At a fundamental level, an overdose prevention center is exactly what it sounds like: a place designed to reduce drug overdose, and specifically reduce fatalities associated with drug overdose. On a more general level, an overdose prevention center is one component of a recent movement in the United States called harm reduction. The harm reduction movement is gathering momentum here for one reason: the opioid crisis.
The opioid crisis began in the late 1990s, and – except for a small dip in overdose fatalities around 2017 – has gotten steadily worse, year on year, since we became aware of the growing number of opioid overdose fatalities.
Public health officials began changing policies to address the crisis in the early 2010s, with changes in prescription policies for opioid drugs, new advisories from the CDC on prescribing opioids for pain, monitoring programs to identify doctors or pharmacies that over-prescribed of over-distributed opioid medications, and various law enforcement efforts to address the crisis by preventing illegal drugs from reaching people on the streets.
However, none of those efforts stopped the opioid crisis or reduced the yearly increase in opioid-related overdose deaths. When nothing else worked, we turned to harm reduction, following the example of several European countries, where evidence showed policies based in harm reduction are safe and effective. Harm reduction is a new approach in the U.S., and part of a new national strategy developed by the White House to mitigate the harm caused by the opioid crisis.
In this article, we’ll answer the question posed in the title: do overdose prevention centers – a core component of a harm reduction approach – increase crime in the communities where they’re located?
Let’s take a look.
What is Harm Reduction?
Here’s a comprehensive definition of harm reduction, as published by the non-profit harm reduction advocacy group Harm Reduction International (HRI):
“Harm reduction refers to policies, programs and practices that aim to minimize the negative health, social and legal impacts associated with drug use, drug policies and drug laws. Harm reduction is grounded in justice and human rights. It focuses on positive change and on working with people without judgement, coercion, discrimination, or requiring that people stop using drugs as a precondition of support.”
The underlying concept behind harm reduction is in the name: harm reduction advocates seek to reduce the widespread pain and suffering associated with drug use, drug addiction, and drug overdose.
The three primary goals of harm reduction policies are to (1) save lives, (2) reduce unintended negative consequences of drug policy, and (3) create treatment alternatives and options for people who want to stop using drugs. Policymakers pursue these goals through eight types of evidence-based programs:
- Educational Programs
- Overdose Prevention/Reversal
- Treatment with medications for opioid use disorder (OUD) in medication-assisted treatment (MAT) programs
- Needle/Syringe Programs
- Safe Consumption Sites/Overdose Prevention Centers
- Drug Checking (for presence of dangerous/fatal additives like fentanyl
- Housing Support
- Legal Support
In this article, we’ll focus on three of these programs that overlap: overdose prevention/reversal, needle/syringe programs, and safe consumption sites. A paper published in November 2023 called “Overdose Prevention Centers, Crime, and Disorder in New York City” explores the community impact of two new overdose prevention centers that opened in New York City in November 2021.
The Study: The Impact of Overdose Prevention Centers on Community Crime
Researchers collected data in order to examine the community impact of harm reduction programs that offer overdose prevention centers/safe consumption sites, compared to other harm reduction facilities that do not offer safe consumption sites. Researchers assessed the following indicators with information gather between January 2019 and December 2022:
- Requests for assistance for emergency
- Nuisance complaints
- Police enforcement in the vicinity of the safe consumption sites
The study is called a difference-in-differences study, wherein researchers look at two similar phenomena that involve quantifiable change, and identify the discrete variances in change between the two similar phenomena. In this case, the researchers looked at the difference-in-differences between changes in crime measured around two new overdose prevention centers in New York City, and compared them to the changes measured around harm reduction centers that did not operate overdose prevention centers.
What Are Overdose Prevention Centers?
The National Institute on Drug Abuse (NIDA) defines and explains the practical utility of OPCs as follows:
“OPCs are facilities where individuals consume illicit drugs under the observation of trained staff to mitigate risk of fatal overdose. By intervening with use of naloxone, oxygen, and other overdose mitigation techniques, OPCs prevent fatal opioid overdoses on their premises.”
While this isn’t stated officially anywhere, it’s clear the name/designation overdose prevention centers (OPCs) replaced the terms safe injection or safe consumption sites to address the automatic, knee-jerk resistance and stigma attached to safe injection/consumption sites in the U.S. OPCs have operated in Europe and other regions around the world for the past several decades. However, despite overwhelming evidence supporting their safety and effectiveness, before the opening of the two OPCs in New York City in 2021, no such sites existed in the U.S.
Overdose Prevention Centers: Benefits and a Brief History
Although the U.S. is in the midst of a decades-long opioid addiction and drug overdose crisis, officials have been reluctant to implement OPCs. Resistance to OPCs coalesces around fear associated with these issues:
- They sanction illegal activity
- People who use OPCs will increase crime in communities
- OPCs will drive up drug use in communities
However, around the world, there’s no indication these fears are justified – we’ll report the details on that in a moment. For now, we’ll continue with the basic facts about OPCs, then discuss the benefits of OPCs for individuals and communities, and finish with the results of the study on the two new OPCs in New York City.
First, the history.
The first OPC opened in Switzerland in 1986, with no negative impact on the surrounding community. Here’s the data on the prevalence of OPCs worldwide:
- Canada: 36 OPCs
- Netherlands: 31 OPCs
- Germany: 24 OPCs
- Spain: 13 OPCs
- Switzerland: 12
- Denmark: 5 OPCs
- Australia: 2 OPCs
- Norway: 2 OPCs
- France: 2 OPCs
- Luxembourg: 1
- Portugal: 1
- Ukraine: 1
By our count, that means there are over a hundred OPCs operating safely and successfully around the world. The two new centers in New York add to that number. If they’re successful, then ideally every major city with an overdose problem – meaning every major city in the U.S. – may adopt this approach and sanction the opening of OPCs to mitigate the harm caused by the opioid crisis.
Benefits of Overdose Prevention Centers
The Drug Policy Alliance (DPA), a U.S. based non-profit organization dedicated to increasing awareness about progressive drug policy and harm prevention services, describes the following benefits of OPCs for individuals:
- Reduction of fatal overdose
- Reduced sharing of syringes
- Decreased infectious disease transmission
- Increased linkage/access to treatment
- Increased social connection
- Reduced use of emergency medical services
In addition, the DPA identifies the benefits of OPCs for communities:
- Reduction of public drug use
- Reduced presence of drug paraphernalia and used syringes/syringe debris
- Decreased public cost for hospital emergency room visits
- Decreased public cost for emergency medical services related to overdose, e.g. reduced need for paramedics/EMTs/ambulance services
Additional facts provided by the DPA that support the benefits of DPCs include:
- A study in San Francisco that showed opening one (1) OPC could save the city 3.5 million dollars
- A similar study showed Baltimore could save 7.8 million dollars per year
- 64% percent of voters in the U.S. support the implementation of OPCs in areas of need nationwide
That’s compelling evidence for OPCs. And just as a reminder, let’s review the need for OPCs in the U.S.: the opioid and overdose crisis. Here are the latest numbers as reported by the Centers for Disease Control (CDC).
Overdose Deaths: 2020-2021
- 2020: 92,478 deaths
- 2021: 107,573
- 2022: 109,705
For the 12-month period ending June 2023, the CDC reports 106,842 deaths, which leads experts to the following estimate that in 2023, we’ll see over 111,000 overdose deaths.
What the data tells us – to reiterate – is that we need new ideas, including the use of OPCs. Let’s look at the results of the study we mention above about the impact of the only two OPCs in the U.S., after two full years of operation.
Overdose Prevention Centers and Crime: The Results
After the two OPCs opened, relative to comparison sites, which offered harm reduction services but no OPCs, data shows the following changes in criminal activity and neighborhood disturbances in the immediate vicinity of the OPCs:
- 911 calls for crime and other emergencies:
- Decreased overall by 30.1%
- Calls in comparison locations decreased by 3.1%
- 911 calls for medical emergencies:
- Decreased around the OPCs by 50.1%
- Calls in comparison locations decreased by 8.6%
- 911 calls for:
- Crime: 31% decrease
- Assault: 42% decrease
- Trespass: 27% decrease
- Medical reasons: 51% decrease
- 311 calls for nuisance/disturbance:
- Drug-related: 160% increase
- Unsanitary conditions: 16% decrease
- Noise: 25% increase
- Homelessness: 49% decrease
- 311 calls around comparison sites rose 33.3%
- Weapons: 56.5% decrease
- 70.2% decrease in the larger neighborhood around the OPCs
- Drugs: 82.7% decrease
- 74.5% decrease in the larger neighborhood around the OPCs
- Criminal summons, any type: 87.9% decrease
- 59.7% decrease in in the larger neighborhood around the OPCs
- Weapons: 56.5% decrease
Based on these figures, the study authors concluded:
“More research is required to [assert] that the 2 OPCs in NYC will not be associated with localized increases in crime and disorder over a longer span of time. Objections to their implementation that rest on these concerns are not necessarily supported by our initial observations in this cohort study.”
That’s a realistic summary of their findings. The two centers in NYC have only been open for two years, so we’ll need long-term data to assess long-term effects. With that said, over the first two years, the data shows that while some drug activity in areas adjacent to OPCs increased, overall criminal activity decreased, in comparison to harm-reduction sites that did not offer OPC services. Therefore, the data are promising. Not only can OPCs reduce drug related harms to individuals who use drugs, but they can also reduce overall criminal activity in the neighborhoods in which they’re located.
That’s positive news for individuals, families, and communities, and confirmation that our current harm reduction approach to the opioid crisis is a step in the right direction.