Study assessing the effectiveness of overdose prevention centers through research (SAFER): an overview of the study protocol.

More than one million people have died from drug overdose in the United States in the past 20 years. The overdose crisis started in the late 1990s with the proliferation of overdoses involving prescription opioids, transitioned to heroin-involved overdoses in 2010, and is currently driven by illegally manufactured synthetic opioids such as fentanyl. In response to this crisis, New York City implemented two publicly recognized overdose prevention centers (OPCs) in the nation in November 2021. Rhode Island became the first US state to authorize OPCs through state legislation and will open a site in Fall 2024. We are conducting a rigorous, multi-site, multi-component evaluation of OPCs in New York City and Rhode Island. At the individual level, we assess whether a cohort of 500 persons utilizing OPCs experience lower rates of overdose, other health problems (e.g., hepatitis C, skin infections), and emergency department use, and a higher rate of substance use treatment initiation, compared to a cohort of 500 persons who use drugs but do not utilize OPCs. At the community level, we examine whether neighborhoods surrounding the OPCs experience a greater change in overdose, measures of drug-related public disorder, and acute economic conditions following the opening of OPCs, compared to neighborhoods with no OPCs. Third, we delve into the role that the operational context, including neighborhood location, program models, and operating procedures, plays in shaping the effectiveness of OPCs using qualitative and ethnographic approaches. Fourth, we estimate the costs and cost savings associated with starting up and operating OPCs. In this paper, we: (1) present the study design and harm reduction framework which is used to evaluate the impact of OPCs in New York City and Rhode Island; (2) share the types of assessment instruments and data sources used to measure changes at the individual and community level; and (3) discuss the strengths and limitations associated with the planned approach to evaluate the health and community effects of OPCs.