“Once I started going… I had this central wheel hub”: Drivers of overdose prevention center engagement and connections to care in Rhode Island

BACKGROUND: The United States' first state-sanctioned overdose prevention center (OPC) opened in Rhode Island in January 2025. In addition to OPC services, the site offers co-located basic needs services, case management, healthcare, and substance use treatment. We aimed to understand clients' initial engagement with the OPC as well as their consequent service patterns. METHODS: Between May and August 2025, semi-structured interviews were conducted with 30 people who had used the OPC services. Team members also conducted approximately 40 hours of ethnographic fieldwork in the OPC from January to August 2025. Informed by the intersectional risk environment framework, transcripts and fieldnotes were analyzed thematically with a focus on how the site's integrated design shaped participants' experiences and service use trajectories. RESULTS: Participants' immediate needs motivated their initial engagement with the site, whether it be to access the OPC or co-located ancillary services. The provision of OPC services was a particularly important motivator for engagement among participants who were not previously well-engaged with the site's operating organization and existing harm reduction services. Clients' initial engagement with the site was also shaped by word-of-mouth communication between partners, friends, and other people in their existing drug use networks. Once engaged, participants described regularly utilizing multiple on-site services, with site staff playing a key role in connecting and navigating them through these services. CONCLUSION: Our findings underscore how an integrated service model supported clients' individualized patterns of access and engagement over time by offering a range of low-threshold, co-located services.