What does an overdose prevention center look like?

Watch the full video.

An introduction to OPCs

A safe place.

In this clip, we get introduced to the concept of overdose prevention centers. What is their purpose and what do they do?

Transcript

Overdose prevention centers are places where people can bring pre-obtained substances to use while under the care of trained professionals. With over 100,000 U.S. overdose deaths a year, these sites provide a safe setting for people who would otherwise use alone or in risky settings where an overdose could be fatal. Research shows that these sites are effective at preventing overdoses from becoming fatal, and preventing other drug-related harms like infectious disease.

After an OPC opened in Vancouver, overdose deaths dropped by 35% in the surrounding neighborhood within a year.1 In Toronto, the drop in overdoses was 69% in neighborhoods located in a 1000 meter radius from OPCs after a year.2 In New York City, OnPoint stabilized 636 overdoses and was used by 2,841 people within one year of operations.3 Overdose prevention centers also provide additional services to people like healthcare, food, and hygiene services like laundry and showers. 

Entering the OPC

Now we know what an OPC is. Let’s check one out.

In this clip, we enter the overdose prevention site known as OnPoint NYC, located in East Harlem in New York City.

Transcript:

Today, we’re in East Harlem visiting one of the two overdose prevention centers operated by OnPoint NYC – to see how their overdose prevention program works. OnPoint serves over 10,000 people each year, most of whom are accessing services unrelated to drug use. Many of their participants are unstably housed and most are extremely low income. 

This is the drop-in center. Here, people can access food, laundry, and showers, and sign-up for other services in the building, such as medical care, medication-assisted treatment, holistic therapies, case management, support groups, and connections to detox and treatment, housing, and employment services.  

These services are open to the entire community and are completely free. A simple intake process at the welcome desk upon first visit is all that is needed to access these services. 

From here, registered participants can access drug checking services and sign up to use the overdose prevention center, which are in separate rooms. Drug checking provides a detailed breakdown of the substances in a drug sample. This knowledge helps people make informed decisions about their use, which can reduce potential harms associated with drug use, including overdose death.

How does an OPC work?

How do people use an OPC?

In this clip, we find out what happens when people want to access overdose prevention services at OnPoint.

Transcript:

Overdose prevention centers are places where people can use drugs while under the care of trained personnel. In the event of an overdose, personnel will respond to stabilize breathing and other symptoms to prevent an overdose from becoming fatal. 

Signing up to use the overdose prevention center requires answering a few questions including what drugs will be used, the quantity, and a person’s preferred method of consumption.

This overdose prevention center consists of a station in the middle of the room, which allows trained staff to see all participants, and contains all the supplies a participant may need to use safely. 

Before being assigned a space to use, participants wash their hands and get supplies. The booths for injecting, sniffing, or swallowing drugs have a large mirror which allows people to see all of their surroundings and which also allows trained staff to observe the earliest signs of overdose. There is also a sharps bin for the safe disposal of used supplies. All of the supplies used in the overdose prevention center are discarded here as well, reducing the potential for waste to be improperly discarded in public spaces.

Smoking vs Injection

How do people smoke drugs at an OPC?

In this clip, we learn about inhalation services that are offered at an overdose prevention center.

Transcript:

Recently, overdoses that involved smoking overtook those that involved injection use. People prefer to smoke drugs for different reasons – including safety. One study from California that compared smoking to injecting found that people who injected fentanyl were 40% more likely to overdose than those who only smoked. 4

In some regions, smoking is more prevalent than injection use. Although smoking can be a safer modality of use, it does not eliminate the possibility of an overdose. The CDC reports that in 2022, smoking was involved in 23% of overdose deaths, while injection was involved in 16% of overdose deaths.5

In East Harlem, smoking is the most common and dominant modality of use, so OnPoint designed this site to accommodate a high volume of smokers. This center has two inhalation rooms that can accommodate a total of eight people at a time. A high quality air ventilation system prevents smoke or odor from leaving the inhalation rooms. The window allows staff to monitor participants’ well-being.

Responding to an overdose

How do they save lives?

In this clip, we learn how staff at an OPC intervene in the event of an overdose.

Transcript:

Here participants are given the time they need to use carefully and mindfully, which can also reduce the amount of drugs consumed and reduce the likelihood of overdose. Still, overdoses do happen. However, overdose interventions in this room look quite different than they do in emergency settings. Monitoring participants’ vitals and providing oxygen are primary interventions. 

At OnPoint, most opioid overdoses are stabilized using oxygen. Within the first year of operation, 83% of overdoses were stabilized without the use of the opioid reversal medication, naloxone. 6

Although the standard 4mg nasal naloxone is always on-hand in the room, this is generally not used. Instead, when naloxone is needed, staff use microdoses to stabilize the participant without the unwanted withdrawal symptoms that often occur following the use of the 4mg dose. 

Because staff identify and respond to the earliest signs of an overdose, the interventions in this room are less invasive and produce better outcomes. Participants who experience an overdose here are stable enough to leave on their own much more quickly than they would if EMS responded to their overdose in a community setting and brought them back to the emergency room.  

With opioid overdoses, the primary concern is that breathing can slow or stop. Overdoses involving stimulants, such as cocaine, crack, K2, and meth, look very different. Symptoms can include panic attacks, delusions, and rapid heartbeat. At OnPoint, approximately 23% of overdoses involve stimulants and the staff are trained to respond.7

Staff use calming techniques like stimuli management, affirmation and redirection, cooling and heating, monitoring vitals, and hydration.

Other services offered

What other services are at an OPC?

In this clip, we learn about other services that are offered at an OPC.

Transcript:

Here at the East Harlem site, the garden just outside of the overdose prevention center is an ideal space away from the busy neighborhood. The garden also serves as a community space and allows people to rest and recharge. 

At OnPoint, staff from other onsite programs, such as the medical clinic and holistic program, can see participants.

This is the medical clinic, which is just feet away from the overdose prevention center. In addition to buprenorphine induction and wound care, here medical professionals provide primary care, STI testing and care, and connections to further treatment including detox and treatment for substance use disorder. 

In the holistic room, participants can get access to aromatherapy, acupuncture, acupressure, reiki, and more. This seamless care supports the overall health and stability of participants. OnPoint calls their East Harlem overdose prevention center a medical model because medical professionals are co-located onsite. Their Washington Heights location runs a consumer-led model, where the emphasis is on the power of the people with lived expertise leading the operation of services. Both are successful models and show that overdose prevention centers can be adapted to meet different needs.

Overdose prevention centers do more than just prevent overdose death. They are an evidence-based tool that provide an important point of entry into other services, as well as create safety and promote stability for individuals using the site. OPCs also assist in reducing syringe litter in the communities in which they operate, and increase public safety.

To learn more about overdose prevention centers, visit opcinfo.org.

  1. Marshall BD, Milloy MJ, Wood E, Montaner JS, Kerr T. Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. Lancet. 2011 Apr 23;377(9775):1429-37. doi: 10.1016/S0140-6736(10)62353-7. Epub 2011 Apr 15. PMID: 21497898.
  2. Rammohan I, Gaines T, Scheim A, Bayoumi A, Werb D. Overdose mortality incidence and supervised consumption services in Toronto, Canada: an ecological study and spatial analysis. Lancet Public Health. 2024 Feb;9(2):e79-e87. doi: 10.1016/S2468-2667(23)00300-6. PMID: 38307685.
  3. OnPoint NYC Baseline Report. December 2023.
  4. Megerian CE, Bair L, Smith J, Browne EN, Wenger LD, Guzman L, Kral AH, Lambdin BH. Health risks associated with smoking versus injecting fentanyl among people who use drugs in California. Drug Alcohol Depend. 2024 Feb 1;255:111053. doi: 10.1016/j.drugalcdep.2023.111053. 
  5. Tanz LJ, Gladden RM, Dinwiddie AT, et al. Routes of Drug Use Among Drug Overdose Deaths — United States, 2020–2022. MMWR Morb Mortal Wkly Rep 2024;73:124–130. DOI: http://dx.doi.org/10.15585/mmwr.mm7306a2
  6. OnPoint NYC Baseline Report. December 2023.
  7. OnPoint NYC Baseline Report. December 2023.