Thirty-five years ago, the state of Connecticut initiated a controversial program of needle and syringe exchange to improve the health and ultimately save the lives of people whose wellbeing had previously been ignored. At that time, Connecticut was experiencing one of the worse HIV/AIDS epidemics in the country. Around 650 new cases were being diagnosed each year, just among people who were injecting drugs. Connecticut had passed a law preventing pharmacy sales of syringes without a prescription, so syringes were scarce. People who were sharing them were sharing the viruses within those syringes. We found that more than 90% of shared syringes collected from locations were people went to obtain scarce, used syringes were contaminated with HIV and hepatitis C virus. The infections spread to the children of infected individuals. New Haven had the country’s highest rate of mother-to-child transmission as HIV-infected women passed the virus to their infants. After several years of lobbying the state legislature, a provision was enacted permitting the establishment of a pilot needle/syringe exchange in New Haven. The program, operated by the City of New Haven Health Department, opened its doors in November 1990. This was the first step in cutting HIV transmission and AIDS cases. In subsequent years, syringe service programs, as they are now called, expanded and these programs served as a conduit to get people using drugs into treatment for HIV and for their substance-use disorders. The resulting progress has been remarkable. In the five-year period 2018-22, there were an average of 16 new HIV diagnoses each year, a reduction of 97.5%. The New Haven program saved individual lives, as I have learned directly. In 2002, while conducting research in Portland, Maine, a former program client recognized me. He said that access to clean syringes and the caring people who ran the program kept him free from HIV infection and helped him reduce his dependence on drugs. In 2024, I was contacted by another former client who told me his story. He stayed uninfected, joined the army, served as a medic in the Mideast wars, and trained to become a physician assistant. He now runs programs for other physician assistants, training them to have a better understanding of addiction that will reduce the stigma that hampers proper delivery of medical care. He encourages them to offer gold standard, evidence-supported, medication-based treatment for people with opioid use disorder. In both cases, the New Haven Needle Exchange Program was key in helping them turn their lives around. Today, there is another opportunity to save the lives and improve the health and well-being of people whose health has been neglected while using illegal drugs – especially opioids like fentanyl and its analogs. We know we can reduce drugs overdoses, which have exceeded 1,000 every year since 2017, by using all available tools. One tool is the operation of overdose prevention centers. These have been widely implemented outside the U.S. and their benefits, demonstrated through decades of research, include reduced deaths, less public use of drugs, streets less littered with drug paraphernalia, better adherence to medications to treat HIV/AIDS and hepatitis C infections, and better management of acute conditions than that provided by overburdened emergency rooms. Similar benefits have been observed at the few overdose prevention centers recently opened in the U.S. Overdose prevention centers save not only lives, but also money. Once operational, the savings in healthcare expenses are substantial. Insite, North America’s longest-running center, located in Vancouver, Canada, has demonstrated that for every $1 spent, $5 is saved in healthcare and emergency response costs. A systematic review of 16 economic studies found that overdose prevention centers consistently generate greater benefits than costs and that a single overdose prevention center can offset between $831,700 and $2.95 million annually. Conversely, the arguments against overdose prevention centers are insincere and even barbaric. The idea that people with substance abuse disorder have to ‘hit bottom’ fails to recognize that in the era of fentanyl that bottom is six feet below ground. The idea that lack of will power keeps them using drugs is disproven by six decades of neurobiological studies showing that long-term psychoactive drug use produces changes in the chemistry and wiring of the brain. The idea that abstinence-oriented approaches are the solution for opioid use disorder runs counter to a century of epidemiologic data that abstinence-based treatments fail at the astounding rate of 90% within six months. Indeed, we have recently demonstrated that when the outcome is a fatal opioid overdose, those exposed to an abstinence treatment die at a 70% higher rate than those exposed to no treatment at all and they are more than twice as likely to die as those who received the gold standard of methadone or Suboxone treatment. Overdose prevention centers offer other humane services to people whose drug use can be chaotic; they benefit from the structure provided by such centers. In addition to allowing supervised drug use that prevents fatal overdoses, people will find a space to relax and experience rare moments of calm. They will be able to obtain medical attention for simple physical ailments related to their drug use, vaccines and other routine preventative treatment, and personalized referrals to treatment for more complex problems and their substance use. These can be provided at less expense and hassle than at an emergency department, where both drug users and medical staff often clash. Visitors seeking stable housing, employment, or other services can meet with social workers or use internet access in the non-stigmatizing environment of the overdose prevention center. Many will benefit simply from a hot cup of coffee, a warm meal, and a hearty welcome. The bill to set up a panel of experts and community representatives to evaluate the impacts of overdose prevention centers is now under consideration by the state legislature. It is a first, bold, and perhaps controversial step. But so was establishing a pilot needle/syringe exchange program in New Haven in 1990. Our analysis demonstrated that within five months of its opening, HIV transmission was being reduced. It was the vital first step in all but eliminating HIV infections among Connecticut residents who injected drugs and was a model program referred to when other localities wanted to follow in our footsteps. We can do the same to further reduce the death toll from the opioid crisis now, in Connecticut, by pushing the legislature to take action and support the establishment of overdose prevention centers in the areas where most fatal overdoses are concentrated. Robert Heimer, Ph.D. is a Professor of Epidemiology and of Pharmacology. The contents and opinions in this letter do not necessarily reflect the position of Yale University or the School of Public Health. They are those of the author. ...read more read less