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Will R.I.’s overdose prevention center counter overdose deaths amid the opioid epidemic?

A Brown professor who studies the impact of overdose prevention centers hypothesizes that the nation’s first state-led effort in Providence could be an effective strategy to help mitigate the overdose crisis and save lives.

Brian Hackel, right, an overdose prevention specialist, helps Steven Baez, a client suffering addiction, find a vein to inject intravenous drugs at OnPoint, an overdose prevention center in New York City.Seth Wenig/Associated Press

PROVIDENCE — While other states continue to ban safe injection sites, the nation’s first state-led overdose prevention center is scheduled to open in Rhode Island in 2024.

Brandon D.L. Marshall, a professor of epidemiology at Brown University and founding director of the People, Place and Health Collective.David DelPoio

In a project funded by the National Institutes of Health’s Harm Reduction Research Network, researchers at Brown University will evaluate the effectiveness of overdose prevention centers, as well as their impact on the surrounding community.

Brandon D.L. Marshall, an epidemiology professor at Brown University and founding director of the People, Place and Health Collective, said the four-year study is in partnership with New York University’s Langone Health, and will look at overdose prevention centers in Providence and New York City.


“The overdose crisis has touched every community across America,” said Marshall, who previously studied overdose prevention centers and Canada. “From coast to coast and across age, gender, and race/ethnicity, people are dying.”

Q. What do we know about overdose prevention centers [OPC], which are used in other parts of the world, and their effectiveness?

Marshall: Overdose prevention centers are places where people can go to use drugs under supervision, to prevent and reverse overdoses. Nurses and trained peers are on site to intervene in the event of an overdose where they provide oxygen and naloxone [otherwise known as Narcan]. But they also act as a touchpoint to provide many other services to people who are at risk of an overdose, like access to treatment, housing, and social services. Some sites around the world have showers, food, and are meant to be a wraparound service for a very marginalized population.

What we know from data collected in other countries is that when an OPC opens, fairly quickly do we see a significant reduction in public drug use and drug-related litter because we are providing an indoor, safe, and supervised place for people to use.


Q. What are you looking to understand in this study?

A. Our study is evaluating both the acute and long-term outcomes of opening an OPC in three sites — two in New York City and one in Providence. We want to understand how these centers impact both the people who use them, and the neighborhoods in which they are located.

Q. How are you studying how an OPC could impact the community it’s located in?

A. We’ll do a systematic social observation six weeks before the center opens and 12 weeks after it opens. Our research assistants will walk the streets around the OPC and record instances where they see people using drugs in public, drug-related litter, graffiti, police activity, and really getting a systematic understanding of what the neighborhood looks like before it opens. This will allow us to assess if and how opening an OPC impacts the neighborhood.

We’ll work closely with the health department to analyze “surveillance data,” which looks at a community’s overdoses and where, for example, there are EMT runs taking place due to overdoses. We’ll also be looking at things like business activity, and if there are new licenses being issued in the surrounding area.

Q. How do OPCs impact neighborhoods in other parts of the world?

A. Our hypothesis is that opening an OPC actually revitalizes its community. But we want to verify that we see similar results if and, if not, we want to understand why.

Supplies at an overdose prevention center.Seth Wenig/Associated Press

Q. What makes this study in a city like Providence different, and why does it matter on a national scale?


A. The vast majority of OPCs around the world are located in fairly large urban centers like Vancouver, Paris, Sydney, and in New York. There aren’t many examples of an OPC being in a smaller municipality, such as Providence, where we still see a lot of need and the city has been highly affected by the overdose crisis. We’re hypothesizing that an OPC will be an effective strategy to help the city mitigate the overdose crisis and save lives. But there aren’t a lot of examples of this intervention being implemented in a city similar to ours. I think this study could provide a lot of rich information — both for local stakeholders such as the city, state, and health department — but it might also inform efforts in many midsized cities across the US.

Q. What operational variables could either make an OPC useful or useless to its community?

A. One of my colleagues, Dr. Alex Collins, is going to be conducting some qualitative work where she will be interviewing staff, stakeholders, and the people using the facility to understand some of the operational contexts and barriers to using the site. This might include hours of operations and issues of safety. In other countries, some people don’t feel comfortable in these kinds of environments because they are very male-dominated, for example. So in Providence, we’ll want to understand whether this site will be accessible to women and non-binary, gender-diverse folks.


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