2021 was a monumental year for harm reduction in the United States. In July, the country’s first bill legalising overdose prevention centres (OPCs) – often referred to in other parts of the world as drug consumption rooms – was passed in the state of Rhode Island and, in November, the first two city-sanctioned OPCs opened in New York City. Then, following more than three years of advocacy, state regulatory guidance creation, and city authorisation, Project Weber/RENEW opened the first state-sanctioned OPC in Providence, Rhode Island in January 2025.
At OPCs, trained staff are on-site to intervene at the earliest signs of an overdose and offer connections to substance use disorder treatment and critical health and social services. While OPCs have been in operation in other parts of the world for decades, questions have remained as to how these services will impact overdose rates in the US context and fit within the country’s fragmented continuum of care for people who use drugs.
Our study is part of a large, multi-year evaluation assessing the effectiveness of the three US-based OPCs. We aimed to understand how the design and operation of the Rhode Island OPC impacted clients’ engagement patterns and use of other on-site services.
The Rhode Island OPC is part of a larger, comprehensive service hub that includes a drop-in centre with a range of on-site programming on the first floor (including showers, laundry, and case management) and the OPC located on the second floor. The space supports a range of consumption modalities, including inhalation, and has specific design aspects to support clients who use stimulants (for example, a decompression room) as well as opioids.
A clinical service provider also provides medical care, mental health services, and substance use treatment services on-site. The site is also located adjacent to a large hospital campus, to ensure that healthcare services are easily accessible, if needed.
In the first few months after its opening, we interviewed 30 people who had used the Rhode Island OPC and spent approximately 40 hours conducting observations of the space. Our work demonstrated that for most participants, the OPC and the other available wrap-around services served as a key feature in their daily lives.
Specifically, overdose prevention was only one of the several benefits they felt the site provided, highlighting the connections to services and healthcare resources they made when engaging with the site.
Connecting to care
Despite the novelty of the OPC, participants’ initial engagement with the site was not always driven by being able to use pre-obtained drugs under supervision; rather, it depended on whatever their most immediate needs were. For some, this was access to shower and laundry services on the first-floor hub. For others, especially participants who were not previously engaged with the organisation’s existing harm reduction services, the OPC services were especially important for getting them in the door. One participant said:
“[My boyfriend is] telling me about this fabulous place that he found where you can go in and you can smoke freely and it’s a safehouse… I can’t thank them enough for how comfortable they’ve made me feel when I’ve had nowhere to go to smoke. When I was afraid of getting caught outside. When I’m hiding behind my fucking bush, or I’m running into a bathroom in a public restaurant, or public place [to] take a hit.”
“Word-of-mouth” communication and hearing about peers’ experiences at the OPC also proved instrumental for connecting people to the different services:
“I went and told my friend…She had no idea about [the OPC]. She didn’t know where it was. I said, ‘Listen, once you get a taste of this world, you’re never gonna want to go anywhere else [for services]. You’re not gonna want to be in Kennedy Plaza [state’s main transit hub] when it’s hot and fucking sweating your ass off. You’re not gonna want to be in Cathedral Square or Crossroads [service organisation]. I said, ‘You can watch TV, you can wash your ass, you can do laundry, you can fucking sleep in a chair all day if you fucking want to. There’s coffee, there’s food, there’s counseling, there’s also sometimes meditation or relaxation groups or whatever.’”
Once engaged with the site, participants’ use of services often expanded beyond their initial patterns. Over time, almost all participants described regularly using a range of on-site programs in addition to the OPC, including basic needs services, case management, healthcare, and treatment services.
“Once I started going to the OPC, I had this central wheel hub to be able to sort of think about and focus on services and possible assistance. [The OPC is] the hole in the middle that makes everything happen.”
Importantly, site staff played a key role in connecting participants to these “entwined” services. Participants described how staff working in the downstairs drop-in centre, including case managers, volunteers, and peer navigators, regularly introduced them to the suite of services offered on-site.
“Once you’re a new person, they [staff] let you get settled, and then they approach you know that there’s an abundance of services that they do.”
In this way, both the co-location of services and support from staff helped to remove logistical barriers that had previously prevented clients from accessing needed services.
So what?
Ultimately, we found that the Rhode Island OPC’s integrated service model accommodated clients’ priorities and supported clients’ individualised patterns of access and engagement. By providing a wide range of co-located services, the site was able to engage people who were facing broad levels of marginalisation and address a variety of their health and social needs, thereby providing evidence that integrated OPC models can be effective in a US context.
We have recently seen significant reductions in overdose deaths in the US, which underscores the effects of expanded harm reduction and overdose prevention support. However, we must continue to prioritise these evidence-based interventions, including OPCs, to reduce the ongoing effects of the country’s overdose crisis.
Going forward, it is imperative that sustainable, state-level funding be allocated to maintain and support OPCs so they can serve as key resources for people.
This work is part of a larger, ongoing evaluation of the three sanctioned OPCs in the United States. Further information and results from this study can be found here.
