Overdose Prevention Center Coming to Rhode Island

Haley McKee, a former drug user, was hard at work getting legislation passed on the floor of the Senate when, as she recalls, she was approached by Dominick J. Ruggerio the Rhode Island Senate President. 

“These shooting galleries. What's going on? What are you guys talking about?” McKee remembers Ruggerio asking. He was referring to the overdose prevention site she was working to get approved. 

McKee says she thought for a moment and replied: “You like it when people like me recover right? And you get really sad when people like me die? Where do the people in the middle go?” 

She watched as Ruggerio turned and walked away.

McKee is a founding member of the political action group created in 2017 to address the opioid crisis in Rhode Island. She says that this was just one of many similar conversations McKee she’s had since 2018, when the group quietly introduced a bill that proposed the implementation of overdose prevention sites. 

According to the CDC, there were 397 deaths caused by overdoses in the state of Rhode Island in 2020, the majority of which due to the use of illicit drugs. Now, in an effort to prevent overdoses, Rhode Island is working to open its first overdose prevention site, or what the Senate President Ruggerio called “shooting galleries.” The magnitude of the opioid crisis in Rhode Island has prompted the state to be the first in the U.S. to fund the opening of a state-regulated overdose prevention center. In addition to other services, the center will be a sanctioned place for people to go and consume substances that they bring in themselves, under the supervision of staff. Rhode Island is following the lead of many cities around the world that have started overdose prevention centers. 

Rhode Island leaders showed overwhelming support for the bill that authorized the creation of the center, with State Senator Josh Miller and State Representative Jay Edwards sponsoring the legislation. The funding for the center comes from Rhode Island’s opioid settlement dollars, allocating $2.6 million for the site. Project Weber/RENEW and CODAC Behavioral Healthcare are working together to get the center off the ground, which will be located at CODAC’s old location on Huntington Avenue, with an expected opening in 2024.

Project Weber/RENEW and CODAC will staff the center with peer recovery specialists, nurse practitioners, and doctors. Carolyn James, the community outreach coordinator for CODAC, explains that the center will consist of two floors. The main setting for the overdose prevention site will be on the first floor, and clinicians will be available on the second. The center will offer basic necessities like food and water, and distribute harm-reduction supplies ranging from fentanyl test strips, to HIV testing, to condoms. It will also have housing support resources, peer recovery coaching, and support groups. 

In Rhode Island, the most common way drugs are used is through inhalation, and the most commonly used drug is crack cocaine. Despite this, many of the services that are currently accessible in Rhode Island are directed towards people who inject opioids. McKee says that this new site should, and will, be a place for people to safely consume substances however they choose to—swallowing, smoking, injecting, and so on. Drug users will be allowed to consume their pre-obtained substances on-site under the supervision of staff members. There will be medical professionals on site, ready to administer Narcan in case of any overdoses. Staff will make sure that all drug users have the resources to test their drugs for fentanyl, and will be prepared to reverse any potential overdoses. 

New York is the only other state in the U.S. that has opened overdose prevention centers, with two in New York City. Though these two centers have been open for only about a year, the results have been positive, experts say. “They've provided services to tens of thousands of people, prevented thousands of overdoses and have not experienced a death inside the overdose prevention center,” says Brown Professor Brandon Marshall. These results are similar to statistics from the hundreds of other overdose prevention centers around the world.

Once the Rhode Island site is open, Brown University researchers are planning to work with New York University to conduct a multi-site evaluation. Marshall details four main goals of the research project. First, will it help reveal the long-term impacts the facility will have on people using the site and on Providence? neighborhoods. 

Second, this evaluation will ideally uncover any barriers to accessing services, and any staffing challenges. Marshall explains that the researchers plan to look at whether these sites truly increase access to treatment and recovery services, and will use qualitative methods to look into the perspectives of clients. 

The third goal will be to evaluate  the cost effectiveness of the sites. In most countries, Marshall says, these centers have had huge cost-saving benefits. They have prevented emergency room visits and hospitalizations, and protected against costly injection-related conditions. 

Finally, the organizers plan to use the evaluation to determine which strategies work best in different contexts. New York City and Providence are very different cities, and programs will run their sites differently. 

McKee and Marshall express excitement about the possibility that this site will inspire similar programs across the country. “That is the dream. That you put a precedent on the books,” she says, “and then it spreads like wildfire across the nation.” 

There is legislation pending in many states in the New England area. So far none of these bills has gained much traction, McKee says. But she remains hopeful. 

The Senate President’s “shooting galleries” comment illustrates  the stigma and controversy surrounding the implementation of these centers, McKee says, but she believes the political backlash in Rhode Island could have been much worse. “We see the peanut gallery come out in the comments, this is nothing new,” she says. But she explains that the general assembly stood behind the implementation plans, and media coverage showed only moderately heightened curiosity. 

Brown professor Brandon Marshall says that  residents near the injection site have mounted some opposition but that the research from other countries shows that these sites have improved the conditions in surrounding neighborhoods. Improvements have included less public drug use and less drug-related litter. Marshall calls the opposition “reactionary,” and says he remains confident that, once residents understand what the sites do and how they are run, they will be much more supportive. 

Haley McKee says that the fight for approval of the overdose prevention site was led by people like her, who have lived experience with drug addiction—survivors and people who have lost family members to drug use. Progress to end drug-use stigma got started in the 2010s when people who had recovered started to share their stories. Now there is a movement towards listening to the experiences of people who are in active use. “We can’t leave those people out of the conversation; they are the conversation,” she says.