Overdose prevention centers OPCs are safe spaces where people can consume pre-obtained substances and be supervised post-consumption by personnel trained to identify and respond to the earliest signs of overdose. Such supervision is often just one part of the harm-reduction and wellness services made available to participants. Often behavioral-health support, drug treatment, minor medical assistance, showers, laundry and other assistance are available to those who need and want such supports.

OPCs have been implemented throughout the world with significant success for decades. Currently, more than 200 overdose prevention centers operate in at least 14 countries around the world, often staffed by peer mentors and/or medical professionals. OPCs are operating in dozens of sites throughout Canada (click here for a map of existing facilities.)

OPCs have been extensively researched over the past two decades and found to be beneficial for the health, safety and well-being of people who use drugs and surrounding communities. The 2021 National Institutes of Health report reviewing the available literature found that the “preponderance of the evidence suggests these sites are able to provide sterile equipment, overdose reversal, and linkage to medical care for addiction, in the virtual absence of significant direct risks like increases in drug use, drug sales, or crime.”

Several states have conducted their own studies of OPCs. The Massachusetts Department of Public Health concluded in a December 2023 report that “(t)he success, cost effectiveness, and life-saving ability of OPCs has been proven in Europe, Canada, and now in New York City” and recommended that the Commonwealth “should support harm reduction agencies to expand harm reduction drop-in centers to include OPCs, including funding for clinical staff and supplies.”

A more extensive federal study of OPC pilot projects in the United States is underway. In May of 2023, the National Institute on Drug Abuse (NIDA) announced it would provide funding to Brown University School of Public Health and New York University Langone Health to study the impacts of the operating OPCs in New York City and forthcoming OPC in Rhode Island.

Alongside the ongoing research, sufficient and clear evidence supports the establishment of further projects around the United States, particularly in states like Vermont that have experienced high rates of fatal overdose.

Overdose Prevention Centers (OPCs) reduce drug-related loss of life. Instead of a person using a substance alone or with someone else who may not be qualified to properly assist in the event of an overdose, OPCs allow trained personnel to immediately respond with appropriate care. That training and proximity to the individual experiencing the crisis prevents overdoses from becoming fatal. OPCs also prevent many more overdoses by encouraging safer use practices such as reducing dosage and providing on-site drug checking services.

See e.g.:

• Brandon DL Marshall PhD, M-J Milloy MSc, Evan Wood PhD, Prof Julio SG Montaner MD, Thomas Kerr PhD, Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study. Lancet. 2011;377(9775):1429-1437. (reporting a 35% decrease in overdose deaths in the community surrounding an OPC).

• Semaan, S., Fleming, P., Worrell, C., Stolp, H., Baack, B., & Miller, M. (2011). Potential role of safer injection facilities in reducing HIV and hepatitis C infections and overdose mortality in the United States. Drug and alcohol dependence, 118(2-3), 100–110. https://doi.org/10.1016/j.drugalcdep.2011.03.00

• Yoon, G. H., Levengood, T. W., Davoust, M. J., Ogden, S. N., Kral, A. H., Cahill, S. R., & Bazzi, A. R. (2022). Implementation and sustainability of safe consumption sites: a qualitative systematic review and thematic synthesis. Harm Reduction Journal, 19, 73. https://doi.org/10.1186/s12954-022-00655-z.

• Oudshoorn, A., Sangster Bouck, M., McCann, M., Zendo, S., Berman, H., Banninga, J., Le Ber, M. J., & Zendo, Z. (2021). A critical narrative inquiry to understand the impacts of an overdose prevention site on the lives of site users. Harm Reduction Journal, 18(1), 6. https://doi.org/10.1186/s12954-020-00458-0

• Kral AH, Lambdin BH, Wenger LD, Davidson PJ. Evaluation of an Unsanctioned Safe Consumption Site in the United States. The New England journal of medicine. 2020;383(6):589-590. DOI: 10.1056/NEJMc2015435

Decades of evidence shows that OPCs:

• Reduce public drug use & drug-related litter

• Minimize spread of infectious diseases

• Lower burden on emergency services, saving millions

• Increase linkages to healthcare, treatment & community

OPCs save lives, connect people with care, and expand access to lifesaving harm reduction services, such as:

• Hazardous Waste Disposal: Collection & secured disposal of hazardous materials, including hypodermic needles and syringes, other injection equipment, and other drug-consumption tools. As well as education on disposal of use tools, including syringes.

• Services & Support Referrals: Substance use treatment and recovery services, harm reduction services, wound care services, primary care services including: dental, infectious disease providers, and other medical services, housing services, nutritional support, legal aid services, and mental health services.

• Overdose Response: which includes administering overdose antagonists like oxygen, naloxone, etc, and contacting emergency medical services if needed

• Observation: Conduct oversight and assessment of participants during and after drug use.

• Safe Supplies: Safer-smoke supplies, Safer-snort supplies and information Safer-injection supplies, Drug-preparation tools, Opioid antagonists, Drug-checking equipment, Safer-Sex supplies.

• Screenings & Other Services: HIV, HCV, and STI screenings, First aid Care, and Support using the VT Helplink service

• Educational Resources: Safer use practices, harm reduction practices, overdose prevention practices, Overdose response, safer sex practices, and Infectious disease education.

The Vermont Department of Health Published the Overdose Prevention Center State Guidelines in September of 2024. The Guidelines outline the framework, objectives, management, staff, training, participant services, and state, city, and community engagement. Burlington’s OPC is required to adhere to those guidelines. Read and review the guidelines here

The City of Burlington, in partnership with Vermonters for Criminal Justice Reform (VCJR), is in the very earliest stages of implementing the OPC. No site has been selected, and formal planning for site selection has not yet begun. The first steps involve collaboration with police, fire, and EMS services, laying the groundwork for a thoughtful, data and community-informed approach. Learn more about the process and get involved here

See the detailed timeline here: https://decrimvermont.org/btv-opc-timeline

Evidence from existing overdose prevention centers worldwide shows that these facilities overwhelmingly serve people who already live in the immediate neighborhood or city where they operate, not people who relocate to access services.

• A needs assessment for Somerville, Massachusetts, found no evidence that establishing a Supervised Consumption Site (SCS) the term used there for an OPC, leads to an influx of clients from other communities, noting that most clients lived within one mile of the centers. (Somerville Supervised Consumption Site Report, 2020)

• Long-term evaluations of Insite in Vancouver similarly show that most visitors lived in or near the Downtown Eastside neighborhood. 

Given that Burlington is already one of the highest-cost-of-living cities in the state, with limited affordable housing and strained shelter capacity, the suggestion that people would uproot themselves to move here simply to use an OPC is inconsistent both with established research and with Burlington’s housing reality.

Evidence from cities and countries with OPCs shows that these facilities can reduce harm without encouraging drug use. The majority of people who use these centers are not new users but long-time users. OPCs reduce the risk of overdose and also offer access to healthcare, addiction treatment, and other support services that can help people recover.

Security and law-enforcement involvement at the OPC is intentionally structured to maintain a safe, health-focused environment while minimizing punitive or coercive interactions. The Vermont OPC Operating Guidelines outline a layered approach that prioritizes internal safety systems, clear participant expectations, and coordinated, but limited, engagement with external emergency and public safety agencies.

On-site Security Measures

The OPC is required to establish comprehensive security measures tailored to the needs of participants, staff, and volunteers, and aligned with the requirements outlined in Section III.G (p. 7). This includes internal policies, trained staff, and protocols that allow the center to manage most safety concerns without routine involvement from external law enforcement.

The OPC must also maintain a Code of Conduct that governs participant behavior (pp. 8–9) and outlines:

• Expectations while inside the OPC (pp. 25),

• The consequences for violating the Code of Conduct, with a strong emphasis on keeping participants eligible whenever possible (pp. 8–9, 25), and

• Procedures for termination of services only when necessary, plus grievance processes for participants, staff, and volunteers (pp. 8–9).

The guidelines also require protocols for responding to participants who carry firearms or exhibit violence within the OPC (p. 9). These responses rely primarily on trained staff and internal procedures, not law enforcement, unless there is an immediate safety threat.

Coordination with Emergency Services and Law Enforcement

The OPC must coordinate with external agencies—but this coordination is planned, limited, and non-punitive:

• Emergency medical services (EMS): The OPC must formalize policies and procedures with local EMS to ensure clear, agreed-upon processes for medical transport or emergency response (p. 7).

• Hospitals: The OPC must also coordinate with local hospitals that may receive transported participants, ensuring alignment on transport and care procedures (pp. 8–9).

• Fire and Law Enforcement: The OPC is required to engage with local fire and law-enforcement services only to consult on how the center will interface with them (pp. 8–9). This means law enforcement is not stationed inside the OPC, does not interact with participants on a regular basis, and is only contacted in rare circumstances where there is a credible threat to safety that cannot be managed internally.

This consultation requirement ensures that first responders understand the OPC’s public-health approach and that any involvement from law enforcement is supportive, not punitive.

Participant Screening and Eligibility—not a Law-Enforcement Function

Screening for eligibility is conducted entirely by OPC staff (pp. 27–28), and:

• Participants are not asked to show identification** to enter services (p. 27).

• Staff determine eligibility based on internal criteria, not criminal background or law-enforcement databases (pp. 27–28).

• Participants who are deemed ineligible may file grievances, and may become eligible at a later time (p. 28).

These procedures ensure that law enforcement plays no role in participant screening, monitoring, or service eligibility.

OPCs benefit the communities where they’re located in many ways, including by reducing public drug use and syringe litter in public spaces. Studies have documented significant reductions in public injection drug use and publicly discarded syringes in the communities surrounding such facilities. See e.g. Wood E, Tyndall MW, Montaner JS, Kerr T. Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2006;175(11):1399-1404.

In just its first year of operation in New York, OnPoint found that, in 81 percent of visits to facilities, its its OPC participants would have otherwise used the substance in a public space.” (See Dr. Brent Gibson, PhD, Kailin See, Brittney Vargas Estrella, Sam Rivera, Baseline Report on the Operation of the First Recognized Overdose Prevention Centers in the United States (December 2023). Available at: https://onpointnyc.org/wp-content/uploads/2023/12/ONPOINTNYC_OPCREPORT_small-web1.pdf

Studies have shown no increases in drug use or crime in the areas surrounding OPCs. A recent study published in November 2023 found no significant changes in the volume of violent or property crimes reported by police, 911 calls for crime or medical incidents, or 311 calls for public drug use or unsanitary conditions around the OnPoint OPC locations in New York City. Chalfin A, del Pozo B, Mitre-Becerril D. Overdose Prevention Centers, Crime, and Disorder in New York City. JAMA Netw Open. 2023;6(11):e2342228. doi:10.1001/jamanetworkopen.2023.42228

See also:

• Potier C, Laprevote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug and alcohol dependence. 2014;145:48-68.

• Kerr T, Stoltz JA, Tyndall M, et al. Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study. Bmj. 2006;332(7535):220-222.

Since 2021, Chittenden County has consistently reported the highest number of opioid-related fatal overdoses among all counties in Vermont, highlighting the urgent need for effective intervention strategies. Burlington, as the county's only city, plays a crucial role in addressing this crisis. The city is home to institutions like the University of Vermont (UVM), which provides immediate medical support when necessary.

$1.1 million will come from the Opioid Abatement Special Fund to support an Overdose Prevention Center (OPC) in Burlington for fiscal year 2025. The plan also states that funds from the Opioid Abatement Special Fund will continue to be allocated through fiscal year 2028 to provide grants to the City of Burlington for running the pilot program.

In addition to the live-saving benefits of OPCs, such facilities provide a cost savings for local governments. Such facilities reduce calls for emergency services and admissions to hospital emergency departments, not only for overdose-related incidents, but also medical responses resulting from infectious disease transmission, skin and soft tissue infections, other conditions that may be addressed with minor care that can be provided in connection with OPCs.

One study focused on San Francisco found that “each dollar spent on a (supervised injection facility) would generate $2.33 in savings, for total annual net savings of $3.5 million for a single 13-booth (facility.)” Another study estimating the benefits focused on Baltimore estimated an annual net savings of $7.8 million. Yet another study conducted to estimate the costs and benefits of a potential OPC in Providence, Rhode Island, found that it would prevent approximately “261 ambulance runs, 244 ED visits, and 117 inpatient hospitalizations for emergency overdose care annually compared to a scenario that includes a syringe service program only” for an estimated savings of over $1.1 million annually compared to the syringe service program only.

See e.g.:

• Irwin, A., Jozaghi, E., Bluthenthal, R. N., & Kral, A. H. (2017). A cost-benefit analysis of a potential supervised injection facility in San Francisco, California, USA. Journal of Drug Issues, 47(2), 164–184. https://doi.org/10.1177/0022042616679829

• Irwin, A., Jozaghi, E., Weir, B. W., Allen, S. T., Lindsay, A., & Sherman, S. G. (2017). Mitigating the heroin crisis in Baltimore, MD, USA: A cost-benefit analysis of a hypothetical supervised injection facility. Harm Reduction Journal, 14, 29. https://doi.org/10.1186/s12954-017-0153-2

• Chambers, L. C., Hallowell, B. D., Zang, X., Rind, D. M., Guzauskas, G. F., Hansen, R. N., Fuchs, N., Scagos, R. P., & Marshall, B. D. L. (2022). The estimated costs and benefits of a hypothetical supervised consumption site in Providence, Rhode Island. International Journal of Drug Policy, 108. https://doi.org/10.1016/j.drugpo.2022.103820

• Institute for Clinical and Economic Review. (2020). A Look at Supervised Injection Facilities. https://icer.org/wp-content/uploads/2020/10/SIF-RAAG-010521.pdf

There is no clear estimate of usage. Local advocates and service providers have stated that the center will most likely be used by individuals who are already utilizing harm reduction and syringe services. The number of users fluctuates, but it may range between 15 to 20 people a day. The location and operational hours will have a significant impact on the utilization of the center.

Yes, $300,000 from the Opioid Abatement Special Fund for the Department of Health to hire a researcher or consultant to study the impact of OPC pilot programs.

Some who oppose harm reduction strategies like OPCs argue that federal law prohibits them. The argument relies on a minor part of the Controlled Substances Act intended to criminalize selling of drugs from homes or other properties - a law passed before OPCs had been established widely throughout the world.

The federal law in question, often referred to as the “crackhouse statute” (21 USC 856), makes it unlawful to “knowingly lease, rent, use, or maintain any place, whether permanently or temporarily, for the purpose of manufacturing, distributing, or using any controlled substance.”

Many legal scholars and law enforcement leaders (including many state attorney generals, prosecutors, and former Department of Justice officials) believe that federal law does not prohibit interventions like OPCs - particularly when they are authorized by states. See e.g. Amicus brief by the District of Columbia and nine states in U.S. v. Safehouse, July 6, 2020 (Indeed, unlike crack houses or raves, (OPCs) do not distribute, manufacture, or encourage drug possession, but rather “serve a medical purpose by providing counseling to people with a substance use disorder, preventing overdoses, and stopping the use of dirty needles. . . SISs thus do not present the identified dangers that Congress feared when Section 856 was enacted.)

An attempt to use the statute to prohibit the opening of an OPC has only been raised in one federal district court in Philadelphia. Despite a finding by the Third Circuit Court of Appeals that the federal statute could be interpreted to prohibit OPCs, there has been no finding by a federal court with authority over Vermont that the law would prohibit OPCs.

No federal agency has attempted to intervene in other states that are moving forward on OPCs. There has been no enforcement action to halt the operation of OnPoint NYC’s two OPC locations in New York City, and no federal objections have been made to the statute passed in Rhode Island to establish an OPC, which is expected to launch this year. Notably, a spokesperson for the Department of Justice reportedly has said “that supervised consumption sites were being evaluated on a district by district basis, in discussion with local leaders, to determine ‘appropriate regulatory guardrails.’”

Even if more federal courts interpret the disputed federal statute to at least permit federal intervention, the federal law should not serve as a barrier to opening OPCs any more than federal drug laws have impeded establishing legal, regulated access to cannabis in the states. Despite federal cannabis prohibition a large majority of states provide medical access to the substance and nearly half regulate access to cannabis for non-medical adult use.

States retain broad power to legislate protection for their citizens in matters of public health. Most states, including Vermont, have “Good Samaritan” laws that eliminate the threat of arrest for drug possession by those who call for emergency help during a medical emergency. Last year Vermont passed a law providing criminal and civil immunity to those participating in or providing “drug checking” services, and permanently decriminalized unauthorized possession of the treatment medication, Buprenorphine. The continued existence of federal laws prohibiting possession of drugs did not prevent Vermont or other states from passing such laws that prioritize saving lives over criminalization.

Attorney Generals from around the country, including former Vermont Attorney General T.J. Donovan, former U.S. Attorney Jerome O’Neill, and former Attorney General Kimberly B. Cheney have joined legal briefs supporting states’ rights to establish OPCs.

Any unresolved and unlikely conflict with federal law should not stop Vermont from life saving services like an OPC.

The OPC is designed to provide a safe, supportive environment while maintaining public safety. It will function as a resource hub, connecting individuals to medical care, private consultations, and essential services, including harm reduction, treatment, and wraparound support—rather than serving as a place for prolonged stays. With a strong emphasis on safety, structured operations, and collaboration with law enforcement, the OPC is committed to benefiting both participants and the wider community.

Security will be a top priority, with comprehensive measures in place to protect both participants and the surrounding community. The OPC will follow a structured process that includes a registration and waiting area, medical intervention spaces, and private consultation rooms to ensure participants receive services efficiently and respectfully.

Additionally, research on existing OPCs, such as OnPoint NYC, has shown no significant increase in crime, including drug-related offenses, in surrounding areas.

While it's true that preliminary data show a slight decrease in opioid-related accidental and undetermined fatal overdoses, this improvement is largely attributed to expanded access to harm reduction tools and services—such as Naloxone (Narcan), medications for opioid use disorder (MOUD), and broader harm reduction programs.

This is good news—and it doesn’t mean the problem will resolve itself.

Why the overdose crisis is far from over:

• The drug supply is increasingly lethal and unpredictable: Substances like fentanyl and xylazine are becoming more common and are often mixed into drugs without users’ knowledge. This makes the potency highly variable and increases the risk of overdose. New synthetic compounds are also emerging faster than testing and treatment systems can adapt, making prevention and response efforts more difficult.

• BIPOC and rural communities remain at high risk: Public and political concern often grows only when predominantly white communities are affected. Meanwhile, BIPOC and rural communities continue to face limited access to harm reduction services, healthcare disparities, and the harmful impacts of criminalization over care. In Vermont, overdose death disparities persist: while white, non-Hispanic individuals saw a 3.4% decrease in overdose deaths, the decrease among BIPOC individuals was only 0.8%.

• OPC, MOUD, and widespread access to Naloxone continue to play a critical role in saving lives. Without ongoing investment in these resources—and targeted support for underserved communities—the progress we’ve made is fragile.

• Consistency & Accessibility: Fixed sites provide a stable location, making it easier for individuals to access services consistently. This stability fosters trust and encourages regular use, which is crucial for effective harm reduction. 

• Comprehensive Services: Fixed OPCs can offer a broader range of services, including medical care, counseling, and social support, due to their permanent infrastructure. For example, facilities like OnPoint NYC provide services such as showers, laundry, syringe exchange, and connections to treatment programs. healthvermont.gov

• Operational Stability: Fixed sites benefit from dedicated infrastructure, which allows for better sanitation, security, and the ability to handle medical emergencies effectively. This stability is challenging to achieve with mobile units that must frequently relocate.

• Higher Capacity: Fixed OPCs can accommodate more individuals simultaneously and provide stable working conditions for staff, leading to greater efficiency and effectiveness in service delivery.

• Data Collection & Research: A stable location facilitates consistent data collection on usage patterns, overdose reversals, and health outcomes. This data is vital for evaluating the effectiveness of services and securing funding. For instance, studies have shown that OPCs are associated with reduced morbidity and mortality among people who use drugs. jamanetwork.com