Swathi Srinivasan, MPhil, is an AmeriCorps Fellow in overdose prevention at Boston Health Care for the Homeless Program. As a Rhodes Scholar, Swathi documented community harm reduction/overdose response in 20+ countries. At Harvard, Swathi co-founded Harvard College Overdose Prevention and Education Students, helping to implement legislation on public-access naloxone.

Since the opening of the first government-sanctioned overdose prevention center (OPC) in 1986, OPCs have become the subject of global discussion, activism, and debate. Otherwise known as drug consumption rooms or safe/supervised consumption sites, OPCs operate in over 60 cities and 12 countries worldwide and have notable success in preventing overdose fatalities on site, decreasing HIV and HepC transmission, as well as increasing access to educational, health, and social services. While much public attention is given to OPCs as a concept, especially in contexts where they do not formally exist, this research is focused on the operation of individual OPCs, such as geographic placement, internal use of space (for example: individual versus communal substance use), ambience, and reflection of local dynamics. Through fieldwork and photographic analyses, as well as semi-structured interviews with staff from each OPC, this research compares and contrasts the operation of seven different OPCs in Norway, Denmark, Spain, Canada (2x), Portugal, and Switzerland (2x).

Several similarities were identified between OPCs, including the availability of harm reduction supplies and the presence of a multidisciplinary team. Some OPCs operated within larger healthcare centers, while others were incorporated within social and community spaces. Several distinctions were identified between OPCs based upon funding and operation, particularly those that were a) government-funded and government-operated, b) government-funded and NGO-operated, and c) NGO-funded and NGO-operated. Photographic analysis indicates that OPCs range from highly clinical to highly social in ambience, largely associated with the operating entity. Ultimately, each OPC not only serves a context-specific role within their community, but also reflects the community they serve, including the social, economic, and political climates around substance use. Such reflections are integral to the construction of future OPCs and the evaluation of existing OPCs, particularly when dissonance exists between such spaces and the needs of the PWUD community.