(Originally published in the Health section of the Rhode Island Current)

Dennis Bailer has seen what happens when people are forced to hide their drug use in his nearly 20 years working in harm reduction: Lives can end next to trash cans, on sidewalks or in an alleyway’s shadows.

For almost just as many years, Bailer and his peers have looked across the pond to Europe and its “safe injection sites” — public facilities where people come to use drugs under supervision and without fear of police. Would the United States ever entertain such careful attention to drug users?

“We thought, ‘Oh, that’s never gonna happen,’ that it’ll be many, many, many years until that actually comes about,” Bailer said in a phone interview.

Now it’s actually about to happen after the Providence City Council passed a resolution Thursday night that permits the state’s first overdose prevention center to open at 45 Willard Ave. in Providence, next to the Rhode Island Hospital campus.

The facility could open this summer, pending final approval from the Rhode Island Department of Health (RIDOH). It will be run by Project Weber/RENEW, the harm reduction nonprofit where Bailer works as the overdose prevention program director. Clinical services will be provided through a partnership with VICTA, a provider of outpatient recovery treatment.

A similar center, OnPoint NYC, opened in New York City in 2021, but Providence’s iteration would be the first nationally that’s approved at the state level. Its origins go back to July 2021, when Gov. Dan McKee approved legislation by Majority Floor Manager John G. Edwards and Sen. Joshua Miller, both Democrats from Tiverton and Cranston respectively, for a two-year pilot program of overdose prevention centers. In 2023, the legislation was extended to 2026. The centers are subject to municipal council approval, as well as regulation and inspection by RIDOH. 

The Willard Avenue property will be the new home for Project Weber/RENEW’s entire operation, Bailer said. The consumption sites planned for the second floor are the only part of the nonprofit’s new digs that need health department approval. The nonprofit’s existing offerings, as well as behavioral health services from VICTA, will occupy the first floor.

On the second floor, Bailer anticipates eight to 12 injection spaces. Discussions with OnPoint NYC helped Project Weber/RENEW determine comfortable arrangements for the consumption spaces.

“We determined that the best ratio would be one employee per four people using the site,” Bailer said. “We have a one to four ratio to keep a close eye on people.”

Bailer also advocated for the inclusion of two inhalation rooms where people will be able to smoke drugs like crack cocaine, the majority of whose users are Black and brown people, Bailer noted.

We have a one to four ratio to keep a close eye on people.

– Dennis Bailer, Project Weber/RENEW overdose prevention program director

Racial disparities exist not only in use but overdose deaths, too. Per a CDC report, 2020 saw a 44% increase from the previous year in overdose deaths of non-Hispanic Black men.

“We can really outreach to more of a Black and brown community and say, ‘Hey, we care about your wellbeing also, despite what’s happened in the past, despite those feelings you may have about the history of our nation and our state,” Bailer said. “Here, we’re gonna try to display that everybody’s welcome. And we care about everybody’s lives.’”

Other states watching closely

There’s no federal funding for the center, as overdose centers are illegal according to a federal statute that forbids the operation of any place with “the purpose of unlawfully manufacturing, storing, distributing, or using a controlled substance.”

But it won’t be a burden on taxpayers either: “There are no taxpayer dollars going to fund the overdose prevention center,” Project Weber/RENEW notes on its website. “The majority of funds are coming from opioid settlement dollars, which were negotiated by RI’s attorney general from pharmaceutical companies as reparations for harm caused by prescription opioids.”

Opioids are the most common drugs leading to accidental overdose, according to RIDOH. Since 2016, there have been more than 300 opioid overdose deaths every year in Rhode Island.

A policy brief by the Cato Institute noted that “underground” prevention centers have existed in the United States since at least 2014. Other states, meanwhile, have started to embark on creating the official frameworks for their own overdose prevention centers. As of December 2023, both Massachusetts and Vermont were also looking into the feasibility of such facilities.

Bailer acknowledged that other states are watching closely: “We’ve done a lot of preparation, a lot of work to get this done,” he said. “It’s a pilot program that many other states are looking at. They want to see the cost effectiveness, they want to see the impact on the community…We think we’ve done our due diligence to really set this up to be a model for the rest of the country.”

Bailer, who notes he’s in long-term recovery himself, is already thinking about options for future expansion, such as an onsite pharmacy or primary care provider for prescription medications such as HIV meds.

‘There is no doubt in my mind that the center will save lives’

Even without those amenities, the Providence City Council was impressed before the resolution passed.

“A few weeks ago, I had the opportunity to tour the facility — there is no doubt in my mind that the center will save lives and prioritize the well-being of city residents,” said Rachel Miller, the city council president, in an emailed statement.

“By creating a supervised and trusting environment and partnering with like-minded organizations, Rhode Island’s first harm reduction center will connect clients to healthcare, counseling, and outpatient services that will make a difference in people’s lives and throughout our city.”

Bailer knows that difference could literally be lifesaving: “[To] people who want to push back on this type of program, we say, ‘What is the human life worth?’ Isn’t it worth taking some extraordinary actions to ensure that people don’t have to die behind abandoned buildings and by trash bins and out in public spaces?,” he said. “People with substance use disorder are gonna use drugs — they’re going to use drugs. Let’s take some steps to try and make sure they don’t die in the process.”

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