New research to measure the impact of overdose prevention centers in the United States

NYU Langone Health and Brown University's School of Public Health today announced a grant award from the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), to conduct research to measure the impact of some of the first publicly recognized overdose prevention centers (OPCs) in the United States, located in New York City and Providence, Rhode Island.

Overdose prevention centers are community-based spaces where people who use drugs can more safely test and self-administer, including by injection and inhalation, previously obtained controlled substances, under the supervision of staff trained to respond when medically needed. These facilities also connect people who use drugs with health and social services, including drug treatment, harm reduction, medical care, mental health treatment, and social support.

As part of this first-of-its kind research project, the interdisciplinary team of researchers will conduct a rigorous and comprehensive evaluation of the first publicly recognized OPCs in the country: two sites in New York City and one site that will open in Providence in 2024. The study seeks to enroll 1,000 participants in both New York and Providence over the age of 18 who already use drugs and have visited an OPC or other site providing harm reduction services.

According to the Centers for Disease Control and Prevention, more than 106,000 Americans died from drug overdoses in 2021—the highest number in recorded history, reflecting a rate that has doubled since 2015. There are more than 200 overdose prevention centers in 14 countries globally, and international research shows they are associated with fewer overdoses, reductions in emergency department visits, increased access to addiction treatment, and improved public order.

There is an urgent need for data to determine the impact of overdose prevention centers in the United States, which has distinct healthcare delivery systems, social policies, and policing practices. The current U.S. overdose crisis is driven largely by fentanyl, a synthetic opioid up to 50 times more potent than heroin. Fentanyl is involved in about two-thirds of all U.S. overdoses.

We have an unprecedented opportunity to study the first publicly recognized overdose prevention centers in the country across two different states, as well as the impact on the communities in which they operate. This research is urgently needed to inform policies that can best support public health, as more jurisdictions across the country consider implementing OPCs."

Magdalena Cerdá, DrPH, professor in the Department of Population Health at NYU Langone, director of its Center for Opioid Epidemiology and Policy, and one of the study's two lead investigators

"The overdose crisis has touched every community across America. From coast to coast and across age, gender, and race/ethnicity—people are dying," said Brandon DL Marshall, PhD, professor of epidemiology at the Brown University School of Public Health and the founding director of the People, Place & Health Collective at Brown University. "This groundbreaking study will help us determine whether and how OPCs are an effective public health tool as part of a more compassionate, evidence-based response to this crisis in the U.S."

From 2023 to 2027, a multidisciplinary team of researchers will conduct a multi-method, individual- and community-level evaluation of OPCs in New York City and Rhode Island. They will do the following:

• investigate whether enrolled participants who visit OPCs experience lower rates of fatal or nonfatal overdoses, drug-related health problems, and emergency department visits, and whether they are more likely to enter treatment for substance use disorders compared to people who use drugs but do not visit OPCs
• examine the community impact of OPCs by assessing whether neighborhoods surrounding OPCs experience a greater change in overdoses, public disorder such as drug-related litter, arrests and noise complaints, and economic activity compared to similar neighborhood blocks that do not have an OPC
• estimate the operational costs of OPCs and the potential cost savings to the healthcare and criminal justice systems associated with OPC use

No funds from the National Institutes of Health will be used to support the operation of overdose prevention centers. Grantees at NYU Langone and Brown will study the impact of sites already in operation to elucidate the study aims.

The study will involve repeated assessments over 4 years of the 1,000 study participants, with half from New York City sites and half from Providence, as well as qualitative and ethnographic methods and cost-effectiveness analysis.

"Overdose prevention centers have saved lives over the past year," said Ashwin Vasan, MD, PhD, commissioner of the New York City Department of Health and Mental Hygiene. "Their operation in New York City also offers a unique opportunity in the years ahead to learn about their clients, the services offered, and their wider impact on the communities served. We look forward to partnering with NYU Langone, OnPoint, and the State of Rhode Island on a robust, long-term study. The findings, when they're ready, could have national implications as we all fight the rising tide of overdose deaths in the U.S. In the meantime, we will proudly continue to work with our partners at OnPoint, as they bring lifesaving resources to New Yorkers."

"We are so proud of the work we are doing in the first two overdose prevention centers in the U.S., and we look forward to providing access to the teams at NYU Langone and Brown to rigorously evaluate our services and related outcomes," said Sam Rivera, executive director of OnPoint. OnPoint and Project Weber/RENEW are operating the OPCs in each jurisdiction but will not receive NIH funding as part of this study.

This study will be a part of the NIH Harm Reduction Research Network, which was established in 2022 to test harm reduction strategies in different community settings to inform efforts to help save lives.

Funding for the study was provided by the National Institute on Drug Abuse, part of the National Institutes of Health, under grant number R01DA058277. This article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.