Overdose-Prevention Centers

The May 26 issue of The New England Journal of Medicine includes 2 articles on a subject that deserves more attention than it has received from us.1,2 Drug overdose deaths rose above 100,000 annually during the Covid-19 pandemic in the US, fueled at least partly by purposeful fentanyl contamination of illicit drugs. Naloxone is widely available in the US, but as the title of one article tells us, naloxone is not enough.

The one remedy that has saved many thousands of lives internationally appears to be illegal in the US. Overdose-prevention centers provide a place where patients – and they are patients, not criminals – can safely inject their own drugs, using sterile syringes in sight of trained personnel, with naloxone close at hand. In Vancouver, Canada, the opening of an overdose-prevention center decreased overdose deaths by 35%. Similar experience has been reported in Australia and Europe.

So what is the problem in the US with opening these facilities throughout the locales where the most overdose deaths have occurred? The problem is section 856 of the Controlled Substances Act, cosponsored by then-Senator Joe Biden, which makes it illegal to maintain any place, among other things, for the purpose of using controlled substances. When a nonprofit agency attempted to open an overdose-prevention center in Philadelphia during the Trump administration, the US Department of Justice sued to close it and was upheld on appeal.

Nevertheless, one state-authorized overdose-prevention center has opened in Rhode Island and 2 in New York City, but all three could be considered in violation of federal law, and other jurisdictions have chosen not to risk becoming involved in litigation with the Department of Justice. As these articles explain, either the President or the Congress could remedy this situation, but to date they have not done so, and the deaths continue to mount.

  1. S Messmer and J Jarrett. When Naloxone Isn’t Enough. N Engl J Med 2022; 386:1967.
  2. AH Naeem et al. The Importance of Federal Action Supporting Overdose-Prevention Centers. N Engl J Med 2022; 386:1965.

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