Overdose Prevention Centers, Disorder, and Economic Activity

At present, there are 3 places in the United States where local governments have officially sanctioned an overdose prevention center (OPC): 2 in New York City and 1 in Providence, Rhode Island.At these OPCs, people can consume illicit drugs under the supervision of trained staff and receive lifesaving care, such as naloxone and oxygen, if they overdose.The centers have reversed thousands of overdoses, several of which would have been fatal or resulted in lasting injury.Despite this track record, opposition to expanding OPCs as part of a comprehensive drug policy has increased. 1Philadelphia officials, for example, went from endeavoring to establish the nation's first OPC to preemptively banning them over concerns about their effects on public safety and the vitality of a community. 2Evaluating outcomes at the nation's 3 sanctioned OPCs is therefore critical for public health policymakers.To assess their impact in New York, Allen et al 3 used mobile phone location and financial transaction data collected at the micro-level to assess changes in commercial activity around the city's sites.They found New York's sanctioned OPCs were not associated with a discernible change in foot traffic or consumer spending in the communities they served.The findings from Allen et al 3 are in one sense novel and important, but in another, globally consistent and unsurprising.Theirs is the first study of the economic effects associated with this intervention in the United States, adding to a small but growing body of domestic research that the collateral consequences of OPCs feared by opponents, including increases in crime, disorder, and drug-related arrests, have not materialized. 4,5Yet, these findings closely align with several studies in Europe and Canada undertaken since the first government-sanctioned OPC was established more than 35 years ago in Berne, Switzerland; the supervised substance use occurring at these sites also did not have negative effects on their wider communities, and in many cases, yielded improvements in conditions on the street. 6,7In that regard, the United States seems to be unexceptional.Interpreting the present study's results with clarity and precision is still critical for US policy, however, since they come with important caveats.The OPCs in New York City were not commissioned from whole cloth or built from the ground up.Rather, they were 2 longstanding brickand-mortar syringe service programs (SSPs) that modified their facilities to accommodate formally supervised drug consumption, then publicly announced the availability of this service with the support and coordination of city government.Indeed, this fact is what allowed for the robust quasiexperimental design used in initial evaluations, since any changes in neighborhood conditions around the 2 converted SSPs could be compared with the 17 similarly situated SSPs throughout the city that did not formally engage in on-site overdose reversal. 3,5In other words, the OPCs were introduced at physical locations already providing a wide range of health and harm reduction services to people who use drugs (PWUD), including people with problematic or potentially disruptive patterns of use.It may therefore not be surprising that sanctioning overdose prevention services at these extant locations was not associated with a marginal negative effect on the community.Another important subtlety is that at least one of New York City's OPCs operated as an unsanctioned program for several years before its transition to a formally acknowledged one. 8The intervention under consideration, in that case, was publicizing the service rather than commencing it.In one respect, this underscores the ways in which harm reductionists have historically had to resort to underground measures in their sustained effort to save lives, with the government taking years or decades to support or even acknowledge their work.From a more pragmatic standpoint, policymakers should wonder how many underground OPCs are presently operating in US communities, how many lives are unnecessarily lost to overdose because of their obscure