First Federally Sanctioned Safe Injection Sites Curb Overdose Risk, Public Drug Use

Megan Brooks

July 22, 2022

Overdose prevention centers (OPCs) decrease overdose risk and curb public use of illicit drugs, according to early data from the first two federally sanctioned centers in the United States — both in New York City (NYC).

In 2020, 2062 people died of a drug overdose in NYC — the deadliest year on record for the city and the US. Most deaths involved fentanyl.

In response to the crisis, and with government backing, on November 30, 2021, NYC launched OPCs in two syringe service programs operated by OnPoint NYC. These centers are also known as supervised or safe consumption sites.

In the first 2 months of operation, 613 individuals used OPC services 5975 times across the two sites.

Trained OPC staff intervened 125 times to mitigate overdose risk, which included oxygen or naloxone administration for individuals using opioids, and hydration, cooling, or de-escalation for people with stimulant-related symptoms (aka, overamping).

Emergency medical services were called five times, with three individuals transported to the emergency department. No fatal overdoses occurred in OPCs or among individuals transported to hospitals.

Led by Alex Harocopos, PhD, with the NYC Department of Health and Mental Hygiene, the study was published online July 15 in JAMA Network Open.

Most OPC visitors were men (78%). The age range was 18-71 years (mean age, 42.5 years).

One third of OPC visitors were homeless. Most injected heroin or fentanyl. Three quarters said that they would have injected in a public place if they did not have access to the OPC.

More than half (53%) of individuals using OPC services also received ancillary health services, including naloxone, counseling, hepatitis C testing, medical care, and holistic services.

The investigators note that studies are needed to explore whether OPC services are associated with improved overall health outcomes among drug users, as well as neighborhood-level outcomes, including public drug use, improperly discarded syringes, and drug-related crime.

They caution that the findings are limited by the short study period and lack of a comparison group with drug users who did not use OPC services.

An Effective Strategy

The authors of an invited commentary point out that this first description of OnPoint NYC suggests that OPCs are not only feasible, but also that people who are homeless and at high risk for overdose death were willing and interested in using OPCs.

"Interventions at the center to mitigate overdose risk suggest, as previously observed in other countries, that OPCs in the US may provide an effective strategy associated with reduced overdose deaths and reduced public drug consumption," write Elizabeth A. Samuels, MD, Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, and co-authors.

The opening of OPCs in the US, they state, is an important addition to the national overdose-prevention strategy. "These centers alone will not solve the overdose crisis but are one component of a comprehensive, person-centered strategy to reduce overdose deaths," they caution.

"This includes treating people with dignity, rather than stigmatizing, criminalizing, and incarcerating them, and addressing root causes of substance use, particularly systems that produce health inequities," they add.

"Since the 1970s, the US has primarily taken a criminal justice approach to substance use, and the country now has more deaths than ever. To prevent further increasing deaths, we can and need to fundamentally transform our approach—and urgently. We cannot afford to wait," Samuels and colleagues conclude.

The study had no specific funding. Harocopos has no relevant disclosures. Author Brent Gibson, PhD, reported working for OnPoint NYC, which receives core funding from the NYC Department of Health and Mental Hygiene. Dave Chokshi, MD, reported serving as NYC health commissioner when the first overdose prevention centers were launched in NYC.

JAMA Netw Open. Published online July 15, 2022. Article; Commentary

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