The latest statistics from the Centers for Disease Control and Prevention (CDC) are simply staggering: there were more than 95,000 drug overdose deaths between February 2020 and February 2021, an all-time record. With thousands of Americans dying from preventable overdoses each year, it is clear that persistent, societal, and systemic failures are perpetuating pain and suffering among far too many people. Policymakers and public health officials must do more to prevent these deaths.
Recognizing that overdose prevention strategies are vital to save lives, the American Society of Addiction Medicine, which I currently lead as president, recently issued a public policy statement recommending that federal, state, and local leaders allow state- or locality-sanctioned pilot overdose prevention sites (OPS) to operate without fear of prosecution in communities where there is perceived need and local support by people who use drugs and other community members. The success of such test sites could lead to more widespread adoption of these life-saving facilities.
Such a recommendation could not come at a more critical time.
Federal authorities have previously argued that overdose prevention sites violate sections of the federal Controlled Substance Act, which prohibits the unlawful possession of controlled substances and makes it illegal to knowingly open or maintain a place for the purpose of using controlled drugs. Federal judges, however, have issued conflicting opinions on their legality. To ensure that legal concerns are not a barrier to their implementation, the Biden-Harris administration should provide explicit assurances that it will not challenge these sites.
While overdose prevention sites are controversial in the U.S., their role is not always well understood. These are places where people can consume previously obtained drugs in a hygienic, monitored environment without fear of arrest. The primary goals of these sites are to prevent deaths, reduce harms from drug use (including infectious disease transmission, which has surged in many areas across the country in recent years), connect individuals with treatment and support services, and reduce public disorder.
Overdose prevention sites are located primarily in high drug-use areas and serve marginalized and hard-to-reach populations who face barriers to good health or safe living, including people who engage in sex work, people who are experiencing homelessness or housing insecurity, and people with a history of incarceration.
Often staffed by health care professionals and case management specialists who connect people who use drugs with the wraparound services they need, overdose prevention sites represent a space where people can more safely consume controlled substances that they have obtained themselves beforehand; staff members are forbidden from obtaining drugs for anyone. While some opponents see this as “enabling” — a term steeped in stigma — physician-led organizations like the American Society of Addiction Medicine, the California Society of Addiction Medicine, and the American Medical Association see the approach as an opportunity to offer primary care services, health screening, naloxone (a medication that can reverse opioid-related respiratory arrest and prevent overdose deaths), addiction treatment, and recovery assistance to hard-to-reach people who use drugs.
Rhode Island, inspired by best practices implemented in more than 100 legally sanctioned sites in Canada, Australia, and Europe, recently passed a law to open an overdose prevention site. This first-in-the-country approach has been shown in other countries to promote safer injection conditions, enhance access to primary care, and reduce overdose frequency. Around the world, research shows that overdose prevention sites have not led to increases in drug use or crime in the communities surrounding the facilities.
Local residents and businesses have also reported significant community improvements in the years following the opening of overdose prevention sites.
Advocates are clear-eyed about how overdose prevention sites can complement existing interventions, not replace them. As important as these facilities can be, they are not a panacea. For example, they cannot address all the social determinants of health that can influence the development of addiction, nor do they solve systemic failures like racism, lack of economic opportunity, or safe and affordable housing issues faced by many people who use drugs.
But harm reduction efforts, including overdose prevention sites, can keep people alive and promote recovery. That alone means they are worth trying.
In the years to come, policymakers and advocates must continue to work on comprehensive strategies to address the U.S.’s addiction and overdose crisis. In addition to initiatives that expand access to evidence-based treatments, reduce stigma, and address the systemic failures that have led to this emergency, the nation must also be willing to give overdose prevention sites the chance to save lives by meeting people who use drugs where they are today.
Without judgment, overdose prevention sites can be used to build connections, relationships, and trust, which are essential for providing the medical and social services certain vulnerable individuals need. Instead of leaving them to struggle alone, we can start creating more safe spaces to ask: How can I help?
William F. Haning, III is an addiction specialist physician who directs residency training and research programs in addiction medicine and addiction psychiatry in Hawaii. He is the current president of the American Society of Addiction Medicine.
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