Jeffrey A. Singer
Last week, the staff at an overdose prevention center (OPC) in London, Ontario were unable to save a client who overdosed on a drug consumed at the facility, even after they rushed the person to a nearby hospital for further resuscitation. Harm reduction opponents have already begun pointing to the event as an argument against Canada’s 38 OPCs.
The coroner’s report and toxicology results are not yet available, so it is important not to jump to conclusions. We don’t yet know what substances contaminated the drug the deceased obtained on the black market. It is possible there were other substances in addition to or in place of fentanyl that rendered naloxone less effective as a reversal agent. For example, an increasing number of toxicology studies are finding another synthetic opioid, isotonitazene or “iso,” which can be ten times more powerful than fentanyl, present in the victim’s system. In late 2023, British law enforcement reported a big influx of this class of opioids called nitazenes had entered the illicit drug market in the UK.
Regardless of what the report ultimately reveals, it is important to maintain perspective. No medical treatment is perfect. The operative word in the term harm reduction is “reduction.” In a 2023 Cato briefing paper, I reviewed the worldwide experience with OPCs, initially called “safe consumption sites.” The oldest legally sanctioned OPC has been operating in Bern, Switzerland since 1986. The paper concluded:
OPCs have a more-than-30-year track record of preventing overdose deaths, HIV and hepatitis, and other diseases, and of helping people with substance use disorder find treatment. As of August 2022, 147 OPCs are providing services in 91 communities in 16 countries. They continue to gain acceptance as an effective tool for reducing the dangers of using drugs obtained through the increasingly deadly black market.
My research at the time found no report of any overdose deaths from any of the 147 OPCs. Eighteen months after the first two OPCs in the US opened in New York City, OnPointNYC, the harm reduction organization operating them, reported that it reversed 1,008 overdoses with no fatalities at its centers.
However, it was never realistic to believe that staff at OPCs would be able to resuscitate every overdose. As Dr. Gillian Golla of the University of Victoria’s Canadian Institute for Substance Use Research told CTV News reporters about the unsuccessful resuscitation at the Canadian OPC:
“…we don’t expect absolute perfection from other parts of the healthcare system. We don’t expect emergency departments to save every single person who walks in their doors.
“As someone who has worked in a supervised consumption site, there are frequently very complex overdoses that occur, and this is happening more frequently as the toxic mix of unregulated fentanyl gets more worse. This emphasizes the need for easily-accessible harm reduction services.”
A May 2022 study found that bystanders successfully reversed 95 percent of overdoses with naloxone nasal spray—usually from illicit fentanyl—but they often needed to administer multiple doses because of fentanyl’s potency. Another study by researchers at Brigham and Women’s Hospital in Boston found that 6.3 percent of overdose victims whom Emergency Medical Technicians (EMTs) attempted to save with naloxone died on the same day.
While it is wrong to claim that overdose deaths are completely prevented at OPCs, it remains the case that they are exceedingly rare.
Just as it would be unreasonable to close emergency rooms for not being able to save every patient, it would be similarly unreasonable to abandon overdose prevention centers for not being able to reverse every overdose.