More than two years ago, Rhode Island became the first state in the nation to authorize overdose prevention centers, facilities where people would be allowed to use illicit drugs under professional supervision. On Thursday, the Providence City Council approved the establishment of what will be the state’s first so-called safe injection site.
Minnesota is the only other state to approve these sites, also known as supervised injection centers and harm reduction centers, but no facility has yet opened there. While several states and cities across the country have taken steps toward approving these centers, the concept has faced resistance even in more liberal-leaning states, where officials have wrestled with the legal and moral implications. The only two sites operating openly in the country are in New York City, where Bill de Blasio, who was then mayor, announced the opening of the first center in 2021.
The centers employ medical and social workers who guard against overdoses by supplying oxygen and naloxone, the overdose-reversing drug, as well as by distributing clean needles, hygiene products and tests for viruses.
Supporters say these centers prevent deaths and connect people with resources. Brandon Marshall, a professor and the chair of the Department of Epidemiology at the Brown University School of Public Health, said studies from other countries “show that overdose prevention centers save lives, increase access to treatment, and reduce public drug use and crime in the communities in which they’re located.”
Opponents of the centers, including law enforcement groups, say that the sites encourage a culture of permissiveness around illegal drugs, fail to require users to seek treatment and bring drug use into neighborhoods that are already struggling with high overdose rates.
Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University, said that while supervised drug consumption sites “reduce risks while people use drugs inside them,” they reach only a few people and “don’t alter the severity or character of a neighborhood’s drug problem.”
The Providence center, located next to the campus of Rhode Island Hospital, will be run by the nonprofit Project Weber/RENEW and VICTA, a privately owned outpatient substance abuse and mental health treatment program. A majority of the funding for the center will come from opioid settlement money, Project Weber said. The center will be subject to regulation by the Rhode Island Department of Health.
In addition to drug-related resources, the center is set to offer a range of services including food and showers, case management services and housing support.
In 2022, 434 people in Rhode Island died from drug overdoses, according to Colleen Daley Ndoye, the executive director of Project Weber/RENEW. The center, she said, “is a pivotal element in the state’s comprehensive efforts to combat this crisis.”
New York City’s two centers, which opened in 2021, are funded by the city and run by two nonprofits that merged into one, OnPoint NYC. Since 2021, OnPoint says the centers have served nearly 4,500 people and completed more than 1,300 overdose interventions.
Some residents and politicians have argued that the New York centers are increasing crime and public drug use in the neighborhoods where they operate. But a study released in November 2023 found no significant increases in crimes recorded by the police or calls for emergency services in those areas.
The centers, which were created by an executive order from Mr. de Blasio, are technically illegal because the drugs consumed there are controlled substances, and federal law bars individuals from maintaining property where controlled substances are consumed.
New York City’s centers have functioned without disruption by law enforcement and with the knowledge of local, state and federal authorities. Still, last summer, Manhattan’s top federal prosecutor, Damian Williams, suggested that his office could crack down. And in November, Gov. Kathy Hochul opposed giving money from the opioid litigation settlements to fund overdose prevention sites, despite a state board’s recommendation to do so.
The Biden administration has embraced harm reduction methods but has not explicitly endorsed supervised injection sites.
In 2019, a nonprofit was set to open a center in Philadelphia, but it was sued and blocked from doing so by the Trump administration. In 2021, a federal appeals court ruled that the site would violate federal drug laws, halting efforts to establish the center in Philadelphia and in other cities such as Seattle. The case remains in litigation.
Efforts in Colorado and Massachusetts to authorize centers have fallen short. In 2022, the governors of California and Vermont vetoed safe injection site bills, and last year, Pennsylvania’s state senate voted to ban them.
The bill in California, vetoed by Gov. Gavin Newsom, a Democrat, would have created sites in San Francisco, Los Angeles and Oakland, but Mr. Newsom said that while he had “long supported the cutting edge of harm reduction strategies,” he was concerned about the operations of safe injection sites without well-documented plans. He added that he was worried about “a world of unintended consequences” that could result from authorizing an unlimited number of sites.
In Providence, where officials hope the center can open later this year, Ms. Daley Ndoye said the approval by her city could help persuade more officials elsewhere to sign on.
“This sends a message that Rhode Island is a leader in evidence-based public health responses to the overdose crisis,” she said, “and will serve as a catalyst for other cities and states to follow our lead.”
Noah Weiland, Sharon Otterman and Jill Cowan contributed reporting.