Establishment of an Overdose Prevention Site Was Not Associated With an Increase in Visible Signs of Substance Use and Homelessness

Overdose prevention site (OPS) services—also referred to as safe consumption sites—are intended to prevent overdose and other harms associated with substance use, and to provide support and linkage to other services. Critics argue that these sites may encourage substance use, and have negative effects on nearby neighborhoods. In 2022, researchers in San Francisco, California conducted systematic street observations of 10 indicators of substance and homelessness-related “social nuisance”* in a 500-meter radius around an OPS, and a comparison point in the same city, with two prior observations in both locations in 2018 and 2019.

• During the study period, an average of 400 people per day consumed substances at the OPS.
• The risk of any “social nuisance” in the area around the OPS declined by nearly 7 percent, while it increased by 5 percent in the control area.
• The difference-in-difference in risk of any reported “social nuisance” in the area surrounding the OPS—from pre- to post-intervention to that of the control area—was -0.12.

* Defined as: “people smoking crack/meth/fentanyl,” “people injecting,” “people dealing drugs,” “discarded needle caps,” “discarded full needles,” “discarded baggies, cookers, pipes, etc.,” “human excrement visible,” “people sleeping or laying on the ground,” “tents or other sleeping structures,” and “shopping trolleys and other property.”

Comments: This study adds to the growing evidence of the benefits of OPS services for individuals with substance use and the areas in which the OPS services are located. It should provide some reassurance to people who live or work near a proposed OPS, and facilitate the establishment of more sites like this, which provide critical services to a vulnerable population.

Darius A. Rastegar, MD

Reference: Davidson PJ, Wenger LD, Morris T, et al. Impact of a high-volume overdose prevention site on social and drug disorder in surrounding areas in San Francisco. Drug Alcohol Depend. 2023;252:110969.