How overdose prevention legislation is faring across the US

Amid landmark opioid settlements and evolving public sentiment around drug use, nearly 107,000 US adults died in 2021 from an overdose, according to the CDC.

To combat the ongoing overdose crisis, which has worsened with opioid availability in medical practices and illicit markets, states and jurisdictions have turned to a model that works in other countries: overdose prevention centers (OPCs).

OPCs offer sterile materials and provide supervision while community members consume or inject pre-obtained drugs. The centers also allow people who use drugs to build community and potentially open avenues for them to seek treatment or reduce their drug use—but not every locality is willing to open one due to federal restrictions.

A federal judge on April 3 rejected Philadelphia nonprofit Safehouse’s bid to open an OPC. Lawyers for Safehouse argued that the organization’s founders and directors are motivated by Judeo-Christian beliefs focused on the preservation of human life and that a threat of prosecution violated the organization’s religious freedom.

US District Judge Gerald McHugh dismissed the case, US v. Safehouse, arguing that the organization doesn’t have a religious right to open an OPC. Philadelphia reported 1,413 overdose deaths in 2022, an 11% increase from the previous year, according to the latest data from the city’s health department.

“The noble intentions of Safehouse and its founders are self-evident, and the public health crisis they seek to address continues unabated, but their religious inspiration does not provide a shield against prosecution for violation of a federal criminal statute barring its operation,” McHugh wrote.

That dismissal followed a January 2021 decision from the US Court of Appeals for the 3rd Circuit that determined Safehouse’s planned operations violated the federal Anti-Drug Abuse Act of 1986. Commonly referred to as the “crack house” statute, the federal legislation prevents the maintenance of an establishment for the purpose of using controlled substances. A handful of jurisdictions consider OPCs to be a legal gray area and have successfully authorized supervised drug-injection sites at state or local levels.

“The lack of clarity at a federal level has made it challenging for some jurisdictions to move forward,” Brandon Marshall, epidemiology chair at the Brown University School of Public Health, told Healthcare Brew.

The Supreme Court rejected a request to hear a case on the legality of establishing a Safehouse OPC in October 2021.

Still, New York City’s then-mayor Bill de Blasio greenlit the opening of the nation’s first authorized OPCs in East Harlem and Washington Heights in November 2021. Since opening, staff at the two OPCs have intervened in 1,500+ overdoses and more than 5,000 people have used the sites, according to Reggie Johnson, a spokesperson for OnPoint NYC, the organization that runs the OPCs.

Needing about $2 million a year to operate, the Manhattan-based centers are struggling to raise enough capital to stay open. Advocates such as Housing Works, a nonprofit aimed at serving people who are experiencing homelessness or have AIDS, have called on legislators, including Governor Kathy Hochul, to allocate some of the state’s $2.6 billion opioid settlement dollars for these programs.

Hochul declined to use the money for OPCs in November 2023, citing legal barriers. Instead, the governor announced plans the following month to prioritize the funds for other harm reduction efforts, such as fentanyl test strip distribution and expanded community health clinics.

A spokesperson for Kathy Hochul didn’t immediately return Healthcare Brew’s request for comment.

Housing Works CEO Charles King said the organization has considered opening two OPCs in downtown Manhattan.

Bills in the New York State Senate and Assembly would allow the state to authorize the opening of more OPCs without the allocation of state funding, though they haven’t gained traction—and King predicted that Hochul, a Democrat, would veto the legislation even if it did get to her desk.

“The more we see states going ahead, irrespective of the Third Circuit Court of Appeals’s interpretation of the ‘crack house’ statute, and authorizing these [centers], the harder it’s going to be for someone like Governor Hochul to resist moving this forward,” King told Healthcare Brew.

Other states may be poised to move on their plans as well.

A Providence-based OPC is set to open later this year, which Project Weber/Renew, a peer-led harm reduction and recovery services organization, will operate.

Colleen Daley Ndoye, Project Weber/Renew’s executive director, told Healthcare Brew that the state legislature overwhelmingly passed a bill to authorize the Providence OPC. The site proposal also received unanimous approval from the Providence City Council, she said.

“It wasn’t a partisan issue,” Daley Ndoye said. “It’s really exciting and really sends a message.”

Authorization for the Providence OPC falls under a state-approved pilot program that’s been extended through 2026, but Daley Ndoye anticipates permanent authorization once the center is able to open and deliver results.

Marshall is directing the Rhode Island portion of a four-year, National Institutes of Health-funded study on the efficacy of OPCs—the first of its kind in the US, according to Brown University.

Marshall said that the support in Rhode Island, as well as the research collected from the Providence and New York City sites, should provide momentum to jurisdictions that “may be considering not just overdose prevention centers, but scaling up harm reduction efforts to address the overdose crisis more broadly.”

In Minnesota, Governor Tim Walz, a Democrat, signed a budget proposal in May 2023 that effectively allocated $14 million to harm reduction organizations, including safe injection spaces.

Scott Peterson, spokesperson for the Minnesota Department of Human Services, said in a statement that the state has not used any of the funds for OPCs. “The first request for proposal (RFP) will be for start-up and capacity-building. The safe consumption aspect will not be a part of our first RFP,” he said.

The Vermont House of Representatives passed legislation in January that would authorize and fund two OPCs. An amended version of the bill received preliminary approval from the state Senate on May 1 and will return to the House for a second vote.

Republican Governor Phil Scott previously vetoed a 2022 bill directing the design of one or more OPCs. Scott wrote in his veto letter to lawmakers that the plan seemed “counterintuitive.”

If Scott vetoes the bill, it must receive a two-thirds majority vote in each chamber to override the veto and pass as legislation.

Both the House and the Senate supported the bill with more than the required majority in preliminary votes.