Overdose prevention centres in the United Kingdom

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Overdose prevention centres in the United Kingdom

17 March 2022

By Adam Holland, Magdalena Harris, Matthew Hickman, Dan Lewer, Gillian W Shorter, Jason Horsley, Martin Powell, Maggie Rae / The Lancet

In response to the drug related death crisis in the UK, more than 80 prominent medical, academic, and third sector organisations have called for the introduction of pilot overdose prevention centres (also called drug consumption rooms).

The government, however, has repeatedly indicated it has no plans to introduce them, and overdose prevention centres are not mentioned in it's 10-year drug strategy. Here, we question the arguments used to defend this position with relevance for other countries debating the introduction of overdose prevention centres.

First, regarding the argument that there is insufficient evidence to show that overdose prevention centres are beneficial. These centres have been introduced in at least 14 countries across more than 130 sites (with an unsanctioned mobile site operating in Scotland between 2020–21).

They provide a safe environment for the most vulnerable to use drugs under the supervision of trained professionals, who intervene in the event of an overdose; and an opportunity to provide evidence-based interventions, including naloxone, oxygen, psychosocial support, and needle and syringe programmes. Observational evidence shows fatal overdoses decreased in areas where overdose prevention centres were introduced alongside other beneficial outcomes, including reductions in self-reported high-risk injecting practices and increased engagement with drug treatment services.

There are no randomised controlled trials (RCTs) showing that overdose prevention centres reduce drug-related deaths.

As overdose prevention centres are complex community level interventions, and deaths are a relatively rare outcome, a fully powered RCT would be very large and expensive. Given the observational evidence in favour of overdose prevention centres and the clear understanding of the mechanisms by which they would prevent drug-related deaths, it is not justifiable to oppose their introduction until RCTs, which might never be conducted, are available.

Many public health interventions have been introduced without RCTs when their mechanism of action is clearly understood. The inconsistent requirement for more rigorous evidence in the case of overdose prevention centres might relate to moral perceptions of illicit drug use. However, RCTs did not show the effectiveness of opioid agonist therapy to reduce mortality or blood borne virus transmission, which is recommended on the basis of observational evidence and clinical experience.