previously supported overdose prevention sites (and joined an amicus brief supporting the organization wishing to open a facility in Philadelphia), clearer statements of support from federal leadership would go a long way toward assuaging concerns at the state or local level. Finally, we are encouraged that the CDC and the National Institute on Drug Abuse have been directed to publish a report on the potential public health impacts of overdose prevention sites as part of appropriations bill HR 7614. This report should be authored (or at least reviewed) by a panel of independent experts and focused on the scientific evidence.

At the state level, Governor Charlie Baker of Massachusetts and incoming Governor Dan McKee of Rhode Island should work with their respective legislatures to pass bills that would formally authorize these sites. Moreover, it is encouraging that mayors such as Jorge Elorza in Providence and Joseph Curtatone in Somerville wish to see overdose prevention sites in their cities, but they need state support.

A recent report from the Institute for Clinical and Economic Review found that such sites also actually save money. Researchers estimated that one center in Boston could save over $4 million annually in averted emergency department visits and overdose-related hospitalizations, which is particularly notable during the COVID-19 pandemic, when health care systems have been pushed to the brink.

A new era of American public health opportunity and innovation could be upon us, but we now need to seize it. When it comes to overdose prevention sites, the science is clear. We should let cities open them, study their impacts, and identify ways to make such programs even more effective at saving lives.

Brandon D.L. Marshall is an associate professor of epidemiology and Dr. Ashish K. Jha is dean of the Brown University School of Public Health.