US: Overdose Prevention Centers Get Spotlight at Rx Summit

For the first time in the 12-year history of the Rx and Illicit Drug Summit, the topic of overdose prevention centers (OPCs) took center stage on Thursday morning.

Three stakeholders involved with the operation of OPCs in the United States convened for a panel discussion during a plenary session:

  • Sam Rivera, executive director, OnPoint. Located in New York City, OnPoint operates the nation’s first 2 overdose prevention centers.
  • Theresa Tobin, PhD, MSW, chief of interagency operations, New York City Police Department.
  • Brandon Marshall, professor of epidemiology, Brown University School of Public Health. Rhode Island, the state in which the university is located, became the first state to formally legalize supervised injection sites in 2021. Facility openings are planned for 2024.

Rivera opened the session by highlighting the services offered at OnPoint, which in addition to supervising drug use also provides case management, holistic health, and support services. OnPoint has registered about 3200 users since beginning to allow drug consumption on its premises in November 2021. Users are not provided with any drugs by OnPoint, but they are allowed to consume what they bring in themselves.

At launch, opponents of OnPoint’s supervised injection services expressed concern that the facilities in East Harlem and Washington Heights, New York, would become magnets for drug dealers, but that has not been the case, Rivera said.

In general, dispelling myths was a large topic of conversation during the 50-minute discussion. Before arriving in Rhode Island, Marshall served on a team that evaluated the first OPC to open in North America, Insight, which launched in Vancouver, British Columbia, Canada, in 2003. Marshall said his team has found that overall, OPCs have improved the conditions of the neighborhoods in which they operate by reducing public drug use, drug-related disorderly conduct, and discarded drug paraphernalia.

Marshall added that it is also a misconception that OPCs operate only in large, urban areas. They are scalable for different communities and can be adapted to local needs. While OPCs do require a significant upfront investment—OPCs in Rhode Island are using opioid settlement funds the state received to launch—they can ultimately save public dollars by preventing emergency visits, Marshall said, adding that Vancouver saw a 35% reduction in community overdose mortality rates after the opening of Insight.

At launch, Rivera said he was warned that OnPoint would face large-scale protests. That ended up not being the case.

“It turned out to be 4 people and a dog,” he said. “We fed the dog.”

One of the most effective ways OnPoint has gained community acceptance is by being transparent in its operations and welcoming in anyone who wishes to see how the organization conducts its operations.

Marshall added that it is also important for jurisdictions considering implementing OPCs to engage with users in their communities to better understand their needs and create solutions that meet them.

While overdose prevention sites remain a novel concept in the United States, there are currently more than 200 centers operating in 14 countries. Dr Tobin remarked that it might not be long before the novelty wears off within the US.

“I’ve been in this business a long time,” she said “Maybe 5 years from now, we will be reacting to OPCs like we do safe syringe exchanges. That’s where we are heading. It’s going to be a no-brainer shortly.”


Rivera S, Marshall B, Tobin T. Plenary session: discussing overdose prevention centers. Presented at the Rx and Illicit Drug Summit; April 10-13, 2023; Atlanta, Georgia.

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