The first overdose prevention centers (OPCs) in the United States opened in New York City just 2 weeks ago. Within their first 6 days of operation, they have reversed 9 overdoses and are saving lives already!a
See here for ASAM Public Policy Statement in support of OPCs.
Additionally, check out the below blog post on OPCs by Dr. Aaron Fox, NYSAM Policy and Advocacy Committee Chairperson, and Dr. Frank DiRenno.
Overview
The overlapping crises of the COVID-19 pandemic and decades-long opioid epidemic have hardened us into believing that any good news will be quickly followed by new challenges. In 2019, The United States’ drug overdose death rate stabilized after three decades of increases – but now has rebounded to historic highs.
In the first quarter of 2020 – before the worst of the pandemic – New York City (NYC) saw more overdose deaths than in any quarter of the past 5 years. Many New Yorkers will remember April 2020 as the pandemic’s chaotic peak, but it also marked the end of a 12 month period when 1,656 New Yorkers died from overdose alone – a 16% increase over the previous year. While new vaccines and treatment have become available for COVID-19, the strategies that stabilized NYC’s overdose rates – naloxone distribution, medication treatment for opioid use disorder, and safer prescribing initiatives – no longer seem to be enough. However, with the opening of two Overdose Prevention Centers (OPCs) in NYC, we have a reason for more optimism.
First Supervised Injection Facilities
On November 30, 2021, the non-profits New York Harm Reduction Educators and Washington Heights CORNER Project, opened the first official OPCs in the United States. The sites accommodated 72 clients and reversed two overdoses. OPCs offer physical space for people to use drugs that they have obtained elsewhere, and clients are provided with sterile injection equipment and education on preventing transmission of infectious diseases, like HIV or Hepatitis C Virus. Trained staff members are present to recognize and reverse overdoses, as well as, make referrals for social services.
OPCs (sometimes called supervised injection facilities or safer consumptions sites) can be found in over 65 cities across the globe and have operated for many years. There has never been a fatal overdose at any of these sites globally. They offer other services to address a variety of client needs, including referral to substance use disorder treatment or other recovery services. These are evidence-based harm reduction interventions that reduce overdose deaths and increase treatment access. The American Society of Addiction Medicine has released a policy statement in support of Overdose Prevention Sites.
In 2018, the NYC department of health released a report recommending the establishment of four OPCs in NYC. Researchers from Weill Cornell Medical Center estimated that OPCs could prevent between 60 and 130 deaths due to overdose each year. Studies of established sites have shown that their presence decreases public injection, unsafe disposal of needles, and crime in surrounding neighborhoods. One study demonstrated that 57% of OPC clients entered addiction treatment.
Since this time, pandemic conditions and an increasingly toxic drug supply have created an even more dangerous environment for people who use drugs. Social distancing means that more people use drugs alone – a known risk factor for overdose. First responders are stretched thin, potentially limiting whether those in need will receive the opioid overdose-reversing drug, naloxone. Fentanyl, a highly potent opioid, continues to contaminate drug supplies nationally and has been implicated in most overdose deaths in NYC, meaning that anyone who uses drugs is at risk. Without urgent action, the overdose death rate would likely continue its rapid increase.
OPC’s Success
What makes overdose prevention sites effective is that they address the very overdose risk factors that have now been exacerbated by the pandemic. People do not have to use alone – trained staff are present and can recognize an overdose. All staff members at the OPCs are trained to administer life-saving naloxone and provide other emergency care. Though OPCs cannot remove fentanyl from the drug supply, many stock fentanyl test strips, so that people know what they are using and can make adjustments to their use based on the presence of fentanyl. OPCs will not alone reverse the worrisome trends in overdose; however, they do provide services to a population that is not yet ready to engage in addiction treatment.
Moving Forward
There are still some unresolved questions relating to OPCs that may affect their operation in the future.
First, the question of cost. Multiple studies have estimated that large American cities could achieve millions in long-term budget savings by opening OPCs. Though startup costs are estimated to be $500,000 if implemented within existing syringe service programs, the NYC Department of Health and Mental Hygiene’s report estimated savings between $1-7 million annually depending on the number of sites opened in the city. These cost estimates were based only on potential savings from reductions in health-related services, such as ambulance services and emergency room visits. Cost savings could be greater from preventing new HIV or Hepatitis C Virus infections or from reductions in law enforcement and criminal justice expenditures related to public injection and overdose. Expanding the number of services available to people who use drugs is a wise investment.
Second, the question of legality. The Controlled Substances Act makes it illegal to “knowingly…maintain any place…for the purpose of…using any controlled substance.” A non-profit in Philadelphia, Safehouse, attempted to open an OPC in 2019 and was sued by the federal government to prevent its operation. However, in February 2020, US District Judge Gerald Austin McHugh determined that Safehouse would not violate federal law.
The district court judge recognized the public health purpose of the site, noting that the goal of the program is to reduce drug use – not facilitate it. The court cited OPCs as an example of harm reduction, an approach to drug use that Congress has endorsed since the Controlled Substances Act was written decades ago and the Biden administration has support in its initial policy proposals. However, this verdict was reversed in January 2021 by the US Third Circuit Court. So far, there has been no legal action against OnPoint NYC, the organization formed by the two non-profits in NYC running the historic OPCs.
Consistent with ASAM’s policy, the board of the New York Society of Addiction Medicine supports the opening of OPCs and applauds Mayor Bill de Blasio, the New York City Department of Health and Mental Hygiene, and OnPoint NYC for their leadership in establishing the first OPCs in the country. We believe that serving our patients with substance use disorders requires a spectrum of services available, including initiatives to prevent addiction, treatment services in specialized and general medical settings, harm reduction initiatives, and broader social supports. We look forward to any opportunities to collaborate with OPCs in serving people who use drugs and encourage other locations outside of NYC to consider whether OPCs can meet a need in their community. We know that there will continue to be challenged in mitigating this overdose crisis, but we are confident that OPCs will offer compassion, dignity, and a new pathway to recovery.
This blog post was adapted from an essay written by Frank DiRenno, MD, and Aaron Fox, MD
Frank DiRenno, MD MS is a resident physician in psychiatry at Montefiore Medical Center-Albert Einstein College of Medicine
Aaron D. Fox, MD MS is an Associate Professor of Medicine at Montefiore Medical Center-Albert Einstein College of Medicine. Dr. Fox is also the Policy and Advocacy Committee Chairperson for the New York Society of Addiction Medicine.
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