Rhode Island has made history by opening the United States’ first overdose prevention center (OPC) that’s sanctioned by a state government.
The site opened on December 10 in Providence. As Filter has reported, it’s run by local harm reduction nonprofit Project Weber/Renew and its clinical partner VICTA, which provides substance use treatment and behavioral health services.
In addition to welcoming people to use drugs on-site—in injection or inhalation booths, with overdose prevention resources like naloxone and trained staff on hand—the facility offers sterile syringes, fentanyl test strips and other harm reduction supplies. Located near the Rhode Island Hospital campus, in the same building as the nonprofit’s drop-in center, the model of “wraparound support” includes food, showers, laundry facilities and referrals for housing and a range of other resources.
“It’s just a place to keep people safe, prevent deaths, and connect people to services,” said Dennis Bailer, the organization’s overdose prevention program director.
OPC unequivocally save lives. Two sites in New York City—sanctioned by the city, rather than the state —were the first to open in the US, in late 2021. Their operator, OnPoint NYC, currently reports almost 1,700 overdoses averted, with no deaths.
It took much advocacy and pressure for Rhode Island to get here. Back in 2021, harm reduction advocates secured an historic victory as state lawmakers and Governor Dan McKee (D) approved legislation to establish OPC—a first among US states. Revising plans and winning local approval took another three years. Only in February did Providence City Council give the green light.
The Rhode Island launch is a milestone. But many other countries began rolling out OPC years or even decades ago.
The facility is benefiting from public funding: The state allocated $2.6 million to support it, from opioid settlement funds with pharmaceutical companies. Technically a pilot program, the OPC will “sunset” by March 2026 unless officials agree to extend it.
Meanwhile, the federal government is funding two studies, in Providence and New York, on how the OPC affect drug use, public costs, and overdose rates. Brown University, in Providence, was awarded part of this four-year, $5 million grant, and will enroll Providence OPC clients as participants.
The Rhode Island launch is a milestone in the US. Yet the nation lags far behind many others in terms of OPC rollout, thanks to political, social and legal resistance to US efforts.
In California, for instance, state lawmakers backed an OPC pilot program, approving legislation in 2022. But at the last minute, Governor Gavin Newsom (D) vetoed the bill, breaking a previous promise. And in Philadelphia, a harm reduction group seeking to open an OPC has been locked in a years-long court battle with the federal government.
No overdose death has ever been recorded at overdose prevention centers, which are known by various other names and acronyms. The US total of authorized OPC now climbs to three, but many other countries began rolling them out years or even decades ago. Here is a non-exhaustive list of examples:
Switzerland: The first OPC opened in the city of Bern in 1986. Despite doubts from some elected officials, it was approved by the state and publicly funded, at a time when drug use was highly visible in the city’s downtown and an HIV crisis demanded action. Over 30 years, the center has averted over 1,000 overdoses. The effectiveness of this approach led to additional centers opening in Basel and Zurich. Later, the Bern site expanded to include methadone provision and heroin-assisted treatment.
Germany: Just after the fall of the Berlin Wall, a newly reunited Germany was among the early European nations to open OPC. In 1994 the first authorized site opened in Frankfurt. But it wasn’t until 2000 that this was formally enshrined in law—after the German parliament passed an amendment to its federal narcotics law, setting regulations for OPC and instructing provinces on how they could authorize the sites. According to the European Monitoring Centre for Drugs and Drug Addiction, there were 24 sites in 15 German cities as of 2018.
The past struggle in Germany resembled that in the US decades later. Throughout the 1970s and ’80s, unauthorized “health rooms” enabled people to use drug and also access harm reduction supplies. It created a kind of absurd scenario: a health room in a remodeled bus in Hamburg welcomed people to use drugs safely, alongside posted warnings that prohibited drug use. A breakthrough came in 1993 when a former drug enforcement official presented a legal opinion to a Frankfurt city panel, supporting the idea of OPC.
The Netherlands: Like Switzerland, the Netherlands also experienced widespread public drug use and surging injection-related HIV transmissions in the 1980s. As BOLTS described, an estimated one in four people injecting drugs at the time had HIV. Drug users took matters into their own hands, giving out sterile syringes and methadone and started initiatives like Mainline magazine. Thanks to their education efforts, even law enforcement would become part of the coalition pushing for harm reduction measures.
The Netherlands first authorized OPC in 1996. Two decades later, the country had 37 sites in 25 cities, more than any other nation.
Spain: The first OPC in Spain opened in 2000, in Madrid. That was followed by a site in Barcelona in 2002. To this day, Spain has not formally legalized or regulated OPC, but low-level drug possession is decriminalized there.
Canada: North America’s first authorized OPC opened back in 2003: InSite, operating in Vancouver, British Columbia. Surging drug-related deaths in the city’s Downtown Eastside had provided the impetus. In over two decades in operation, no overdose at the site has been fatal. Today, there are 39 sanctioned supervised injection sites throughout Canada, as more provinces and cities have taken steps to open them. But a backlash against harm reduction has been gathering momentum. The provincial government in Ontario just passed a new law that will shut down at least 10 of these lifesaving sites.
Norway: Norway was the first Scandinavian country to allow OPC, though only in limited circumstances. Thanks to a special provision passed by the parliament in 2004, an OPC opened in Oslo in 2005. It wasn’t until 2016 that a second site opened, in Bergen. The sites only allow heroin injection. And somewhat uniquely, trained staff there do not administer naloxone in overdose events. However, the sites are located close to ambulance stations which can be called upon. The Oslo site, which saw tens of thousands of injections in 2015 and 2016, had a total of 627 overdose cases in that period, with no fatalities.
Denmark: Danish harm reductionists jumped ahead of official approval in 2011, when they opened a mobile OPC in Copenhagen. For 10 months, police and officials let the nonprofit Fixerum serve people who use drugs without making any arrests. That forced the parliament to take steps to legalize and regulate OPC in 2012. Under the new law, cities could open sites if the health ministry approved, and drug users and harm reduction workers would be protected from arrests for low-level drug possession in and around OPC. The first brick-and-mortar OPC opened in Copenhagen later that year.
Portugal: Portugal led the way in 2001 by decriminalizing drug possession and endorsing a harm reduction approach to drug use. However, the country lagged far behind other European nations on OPC. Progress finally came in 2019, as the Lisbon city council agreed to authorize a mobile facility. In 2021, two decades after decriminalization, Portugal opened its first safer smoking and injection sites.
Colombia: In 2023 Colombia made history as the first country to open an OPC in South America. The facility is run by Acción Técnica Social, a local nonprofit. The organization reports that in over a year since opening, it has given out 40,000 sterile syringes. And it has responded to 14 heroin-involved overdose incidents, each time preventing a fatality. ATS has served 78 individuals, most of them uhoused. Besides harm reduction supplies, the nonprofit provides people with food and shelter.
Screenshot from the video “Overdose Prevention Centers: Got a Minute?” by the Drug Policy Alliance
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