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What to do with opioid settlement funds? Open overdose prevention centers.

Study after study has shown that overdose prevention centers would save cities considerable amounts of money by preventing infections, and fatal and non-fatal overdoses.

An overdose prevention center at OnPoint in New York on Feb. 18. Equipped and staffed to reverse overdoses, New York City’s new, privately run centers seek to help reduce opioid overdose deaths nationwide.Seth Wenig/Associated Press

Over the past year, there have been a number of large settlements with pharmaceutical companies, medical distributors, and pharmacies to account for the harms caused by the overmarketing, distribution, and prescribing of opioids in the late ‘90s and 2000s. Most recently, Rite Aid reached a multimillion-dollar settlement with the state of West Virginia, and Walmart, CVS, and Walgreens were ordered to pay $650.5 million to two counties in Ohio. These are just some of the cases among dozens that have resulted in billions of dollars in payments to public coffers.

At the same time, cities and states across the country have made plans to open overdose prevention centers where people can bring pre-obtained substances to use under the presence of trained staff who can intervene in case of overdose. Two sites have opened in New York City and Rhode Island is making plans to open its first site. Meanwhile, Safehouse, a proposed overdose prevention center, is in settlement talks with the Department of Justice to open a site in Philadelphia. The City of Somerville has shown interest in opening a site, but Governor Charlie Baker has refused to address the issue and the Legislature continues to drag its feet. All of this comes on the heels of the Biden administration indicating that it is interested in pursuing a harm-reduction approach, something the Trump administration actively worked against.


With such large sums of money being doled out, questions arise about the best way to use such funds. Thankfully many of the agreements thus far require the funds to be used to mitigate the overdose crisis, a shift from the 1990s tobacco settlement in which few funds ended up going toward smoking prevention.

New York City and Rhode Island have recently announced that they will allocate funds toward the operations of overdose prevention centers, allowing these sites more flexibility and freedom to operate than they would have with money from private sources and donations alone. Rhode Island is committing $2.25 million from the $20 million 2023 opioid settlement budget for overdose prevention centers alone.


It’s a critical moment for states and cities to approve and financially support these sites using settlement dollars. In 2021 alone, more than 107,000 people across the United States died of an overdose. Research in other countries has shown that overdose prevention centers save lives. Study after study has shown that these sites would save cities considerable amounts of money by preventing infections and fatal and nonfatal overdoses. They also reduce emergency calls, ambulance rides, and emergency department visits for overdoses and drug-related infections.

For instance, a study released in July by the Rhode Island Department of Health and our team at the Brown University School of Public Health found that one site in Providence has the potential to avert 261 ambulance runs, 244 emergency department visits, and 117 hospitalizations for overdoses in one year. This averted need for emergency care would end up saving more than $1 million annually. But beyond saved costs, reduced overdoses and infection mean a better quality of life for people who use drugs.

Overdose prevention centers also serve as nexus points for naloxone distribution, syringe exchange, wraparound support services, and referrals to health care, housing, and treatment — approving these sites and providing them with funds strengthens other harm-reduction and treatment strategies as well.


However, running these sites requires real investment. Our study shows that one site in Providence could cost at least $700,000 a year to run. Apart from the costs of running a site and obtaining equipment, it’s important to recognize that this work — like all front-line harm-reduction work — is not easy and can expose staff to potentially traumatizing and difficult scenarios. Providing substantial and stable funding that fairly compensates overdose prevention center staff and provides medical and ancillary benefits is essential to ensure staff are adequately supported. Too often, harm-reduction organizations are asked to do this work with shoestring budgets that can barely cover operational costs and yet are asked to play a key role in our society’s response to the overdose crisis. Supporting them adequately will mean increases far beyond what states currently provide.

City and state governments have made slow but important progress in opening overdose prevention centers across parts of the country; however, we are still in the midst of a massive public health crisis and only two sanctioned sites are operating nationwide. For these sites to be as effective as they can be, there needs to be multiple locations and models. More research needs to be undertaken to understand how these centers can operate most effectively in both large urban centers and smaller urban and rural communities.


Finally, we cannot ignore the disproportionate toll the overdose crisis has taken on people of color — Black and Indigenous people specifically have faced steep increases in overdose deaths over the past few years and these communities often face barriers to treatment. Previous data on access to treatment show people having differential access to methadone and buprenorphine along lines of racial and ethnic segregation for instance. Since overdose prevention centers provide wraparound services that include access to treatment, it’s essential that they be accessible, including on-site multilingual staff and support for safe inhalation of substances as not everyone injects drugs.

Opioid settlement funding provides a critical opportunity to turn the tide on overdose deaths. Policymakers across the nation must fund overdose prevention centers as part of a comprehensive and evidence-based response to this crisis.

Abdullah Shihipar directs narrative projects and policy impact initiatives at the People, Place & Health Collective at Brown University School of Public Health. Alexandra B. Collins is an assistant professor of epidemiology with the People, Place & Health Collective. Brandon D.L. Marshall is a professor of epidemiology and founding director of the People, Place & Health Collective and serves on the Rhode Island Opioid Settlement Advisory Committee.