The launch of a federally funded study to examine the efficacy of drug overdose prevention centers in the U.S. could have broad policy implications as jurisdictions across the country consider opening such sites to combat the human toll of the opioid crisis.
Overdose prevention centers – also known as safe injection sites or safe consumption sites – allow people to use drugs in a supervised space to prevent a fatality, and can offer access to addiction treatment. They have been in operation for years in other countries, but have gained interest in the U.S. of late as a potential harm reduction tool to help curb the country’s continued overdose epidemic. The latest count of overdose deaths by the Centers for Disease Control and Prevention estimates more than 109,000 occurred over the 12-month period ending December 2022.
Magdalena Cerdá, director of the NYU Langone Center for Opioid Epidemiology and Policy.(Courtesy of NYU Langone Health)
Magdalena Cerdá – a professor of population health, director of the Center for Opioid Epidemiology and Policy at NYU Langone and a lead investigator for the new study – says the hope is that researchers’ findings will provide policymakers and potential stakeholders with evidence regarding whether such sites would work and help identify best practices for operating the programs.
“We are scientists, and we are really committed to bringing evidence to bear about the types of strategies that are most effective at addressing the opioid crisis,” Cerdá says. “This seems particularly important today when we see an unprecedented number of people dying from overdose every day. Among the tools that are available, we think harm reduction in particular needs to be a priority because the current drug supply is so lethal.”
Cerdá recently spoke with U.S. News about the study, how public opinion about overdose prevention centers may be shifting, and what areas involving these sites she would like to see researchers examine moving forward. The interview has been edited for length and clarity.
What prompted the decision to investigate the efficacy of overdose prevention centers now?
We know from other countries that overdose prevention centers seem to have promising effects, both in terms of the effects on the people who use them as well as the surrounding neighborhoods, but in the United States it remains highly controversial. So, when we heard that new centers opened up in New York City, and now in Rhode Island, it seemed like the perfect opportunity to figure out with data what impact these centers would have on the people who use them and the surrounding neighborhoods. We hope that doing this research could inform other jurisdictions that are considering opening overdose prevention centers or that are opening them to figure out what types of models work best within the United States context.
Do you think the launch of this type of a study represents a shift in public sentiment about overdose prevention centers, where there is greater interest in learning about their potential?
I think, in general, there seems to be more of an openness by the federal government to investigate and support harm reduction efforts. We know that harm reduction is one of the four pillars of the federal overdose prevention strategy, and so within that there are multiple, different kinds of options for overdose prevention centers. I think the federal government seems to be interested in seeing what the data shows as a first step, I imagine, to developing a larger position.
What metrics are you using to gauge the effectiveness of overdose prevention center programs?
We have a range of outcomes. One is just the drug use and drug use-related practices – for example, injection practices, smoking and snorting, as well as harm reduction practices, like how well drug needles and other paraphernalia are disposed of, and the use of safe supplies.
We are also interested in examining how well people are connected to other services. For example, looking at connecting people to substance use disorder treatment programs and their use of those services.
How are you gauging the impact of these programs on communities?
We’re using administrative city records to look at drug arrests, mortality and emergency department data for overdose, and citizen complaints. What we do with this kind of administrative data is we look at the neighborhood blocks surrounding an overdose prevention center and we look at these conditions both before it opens and after it opens, and then we compare those trends to trends in other comparable neighborhoods that don’t have an overdose prevention center. So we can see if there was a change in drug arrests, or if there was a change in overdose rates near the overdose prevention center after it opened compared to what happened in similar neighborhoods without a center.
That data is really valuable to look at things like changes in policing after opening overdose prevention centers, but we also want to look at things like what’s the impact of these services on syringe litter, or on public drug use. In order to do that, we’re doing what’s called a systematic social observation, and what that involves is having people walking the blocks around an overdose prevention center to measure those things both before the center opens and then after it opens. So that will allow us to get at some of these more nuanced outcomes that we can’t get from city data.
Given how controversial the subject of overdose prevention centers has become, how concerned are you over the potential political implications of your findings among both proponents and critics of these facilities?
We can’t ignore the political implications here, and because of that the No. 1 priority for us is to have highly rigorous evaluation so that we can really let the data tell the story. We want to make sure that we can provide an objective evaluation of the impact of these centers so that we can rise above the politics and personal opinions, and bring what science can bring, which is providing the data on their impact.
What other aspects about overdose prevention centers are you interested in investigating?
I would like to delve more deeply into what types of centers have better or worse outcomes and the types of delivery models that work best and where. How much does the effectiveness of a center depend on what their operational procedures are? Are they using a peer-led versus a medical model? How much of it depends on community engagement?
As other centers open up across the country, I would love to expand this work beyond Rhode Island and New York City, as well as internationally. So, those are some of the things I think we will be considering in the future.