Providence, Rhode Island, has become the first city in the United States to approve the establishment of a state-sanctioned safe drug consumption site, where people can use illicit substances under medical supervision and access harm reduction services. The Providence City Council voted unanimously on Thursday to authorize the opening of the site, which will be run by a nonprofit organization and funded with money from opioid settlement money. The site is expected to open later this year and be a model for other states and cities that are considering similar initiatives.
A Historic Moment for Public Health and Harm Reduction
The safe drug consumption site, also known as an overdose prevention center or a harm reduction center, will be located at 45 Willard Avenue, near the Rhode Island Hospital campus. It will be operated by Project Weber/RENEW and VICTA, two local organizations that provide support and services to people who use drugs and sex workers. The site will offer a range of services, including:
- Food and showers
- Access to the overdose-reversing drug naloxone
- Testing for fentanyl and other adulterants
- Case management and housing support
- HIV testing and linkage to care
- Referrals to addiction treatment and mental health services
The site will also allow people to use pre-obtained illicit drugs in a safe and hygienic environment, under the supervision of trained staff who can intervene in case of an overdose or other medical emergency. The site will not provide or sell any drugs to the users.
The site will be regulated by the state Department of Health, which will issue rules and guidelines for its operation and oversight. The site will also be monitored by The People, Place & Health Collective at the Brown University’s School of Public Health, which will conduct research and evaluation on the site’s individual and community outcomes.
The site is the first of its kind in the nation to be sanctioned by the state government, following a legislation passed by the Rhode Island General Assembly in 2021. The legislation, sponsored by state Sen. Josh Miller and state Rep. John G. Edwards, authorized the creation of a pilot program for one or more overdose prevention centers in the state, with local approval. The pilot program will expire in March 2026, unless extended by the legislature.
The site is also funded by opioid settlement money administered by the Executive Office of Health & Human Services, which allocated $3.25 million for the site in fiscal years 2023 and 2024.
The site’s approval was hailed by public health and harm reduction advocates, who said it was a historic moment for the country and a lifesaving measure for the people who use drugs.
“The unanimous vote by the Providence City Council is a historic moment for public health in the United States,” said Brandon Marshall, a professor and chair of the Department of Epidemiology at the Brown University School of Public Health who is leading the research project on overdose prevention sites. “The council clearly recognizes that our current efforts to stopping overdose deaths aren’t sufficient and that new harm reduction approaches are urgently needed.”
A Response to the Opioid Crisis and the COVID-19 Pandemic
The site’s approval comes amid a worsening opioid crisis and a COVID-19 pandemic that have exacerbated the risks and challenges faced by people who use drugs. According to the Centers for Disease Control and Prevention, the number of drug overdose deaths nationally was estimated at 112,127 for the 12 months ending in Aug. 2023, up slightly from 109,680 for the year 2022. Rhode Island recorded 384 overdose deaths in 2022, a slight decrease from 401 in 2021, but still higher than the pre-pandemic levels.
The site’s proponents argue that the site will not only save lives, but also reduce the harms and costs associated with drug use, such as infectious diseases, crime, violence, stigma, and discrimination. They also contend that the site will not encourage drug use, but rather connect people with addiction treatment and other services that can help them improve their health and well-being.
The site’s opponents, however, worry that the site will normalize and facilitate drug use, and pose legal and ethical dilemmas. They also question the site’s effectiveness and safety, and the potential impact on the surrounding neighborhood and community.
The site’s legality is also uncertain, as the federal government has not officially sanctioned or approved any safe drug consumption sites in the country. The U.S. Department of Justice has previously threatened to prosecute and shut down any such sites, arguing that they violate the federal Controlled Substances Act and the “crack house statute,” which prohibit the maintenance of any place for the purpose of using, distributing, or manufacturing illegal drugs. The site’s supporters, however, hope that the Biden administration will adopt a more lenient and supportive stance on the issue, and respect the state and local authority to address the opioid crisis.
A Model for Other States and Cities
The site’s approval in Providence could pave the way for other states and cities to follow suit, as several jurisdictions have expressed interest or taken steps to explore the possibility of opening safe drug consumption sites. These include:
- Colorado, where a bill to allow overdose prevention sites was passed by the state House in 2021, but stalled in the state Senate.
- Nevada, where a bill to authorize overdose prevention sites was introduced in the state Legislature in 2021, but did not advance.
- New Mexico, where a bill to create a pilot program for overdose prevention sites was passed by the state House and Senate in 2021, but vetoed by the governor.
- New York, where two unsanctioned overdose prevention sites have been operating since 2021, without any legal authorization or protection.
- Vermont, where a bill to allow for the creation of overdose prevention centers was passed by the state House in 2021, and is pending in the state Senate.
The site’s approval in Providence also comes as the U.S. Supreme Court is set to hear a case involving a proposed safe injection site in Philadelphia, which was blocked by a federal court in 2020. The case, Safehouse v. United States, could have significant implications for the future of safe drug consumption sites in the country, as the Supreme Court could either uphold or overturn the lower court’s ruling, or issue a more narrow or broad decision on the issue.
The site’s approval in Providence is a landmark development for the harm reduction movement in the U.S., which has been advocating for the implementation of evidence-based and compassionate policies and practices to address the opioid crisis and the needs of people who use drugs. The site’s opening will be a test of the feasibility, acceptability, and effectiveness of safe drug consumption sites in the U.S., and a potential catalyst for more action and innovation in the field of public health and drug policy.
