Overdose Prevention Centers Save Lives, But Politics Stand in the Way

Like similar facilities in Canada and Europe that have been around for years, the two overdose prevention centers in New York City drastically reduced public drug use in the areas they serve and intervened in more than 1,500 potentially fatal drug overdoses since opening in 2021. Emergency 911 calls also dropped since the centers opened, saving the city’s health care system time and money.

With the overdose crisis claiming over 100,000 lives each year, public health officials in other parts of the country are eager to learn from New York City’s model and open overdose prevention centers (OPCs) in their own communities. At the same time, grieving families of overdose victims are loudly demanding the government end the failed war on drugs and embrace a public health approach instead of criminalizing people living with addiction.

Now, harm reduction organizations and activists who lost loved ones to overdose are holding a week of protests and events across several states to demand that politicians stop dragging their feet during a major public health crisis and remove the legal and political barriers to establishing OPCs beyond New York City. With marches and community meetings, the groups are demanding an end to the criminalization of drugs and highlighting the massive racial disparities in overdose deaths.

Like syringe exchanges, naloxone distribution, and other lifesaving innovations in harm reduction that provoked controversy before being broadly accepted as effective public health strategies, OPCs face intense stigma and political pushback despite plenty of evidence that they save lives and reduce public drug use. Without clarification from the Justice Department or legislation from Congress, it remains unclear whether law enforcement would crackdown on OPCs under a federal drug law written decades ago that makes it illegal to knowingly maintain a space for the purpose of using or distributing drugs .

When California lawmakers passed a bill in 2022 that would have allowed OPCs to open in Oakland, San Francisco and Los Angeles on a trial basis, Gov. Gavin Newsom stepped in with a veto that fellow Democrats were unable to defeat. In Vermont, lawmakers were recently forced to override Republican Gov. Phil Scott’s veto in order to pass a bill allowing for an overdose prevention center trial in Burlington.

In a rapidly gentrifying area of Philadelphia, a proposed OPC known as Safehouse has been blocked by the courts and local opposition since the Justice Department filed a lawsuit against the nonprofit under then-President Donald Trump in 2019.

When prominent Democrats such as Newsom or President Joe Biden signal their support for lifesaving harm reduction services, Republicans attack with misinformation and the easily debunked claim that liberals are somehow encouraging drug use. In reality, harm reduction helps people stay safe and healthy while providing pathways to the counseling and health care that is often essential for recovering from addiction.

Many Republicans remain hostile to harm reduction as they exploit the moral panic around fentanyl and other synthetic opioids to push harsh immigration policies and turn the overdose crisis into an electoral wedge issue.

Overdose prevention centers, also known as harm reduction centers or safe consumption sites, provide a safe space for people to use drugs inside and under medical supervision, rather than alone at home or on the street. If an opioid overdose occurs, medical professionals are standing by with the antidote naloxone. They also provide a range of basic medical care and health resources to people who would otherwise cram into emergency rooms or simply go without.

OPCs also connect clients to health care and addiction treatment that can be difficult for people on the margins to access. In New York City, about 75 percent of participants access other harm reduction, social and medical services after visiting the centers.

OPCs also provide onsite HIV and hepatitis C testing, which is crucial for preventing the spread of those diseases and getting people started on lifesaving treatments. Laura Thomas, senior director of HIV and Harm Reduction Policy at San Francisco AIDS Foundation, said OPCs are the missing link between a range of services that promote public health and save lives in her community.

“Overdose prevention centers are a perfect location to be able to provide that kind of testing and ongoing treatment and a cure for hep C,” Thomas told reporters this week.

Experts say OPCs benefit the entire community by reducing public drug use and potentially dangerous debris such as used syringes. Research shows no increase in crime (or even a decrease) where OPCs operate. So why are politicians standing in the way?

Partisanship is a major factor. Many Republicans remain hostile to harm reduction as they exploit the moral panic around fentanyl and other synthetic opioids to push harsh immigration policies and turn the overdose crisis into an electoral wedge issue. Migrants arriving at the southern border generally do not smuggle fentanyl, but by scapegoating asylum seekers and Democratic policies as a source of deadly drugs, Republicans such as vice presidential hopeful Sen. J.D. Vance are trying to scare voters to the polls in November.

“It is frustrating that the stigma and the misinformation and the sort of moral panic around fentanyl is one of the barriers in moving forward on this,” Thomas said. “There is a lot of misinformation about what helps give people the support they need to achieve recovery.”

“[California Governor] Newsom’s political ambitions led him to veto this bill; he didn’t think that this would help him run for president.”

While some Democrats look at the evidence and embrace harm reduction as a critical response to the overdose crisis, officially sanctioned overdose prevention in brick-and-mortar facilities still faces an uphill battle legally and politically. This is nothing new for harm reduction activists, who have been forced to provide services outdoors and operate in legal grey areas for decades.

In California, Republicans applauded Newsom for vetoing the OPC bill, with GOP Assembly Leader James Gallagher calling supervised drug consumption “a sign that Capitol Democrats have given up on governing.”

Newsom often casts himself as a compassionate Democrat, but he is also a major figure on the national stage who is often mentioned as a potential future presidential candidate. In his veto statement, Newsom claimed that he has “long supported cutting edge harm reduction strategies” but was concerned that the bill would allow for an “unlimited number” of overdose prevention facilities and called on state health officials to create guidelines for a “truly limited pilot program.”

As reporter Emily Hoeven at CalMatters observed at the time, Newsom was likely trying to avoid pushback from progressive Democrats by identifying the main issue as the potential number of OPCs, rather than the centers themselves. Still, the veto kicked the can further down the road. Meanwhile, nearly 12,000 Californians died of overdose in 2022.

“Newsom’s political ambitions led him to veto this bill; he didn’t think that this would help him run for president,” said Kellen Russoniello, director of public health at the Drug Policy Alliance, during a press call.

Thomas said viral misinformation about fentanyl and harm reduction that is regularly exploited by right-wing pundits and promoted by undiscerning media outlets is preventing the public from understanding the benefits of OPCs. For example, the idea that police are in danger of overdosing by simply coming into contact with fentanyl continues to spread even after being totally debunked.

However, some progress is being made. In 2021, lawmakers in Rhode Island voted to legalize OPCs, and city leaders in Providence have approved the construction of a facility that is expected to open later this year. In Minnesota, Gov. Tim Walz signed legislation in 2023 approving OPCs at the state level and providing $14 million in funding, though public health officials are holding off on opening them citing potential conflicts with federal law.

While the Justice Department under Biden has not interfered with the legally sanctioned OPCs in New York City like the Trump administration did in Philadelphia, the White House has failed to articulate its position on the issue, according to Kellen.

“We continue not to know what the federal government’s position is on this, and it is stifling a lot of state and local leaders from moving forward because they don’t know where federal government stands,” Kellen said.