Brown physician, medical student urge stronger federal support for overdose prevention centers

PROVIDENCE The federal government needs to take clear, specific action to support harm reduction centers, which have been shown to prevent drug overdoses, according to Elizabeth Samuels and Aneeqah Naeem of Brown University’s Warren Alpert Medical School.

In a perspectives piece published in the May 26 issue of the New England Journal of Medicine, Samuels, an assistant professor of emergency medicine, and Naeem, a third-year medical student, outlined a set of recommendations for how the government can encourage the creation of harm reduction centers to combat the continuing staggering rise in deaths from the opioid crisis — which totaled more than 100,000 between May 2020 and April 2021.

“Without dramatic changes in federal policy approaches to substance use, harm reduction, substance use disorder treatment and widening social inequities, rates of drug-related deaths will most likely continue to increase,” Samuels and Naeem wrote.

Overdose prevention centers, also known as harm reduction centers, serve as spaces for people to use previously obtained drugs where trained staff and volunteers can intervene in the event of an overdose. These centers also provide people who use drugs with sterile syringes and other consumption supplies as well as naloxone, counseling services, and referrals to substance use disorder treatment and other services.

In their article, the authors cited a recent systematic review of studies of overdose-prevention centers, which found they were generally associated with significant reductions in opioid overdose deaths, reductions in high-risk injection-related behaviors and improvements in access to substance use disorder treatment — and were not associated with increases in crime.

More than 100 of these centers currently operate internationally, according to the authors. In July 2021, Rhode Island became the first state to legally authorize an overdose-prevention center pilot (Samuels is an advisor for this initiative), and in November 2021, two centers opened in New York City.

While there is mounting interest among state and local officials in opening similar centers elsewhere, some interpretations of a federal law presents a fundamental barrier, the authors wrote. Section 856 of the Controlled Substances Act makes it illegal to “knowingly open, lease, rent, use, or maintain any place… for the purpose of manufacturing, distributing, or using any controlled substance.” Although the statute wasn’t intended to limit the operations of public health facilities, the authors wrote, it was used by the U.S. Department of Justice under President Donald Trump to preemptively shut down a center in Philadelphia in 2019.

While President Joe Biden’s administration has taken steps in support of evidence-based drug policy, it hasn’t clearly stated whether it will shift course from the Trump administration’s approach to overdose-prevention centers — and this needs to change, the authors argued. They detailed a few of the “numerous approaches” the current administration could take to demonstrate support for the centers, starting with declaring its intention not to interfere with public health interventions such as those in Rhode Island and New York.

Over the longer term, the authors urged the administration to work with Congress to modify the Controlled Substances Act to exempt overdose-prevention centers from Section 856 or prohibit using federal funds to enforce the statute against state- or locally sanctioned centers.

“We believe that changing the statute is necessary to ensure that future administrations won’t target overdose-prevention centers,” they wrote. “Doing so would support the Biden administration’s stated commitment to taking an evidence-driven, equity-focused approach to ending the epidemic of drug-related harm.”

Corey Davis, director of the Harm Reduction Legal Project at the Network for Public Health Law and an adjunct assistant professor at the New York University Grossman School of Medicine, was an additional contributor to the piece.