Understanding Connectedness: Patterns of safety, belonging, and community among clients utilizing publicly recognized overdose prevention centers in the United States

Background Understanding the interpersonal and environmental dynamics that drive overdose prevention center (OPC) engagement is critical to inform OPC models in other jurisdictions. We described patterns of connectedness from the perspective of clients attending publicly recognized OPCs in the US. Methods We analyzed baseline data from the Study Assessing the Effectiveness of Overdose Prevention Centers through Evaluation Research (SAFER), which recruited OPC clients in New York City and Rhode Island from July 2023 to November 2025. Our analysis was restricted to OPC clients. Participants responded to the following statements about their OPC experience: ‘I am a part of the community,’ ‘I can be myself,’ ‘I can trust the staff,’ ‘I feel safe,’ ‘I feel judged for using drugs.’ We created a composite scale of OPC connectedness, with higher scores indicating greater connectedness. Multinomial logistic regression models identified associations with OPC connectedness. Results Among 494 eligible participants (30% cisgender women, 35% Hispanic/Latine), ≥70% reported trusting staff, feeling safe, and being myself ‘all of the time’ while at the OPC. Thirty-seven percent of participants had the highest connectedness score of 20. Cisgender women (aRR=1.97; 95% CI: 1.17, 3.30), those who keep naloxone nearby while using (aRR=1.91; 95% CI: 1.17, 3.12), and those who visited the OPC more frequently (aRR=2.00; 95% CI: 1.11, 3.58) were more likely to report high OPC connectedness. Conclusion Findings suggest that US OPCs are successfully fostering environments of safety and belonging for clients. As jurisdictions consider OPC implementation, understanding and actively cultivating connectedness may support OPC accessibility.