Last month, the Arizona legislature proposed HB 2798 to prohibit local governments from developing overdose prevention centers, or OPCs, an effective and mainstream strategy that reduces fatal overdoses, links people who use drugs to treatment, and saves taxpayer dollars.
Although their utilization has been constrained in the U.S. due to a federal law, they have existed around the world since the 1980s. Each OPC is a little different in terms of the services they provide versus those that they refer out, but most include some combination of the following: a safe space where people can use their own illicit drugs under the watchful eye of a healthcare provider trained to treat overdoses, sinks, showers, counselors, harm reduction training and supplies, primary care and substance use treatment. Some even offer a warm meal. Although critics worry that OPCs enable drug use, they actually reduce it. When people who use drugs can go somewhere that actually offers the support they want and need, it’s easier to start the journey towards healing.
Myself an addiction physician, I know what a difference simply being indoors could make for my patients, many of whom have lost their homes and are living on the streets. Similarly, as many of my patients don’t have regular access to a working phone, having a doctor available at the site would also increase their access to the treatment they desperately need. The therapeutic relationships between participants and staff may also contribute to OPCs’ positive outcomes, as loneliness and isolation have been shown to increase illicit drug use.
Data from countless studies have shown that OPCs reduce HIV and hepatitis infections, public drug use, discarded syringes and 911 utilization while also increasing rates of addiction treatment. In Vancouver, 42% of an OPC’s participants entered into addiction treatment. OPCs could also benefit Arizona’s healthcare system as a whole, as OPCs reduce the need for ambulance calls, emergency department visits and hospital beds — something critically important during the worsening ED boarding crisis where patients are forced to wait hours or even days for a hospital bed. Because of their public health impact, OPCs save money: it is estimated that every dollar spent on an OPC results in over twice as many savings.
In December 2021, New York City opened the nation’s first sanctioned OPCs in Harlem and Washington Heights. Within a month of opening, the amount of improperly discarded syringes in the park near one of the OPCs dropped from 13,000 to 1,000. During their first year of operation, 2,841 individuals visited the centers 48,533 times, and staff intervened during 636 visits (1.3%) to prevent overdose-related injury and death. Staff only called emergency medical services 23 times, and no fatal overdoses occurred on site. Researchers believe that these OPCs diverted up to 39,000 instances of public drug use. And because of their accessibility and non-judgemental approach to care, they provided a critical access point into the health care system for participants who otherwise might avoid it due to prior negative experiences or other social barriers such as homelessness — 75% of their participants accessed other harm-reduction, social and medical services through the OPC. New York City has demonstrated that the operation of overdose prevention programs is possible.
Because of these overwhelming benefits, the American Medical Association has called OPCs a “a critical component of a comprehensive solution to addressing the harms of drug use.” Similarly, the American Society of Addiction Medicine recommends the creation of pilot OPC programs and state support. Of course, OPCs are not meant to be a tool used in isolation, but as a complement to other preventative and treatment modalities.
Unfortunately, the Arizona house passed HB 2798 and now the Senate is expected to do the same, placing a preemptive ban on what might otherwise be a useful tool in our communities. This isn’t being tough on fentanyl, it’s just being tough-headed.
Dr. Melody Glenn is an addiction and emergency physician at The University of Arizona. Her first book, Mother of Methadone, is forthcoming from Beacon Press this July.