Reducing harm, saving lives: The case for supervised drug consumption sites

Each year, more than 80,000 lives are lost to drug overdose deaths in America. This staggering toll stretches far beyond hospital walls and deep into our communities, compromising public safety, overwhelming an already strained healthcare system, and cutting short countless futures. Supervised consumption sites (SCS), also known as overdose prevention centers, offer a practical, community-driven response. These facilities allow individuals to use pre-obtained drugs under trained supervision, significantly reducing fatal overdoses while easing the burden on emergency rooms, law enforcement, and local taxpayers.

SCSs do not necessarily condone nor encourage drug use. Instead, they exist to minimize chaos in places where chaos usually rules: sidewalks, parks, alleyways, and public bathroom stalls. In lieu of reacting only after finding someone collapsed in one of these discreet locations, SCS serve as controlled environments that mitigate the risks of open-air drug scenes, discarded needles in public parks, and unnecessary emergency calls. In New York City, where two SCSs have been operating since 2021, officials report that more than 1,700 overdoses have been reversed without a single death on site.

The services offered at SCSs are simple, consistent, and rooted in practicality. Clients receive access to sterile supplies and safe disposal containers, helping prevent the spread of HIV, hepatitis, and other infectious diseases. Medical professionals are on site to respond to overdoses immediately, often within seconds. Many locations offer wound care, testing for different communicable diseases, and drug checking to detect lethal contaminants like fentanyl. These tools, when offered in a single setting, significantly lower healthcare costs and alleviate pressure on already overstretched emergency departments.

Hepatitis C infections, commonly associated with injection drug use, cost the United States over $10 billion annually. The financial burden grows when factoring in emergency response: ambulance rides can range from hundreds to tens of thousands of dollars if an air lift is needed or if the patient doesn’t have insurance. Emergency room visits add even more, with each visit averaging $1,800, contributing to an estimated $32 billion in annual costs. Every infection prevented, every ambulance ride avoided, and every emergency room bed freed up adds up to real cost savings to the taxpayers who have to subsidize the costs of public insurance. In one space, clients get what they need to survive today and what they might need to recover tomorrow.

Just as we accept seatbelts and smoke detectors as essential tools for reducing preventable deaths, supervised consumption sites provide a structured response to a crisis we can’t ignore. SCSs acknowledge the reality on the ground and respond with practical interventions that keep people alive. With local control and real-time data, municipalities can tailor these programs to fit their neighborhoods, saving lives, saving money, and reducing the visible chaos that too often accompanies untreated addiction.

A brief history of supervised consumption sites

SCSs were forged in moments of urgent local crisis. Switzerland opened the first sanctioned site, named Contact Netz, in Bern in 1986 amid a growing HIV epidemic and overdose surge. Results were immediate and impactful: fewer syringe purchases on the street, safer injection practices, reduced public drug use, and a significant drop in sexual assault incidents among vulnerable users. By 2022, Switzerland had established 14 SCSs across 10 communities, codifying harm reduction into national law through the Four Pillars Policy: prevention, treatment, harm reduction, and law enforcement.

Germany followed with its first facility in Berlin in 1994, largely to address visible public drug use in urban spaces. By 2011, a national assessment concluded that Germany’s SCSs had significantly reduced open-air drug scenes, cut down on HIV and hepatitis transmission, and saved lives by preventing fatal overdoses. Germany now hosts 29 SCSs, 27 fixed and two mobile, across 17 cities, averaging hundreds of supervised injections daily with no reported on-site deaths. 

In 2001, Sydney opened the Uniting Medically Supervised Injection Centre in the Kings Cross district in response to rampant public injection and overdose deaths in the area. Since opening, the center has supervised over 1.2 million injections, managed more than 10,800 overdoses, and recorded zero fatalities. The center also provides critical health care access for clients who have rarely engaged with other services. A second site opened in Melbourne in 2018. From 2018 to 2022, it oversaw 300,000 supervised injections, managed over 6,000 overdose events, and made more than 15,975 health and social support interventions, with zero overdose deaths reported on-site.

Canada became the first country in North America to legalize an SCS with Insite in Vancouver in 2003, following a dramatic spike in overdose deaths and HIV infections in the Downtown Eastside. In its first two years of operation, overdose deaths were reduced by 35% in and around the area. That immediate success sparked a national expansion, and as of 2022, Canada has the highest number of SCSs at 39.

Today, over 200 SCSs are operating across 18 countries, including mobile units and facilities that accommodate drugs delivered via inhalation along with injectable drugs, an important innovation in line with changing patterns of drug use.

International models: Discipline meets compassion

Germany’s model strikes a deliberate balance between public order and public health, with over 32 drug consumption rooms operating part-time as of 2023. Access to these sites is generally limited to adults ages 18 and over who are actively using illicit substances and unwilling to stop, often requiring a documented history of addiction or social marginalization. Registration systems in many facilities track visit frequency and allow for personalized health engagement, while ensuring anonymity and confidentiality. These requirements align with stipulations in Germany’s Narcotics Act, which was established to ensure harm reduction services adhere to public health and safety standards. Instead of working at odds, health providers, lawmakers, and law enforcement coordinate efforts under this act, building trust and improving outcomes on both sides. In 2023 alone, Germany’s drug consumption rooms recorded over 650,000 supervised drug use episodes, managed 650 medical emergencies without a single death, provided services to over 18,500 individuals, and facilitated 52,000 counseling sessions and referrals. Germany’s experience demonstrates how harm reduction services can link people to care while maintaining public order.

In Canada, the focus is on low-barrier access. At Insite in Vancouver, clients not only find a safe space to use substances but also gain access to detox services, primary care, and mental health support under one roof. While federal resistance and public scrutiny have fluctuated, Insite has consistently delivered results, having had over 4.6 million visits and 71,000 off-site service referrals since its inception. Over 11,856 overdoses have been reversed, not a single death has occurred on site, and support from both the public and law enforcement has steadily grown.

In the Netherlands, Switzerland, and Spain, Supervised Consumption Sites are thoughtfully structured to reach the most marginalized populations, following requirements similar to those in Germany. Across Europe, there are currently over 78 official drug consumption rooms operating across seven countries. Moreover, these countries’ approach has proved adaptable to shifts in drug use patterns, with inhalation booths becoming more common in Europe and gaining traction in Canada as fentanyl smoking has become more popular. In the U.S., both Rhode Island and New York’s programs include this feature.

Across these international models, results consistently show that SCSs implemented with clear protocols, integrated services, and community input lead to significant reductions in overdose deaths, lower rates of public drug use and syringe litter, and increased referrals to health and detox services.

Current U.S. landscape: Legal barriers and local action

Legal barriers remain the biggest obstacle to expanding Supervised Consumption Sites in the U.S. The most notable is 21 U.S.C. § 856, formally known as the Maintaining Drug-Involved Premises statute, commonly referred to as the “Crack House Statute.” Enacted during the Reagan era, this law makes it a federal crime to knowingly open, lease, rent, use, or maintain any place for the purpose of manufacturing, distributing, or using controlled substances, with no exception for efforts aimed at reducing overdose deaths or providing life-saving care.

In 2019, Safehouse, a nonprofit in Philadelphia, challenged this statute in court, arguing that the purpose of the site was not to facilitate unlawful drug use but to provide life-saving medical services. Their challenge was initially successful in the District Court for the Eastern District of Pennsylvania, but in 2021, the Third Circuit Court overturned the ruling, holding that the statute clearly prohibits operating any site where illegal drug use occurs, regardless of the operator’s intent or public health motivations. The Supreme Court declined to hear the case, leaving the ruling intact. With 1,200 overdose deaths in 2020, the ruling highlights the stark disconnect between the city’s public health crisis and the limitations of federal law. While the Third Circuit’s ruling reflected a strict interpretation of the statute, it also highlighted the need for legislative reform to allow innovative, life-saving interventions, like supervised consumption sites, to operate within a legal framework.

Some states and municipalities have moved to expand supervised consumption sites despite federal bans. New York City opened the first SCS in the U.S. in 2021, with two facilities operated by OnPoint NYC. In their first year, these sites intervened in over 636 overdoses during more than 48,000 visits by 2,841 registered participants. Rhode Island passed legislation to launch a pilot SCS program in 2021, opening a site in Providence in 2025. In its first two months of operation, 135 individuals visited the center over 420 times, 22 overdoses were reversed, and 50 people were connected to external health services. Other cities, including San Francisco and Philadelphia, have begun opening temporary or “pop-up” SCSs in response to local need.

Though SCSs are not federally sanctioned, the change in presidential administrations has led to some signs of evolving attitudes, at least within the executive branch. In 2022, under the Biden administration, the Department of Justice expressed openness to establishing “appropriate guardrails” around local SCS programs. Since then, however, little progress has been made at the federal level under the new Trump administration. Harm reduction services have faced significant federal funding cuts, including for naloxone distribution, and Congress has taken a more oppositional stance by introducing bills like the Defund Heroin Injection Centers Act of 2025, which seeks to bar federal funds from being used to support supervised consumption sites. While there’s currently no pathway for an SCS to gain federal authorization, these developments highlight the importance of local innovation and flexibility. Instead of waiting for top-down approval, cities and states have moved forward with targeted, community-driven solutions. If these efforts prove effective, especially when supported through voluntary public-private partnerships, they can build a stronger case for broader policy shifts.

Legislative recommendations: Moving forward with practical reform

Supervised consumption sites aren’t about growing government or endorsing drug use. Rather, they are a targeted, community-driven, and compassionate response to an urgent crisis.

Policymakers can support them by:

1. Amending the Crack House Statute: Congress should revise the Maintaining Drug-Involved Premises statute (21 U.S.C. §856)  to create a clear exemption for state- or locally-sanctioned SCSs. This amendment would resolve the current legal ambiguity that deters cities and nonprofits from launching these vital programs. As highlighted in the current version of the New York City Council Resolution 0313-2024, a formal call for Congress to amend the Anti-Drug Abuse Act of 1986, the fear of felony liability has chilled the implementation of SCS. In Canada, a similar exemption under the country’s Controlled Drugs and Substances Act allowed Insite to open in Vancouver legally.

2. Launching Time-Limited Pilots: States should follow Rhode Island’s example by piloting SCS programs with intermittent evaluation. Rhode Island authorized its first SCS in 2021, and in 2024, the facility opened in Providence with support from local officials and nonprofit operators. These pilots can be run at low cost with clear goals and benchmarks, allowing lawmakers to reassess after three to five years. Because the overdose crisis directly affects community health and safety, such pilot programs fall within the powers and responsibilities of state governments. State authorities are informed by their local authorities, who are closer to the front lines, witnessing the everyday impact of overdose in emergency rooms, public spaces, and neighborhoods.

3. Establishing Basic Standards Without Overreach: Regulations for supervised consumption sites should ensure safety without creating barriers to access. At a minimum, sites should have trained staff, emergency medical protocols, proper waste disposal systems, and age restrictions for clients. Oversight could be managed by state health departments, with quarterly inspections to ensure compliance. Staff should be trained not only in medical overdose response but also in how to de-escalate tense or potentially volatile situations, such as when someone is in crisis or exhibiting erratic behavior. They should also be equipped with trauma-informed care practices, which emphasize understanding the lasting effects of trauma and responding in ways that promote safety, dignity, and trust.

Apart from minimum safety standards, implementation should remain flexible to tailor solutions to local needs. Insite in Vancouver, for example, is a model site, run by local Vancouver Coastal Health and Progressive Housing Community Service Society. It maintains rigorous protocols, including trained medical staff, emergency response procedures, and strict hygiene standards. The outcomes from 20 years of operation show that, when implemented with the right controls, SCS can reverse nearly 12,000 overdoses—without a single death on site.

4. Prioritizing Local Control: SCSs should only be implemented where local officials and communities support them. Switzerland followed this model in the 1990s, allowing cities like Zurich and Geneva to set up services based on local needs. This local buy-in helped turn once-controversial initiatives into publicly supported health responses that cleaned up city parks and streets.

Supervised consumption sites are about reducing preventable deaths, easing the burden on emergency systems, and helping communities regain control of public space. Lawmakers can choose to maintain the current approach, but the evidence points to a better path. The SCS model is working. It’s saving lives—and that’s what public health initiatives and harm reduction are ultimately about.

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Source: https://reason.org/commentary/reducing-harm-saving-lives-the-case-for-supervised-drug-consumption-sites/