PROVIDENCE — It’s too soon to say whether 2022 will be the deadliest year on record for accidental drug overdoses in Rhode Island. Determining causes of death takes time, and the data lags by months.
But the early picture does not look good. For nearly every month in 2022 for which there is full data — January to June — the number of people who fatally overdosed in Rhode Island is higher than the same month of 2021. Only February was lower, and only slightly.
“Some days you can’t believe it,” said Traci Green, a research scientist at Lifespan and epidemiologist who studies drug overdose. In Rhode Island, Green added, “the data are definitely still trending in the wrong direction.”
Experts generally point to an increasingly toxic drug supply to explain the rise, with powerful opioids like fentanyl and carfentanil all but replacing heroin and also finding their way into other drugs like cocaine, meth, and counterfeit pills. After several encouraging years of decline, Rhode Island experienced sharp increases in 2020 (384 deaths, then the highest on record) and 2021 (435 deaths, now the highest on record). So far, state health officials have accounted for 331 overdose-related deaths in 2022, with data still incomplete from July on.
Few states have escaped the trend.
But Rhode Island will stand apart in 2023 in trying something new, at least by US standards: supervised drug use sites.
A little over a month ago, two organizations — the street outreach organization Project Weber/RENEW and CODAC Behavioral Healthcare — submitted a joint proposal to the state Executive Office of Health and Human Services for funding to open one on Huntington Avenue in Providence, a building CODAC already owns and operates. The initial $2 million in funding would come through settlement money from opioid makers. Though the funding for the proposal hasn’t been approved, it appears to be the only one that was submitted.
New York City opened the first sanctioned sites in 2021; attempts in Philadelphia to open them have been tied up in the courts. Canada and Europe have had them for years. For a US state, though, Rhode Island is trying something unprecedented. Green, who’s also an adjunct associate professor of epidemiology and emergency medicine at Brown University, doesn’t think it’ll be alone for long.
“I think there are more states as well very interested in following the Rhode Island lead,” Green said.
The supervised drug use center — the concept also goes by names like safe injection sites, overdose prevention centers, and harm reduction centers — became possible in Rhode Island thanks to legislation that passed in 2021. The pilot program comes with a number of regulations.
If awarded, the organizations would transform the ground floor of CODAC’s Huntington Avenue building into a supervised drug use center. People would be able to bring their own drugs to use there. Staff on site could offer everything from clean needles to wound care to coats to case management. And given the increasing lethality of the supply, people will be able to test their drugs first for adulterants.
If someone overdosed, a peer outreach staffer from Project Weber/RENEW would use Narcan to revive them. Medical staff, including a nurse and doctor, would be on site.
Upstairs, CODAC would continue offering medication-assisted addiction treatment to people who want to seek it out. But the idea isn’t to force recovery on people; instead it’s to have it available for when they’re ready.
CODAC said some work will be necessary to prepare the site, but it could be open and operating by June if everything gets approved. The proposal still would need a license from the Department of Health and approval from Providence.
It’s grounded in the theory of harm reduction — keeping people alive and healthy for long enough to get into recovery if and when they’re ready. Sometimes that means clean needles so people won’t get hepatitis C or HIV from using dirty ones; in this case it means giving them a place to use drugs while a trained staffer looks on with an overdose reversal kit, with nurses and doctors waiting in the wings.
“We understand that dead people don’t enter recovery,” said Annajane Yolken, the overdose prevention center liaison for Project Weber/RENEW. “Our number one priority is to save lives. We’ve lost too many people. If people aren’t alive, all these great things we talk about with recovery aren’t possible.”
The idea of harm reduction in general, and safe drug consumption sites in particular, is not without controversy.
State Representative Mike Chippendale, a Republican of Foster who is now the minority leader, opposed the legislation for supervised drug use sites in the General Assembly. More needs to be done to invest in recovery, diversion, and prevention before opening up these sorts of sites, Chippendale said.
“We haven’t done all the work that leads up to it,” Chippendale said.
Chippendale said he agrees that the opioid epidemic needs to be treated primarily as a health issue. But “we’re not in a position to expect success from safe injection sites,” which might not even be practical for people to use, he said.
In Canada, a report solicited by the government of Alberta raised concerns about the effect on the surrounding neighborhood, about recordkeeping and oversight, and about the lack of referrals to detoxification and treatment services. (Supporters of the sites reject those claims, pointing to studies on their effectiveness at both keeping people alive and increasing engagement in treatment. The fact that the proposed Rhode Island site will be in a place long used for addiction treatment would seem to alleviate nuisance concerns, some supporters say.) California Governor Gavin Newsom vetoed legislation that would have created safe drug injection sites in some cities.
Linda Hurley is often at the center of these sorts of discussions. The president and CEO of CODAC, Hurley has a ready response to skeptics: You can’t make another adult do anything. If consequence worked, nobody would die of an overdose or end up back in jail. Overdose prevention centers, she said, will keep people safe until they’re ready to make their own choices.
“I really don’t have any doubt in my mind that it’s going to work,” Hurley said.
What does work mean?
“It means it’s going to save lives,” Hurley said.
At this point, the legislation is still just a pilot, and it expires March 2024. Discussions are underway to extend that sunset, Project Weber/RENEW said. The funding is also temporary. CODAC and Project Weber/RENEW would have to find ongoing support for the program.
Given the severity of the crisis, it’s one of several steps state health leaders said are necessary to stem the tide, which also includes meeting people where they are — church communities, nursing homes — and pushing more Narcan into the community.
But it’s a significant one, and it tends to draw attention.
“Whenever I look at the overdose prevention centers, I look at the opportunity to have that person be exposed to services, or, as I say, they’re going to get exposed to hope,” said Thomas Joyce, the community co-chair of the governor’s overdose task force. “In the recovery community, we sell hope — it’s what we do on a daily basis.”
On a drizzly recent December weekday, the scale of the need could be seen at Project Weber/RENEW’s Pawtucket drop-in center, which seemed extremely busy to an outsider, but actually wasn’t.
“This is actually slow,” Chirrell Robinson, a peer recovery advocate, said with a sort of shrug while staffers hustled about and clients waited in the crowded front vestibule.
People go to Project Weber/RENEW for everything from clean needles to coats to Narcan, which can reverse overdoses. But they have to come first. In recent weeks, multiple people in the surrounding area had died of drug overdoses in quick succession. A supervised drug use center, Robinson believes, would help.
“At least this way, we won’t be finding people dead in tents and cars,” Robinson said.
For all the questions these sorts of sites raise, supporters point to one key statistic from the experience in Europe and Canada.
“In the history of overdose prevention centers, no one has ever died” of an overdose, said Lex Morales, sitting behind his desk at the Pawtucket drop-in center, where he is the director. Like a lot of people at Project Weber/RENEW, he is in long-term recovery from substance use disorder. “So it’s going to save lives.”