More supervised consumption sites are on the horizon despite stalled federal guidance

Almost two years after New York City opened the nation’s first overdose prevention centers (OPCs), the two facilities—which allow people to use illicit drugs under medical and/or peer supervision—remain the only locally sanctioned sites in operation in the US.

That could soon change: Rhode Island is set to open its own OPC in early 2024. And the Biden administration is reportedly working on guidance that could lead to more facilities opening across the country.

But when those guidelines could come—and whether additional states or cities would follow suit—is unclear. OPCs, which are also known as supervised consumption sites, remain a thorny issue for politicians, even as early data touts their success in reversing overdoses.

Healthcare Brew broke down where things stand on OPCs.

Federal rules

Supervised consumption facilities are prohibited under the federal 1986 Anti-Drug Abuse Act—sometimes known as the “crack house” statute. But the Department of Justice (DOJ) is expected to release guidance that could pave the way for OPCs to open across the US.

Such a move would mark a stark reversal of how OPCs were previously treated. The Trump administration’s DOJ filed a civil lawsuit in 2019 to declare Safehouse, a proposed Philadelphia overdose prevention site, illegal and bar it from opening. The courts agreed with the government, ruling in January 2021 that it’s a federal crime to open an OPC for illegal drug use.

Later, the DOJ—now under President Joe Biden’s control—began settlement talks with Safehouse. And in January 2023, Safehouse officials announced that they had “agreed to meet with a federal magistrate to expedite resolution and begin saving lives.”

The National Institutes of Health, meanwhile, announced plans in May to study OPCs.

New York

New York City made history when the nation’s first OPCs opened in Harlem and Washington Heights in November 2021. The two facilities operated by OnPoint NYC have since been used 78,000+ times by nearly 3,400 participants, and helped avert more than 900 overdoses.

However, the OPCs, which former New York City Mayor Bill de Blasio greenlit, continue to operate under a legal gray area due to state and federal prohibitions.

State officials have held off on legalizing OPCs. Legislators left Albany in June without passing the Safer Consumption Services Act—a bill that would authorize OPCs statewide—dashing harm reduction activists’ hopes of enacting the bill in 2023.

OPC backers, like advocacy group VOCAL-NY, have criticized the state for taking a hands-off approach amid rising overdose-related deaths.

Meanwhile, OnPoint NYC leaders have cautioned that OPCs could be forced to close because they would be unable to access state or federal funds—including opioid settlement dollars—without authorization.

Rhode Island

Despite becoming the first state to authorize supervised injection sites in July 2021, Rhode Island has yet to open a harm reduction center—and it is not expected to do so until at least 2024.

State lawmakers voted in March to extend the state’s supervised injection site pilot program that was set to end in 2024 through to March 1, 2026, after efforts to open the state’s first OPC were stalled amid pushback and location challenges.

But Project Weber/Renew, a peer-led harm reduction and recovery support organization, announced in April that it—in partnership with CODAC Behavioral Healthcare, Rhode Island’s largest provider of outpatient opioid use disorder treatment—plans to open the country’s first state-backed overdose prevention in Providence early next year.

“With more than 100,000 people dying in this country every year—and hundreds in Rhode Island alone—it is time for us to take action to keep more people from dying,” Project Weber/Renew Executive Director Colleen Daley Ndoye said in an April statement. “We’re ready to make Rhode Island a leader in a new era of harm reduction.”

Project Weber/Renew and CODAC will staff the site with peer recovery specialists, nurse practitioners, and doctors. The Rhode Island Department of Health will regulate the new supervised consumption site.

Rhode Island leaders have allocated $2.6 million from the state’s opioid settlement funds to support the facility’s operation.

Other states

The Pennsylvania Senate overwhelmingly voted in May to ban supervised consumption sites like Safehouse. That bill now sits in the state House’s Judiciary Committee.

Democratic Gov. Josh Shapiro has expressed opposition to opening a supervised injection site in his state. He said in April that his administration is preparing for the possible settlement between the DOJ and Philadelphia advocates about the planned Safehouse facility.

Shapiro said he’s “prepared to take action should that become a reality,” adding that he prefers a legislative solution, the Pennsylvania Capital-Star reported.

Meanwhile, Colorado lawmakers in April rejected a measure that would’ve let cities authorize OPCs.

In California, Democratic Gov. Gavin Newsom vetoed legislation in 2022 that would’ve allowed some cities in that state to move ahead with supervised consumption site pilot projects.