Overdose Prevention Sites
Hello! Welcome to Overdosed a weekly newsletter on drug policy and people who use drugs by me, Diane Roznowski.
I’ve taken the last couple weeks off from the newsletter in order to prioritize self-care. This newsletter is super important to me, but we’ve officially gotten to the part of the year that is really difficult for me grief-wise. I may publish less often and I appreciate your understanding.
Last time we talked about harm reduction and a little bit about Safehouse, a nonprofit in Philadelphia that is working to open the first legal overdose prevention site in the United States. Today we’re going to talk more about overdose prevention sites.
Overdose prevention sites or OPSs are also called supervised consumption sites, safe injection sites, or many other names, I use overdose prevention site as it’s not stigmatizing and because it has a better connotation. It’s harder to argue against something called an overdose prevention site unless you want to be seen as promoting overdoses.
OPSs are currently considered to be illegal in the United States, but there is at least one underground OPS in the country. OPSs have proven to be successful at connecting people to treatment in other countries. They keep people who do not want to seek treatment alive and connect them to other services. Many clients will seek treatment referrals through OPSs, but even if someone is never ready for treatment OPSs can help them manage their use and stay alive.
Overdose Prevention Site in Alberta, Canada.
OPS are medical-like facilities where people bring their own drugs to use under medical supervision. The sites provide sterile equipment, medical supervision, overdose reversal (if needed), referrals to primary care, and connection to various services. They aren’t technically medical facilities because the medical staff is only there to help if something goes wrong. They do not teach you how to or help you use your drugs, but they will give you sterile equipment and be there in case you need help.
There is usually some sort of check-in station, area(s) to consume your drugs which are sometimes separated by the method of consumption (smoking vs. injecting for example), and a check-out station. It’s best to have an observation room that is also medically supervised since some drugs can cause overdoses less quickly. It’s also a best practice to have some forms of medical services on-site like wound care, medication-assisted treatment initiation, and HIV/ HCV testing and treatment and to offer wraparound services like referrals to social, legal and housing services. Most OPSs will also offer services multiple times throughout the visit which helps the drug user know if and when they are ready for these services the site workers are there to help. Most OPSs will dispense naloxone at check-out.
There are no documented cases of people dying in overdose prevention sites.
OPSs are able to connect people with treatment and other services that often allow them to control their use and live productively within society.
I took to my Instagram story to ask my friends what they wanted to know about OPSs and got tons of really great questions/ topics to talk about. I’ve condensed them below, thank you to everyone who asked a question!
Are there admittance criteria for an OPS?
Since OPSs are not technically medical facilities, they don’t have typical admittance criteria. They are meant to help those on the margins of our society who are often excluded from most things.
Are there safeguards against those using the facility not being reported to the police?
This question is really great! The answer is a bit complex. Currently, the ones operating in the United States are underground which means they go to lengths to make sure law enforcement doesn’t know where they are. Safehouse in Philadelphia is attempting to litigate to open the first legal OPS in the United States which would mean it was legal and therefore law enforcement couldn’t arrest people inside of it. Now technically, they could target people as they attempted to enter or exit the site and charge them for possession of drugs and/or drug paraphernalia. This is why OPSs need to be paired with laws decriminalizing drugs at least in reasonable amounts for personal use and decriminalizing drug paraphernalia. Currently, these laws set personal use amounts to be much lower than many habitual drug users will have a tolerance for. OPSs cannot be the only solution to these crises, but they can and should be a component of our solutions.
Are these inpatient or outpatient facilities?
Technically they’re neither since they aren’t medical facilities. It’s kind of like going to a public library. There are people there to help you if you need it but it’s also a place you can go and do what you need to and be on your way.
Why would someone come use here?
I think this is one of the best questions people have about these sites. The answer depends on the location of the sites and who the location makes sense for. Safehouse in Philadelphia has found a site in a neighborhood that has many drug users who are experiencing homelessness. Currently, the neighborhood has many drug users who have no choice but to use in public or public locations like coffee shop bathrooms. I’ve read reports about sites in Canada being used by many business people because of their locations.
I don’t know if my sister Emily would have used OPSs because she had a job, and often had a car and stable housing. She had places she felt safe using but she died because she used alone in her car on the way to work.
These sites need to be carefully planned by looking at where overdoses are most prevalent and by looking a who is experiencing the most overdoses. They cannot be seen as the only solution but must be part of a broader and bolder harm reduction strategy.
Can you talk a bit about existing sites?
These sites have proven to be successful: no one has died in one and people are getting connected to treatment. There’s also a huge social aspect to them. People utilizing the services will regularly interact with the same workers and be able to build relationships and trust with them which can make it easier to ask for help with other issues and seek treatment if and when they are ready to.
There are about 120 OPSs or “safe consumption sites” currently operating around the world in 10 countries: Australia, Canada, Denmark, France, Germany, Luxembourg, the Netherlands, Norway, Spain, and Switzerland.
Further Reading
Drug Policy Alliance - Supervised Consumption Services
Global News - Alberta’s supervised consumption, overdose prevention sites have 100% overdose reversal rate: report
Harm Reduction Journal - Implementation contexts and the impact of policing on access to supervised consumption services in Toronto, Canada: a qualitative comparative analysis
STAT - Overdose prevention sites can help cities like Philadelphia save lives
Hopkins Bloomberg Public Health Magazine - 5 Things to Know About Overdose Prevention Sites
Current Reading
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