Overdose prevention centers (OPCs) provide a safe place where people can consume pre-obtained drugs under supervision so that a life-saving medical response can be provided quickly in the event of an overdose. OPCs are programs that are established in Canada and have recently become legally sanctioned in only a few United States jurisdictions.
We conducted a systematic review that summarizes and identifies gaps of economic evidence on establishing OPCs in North America to guide future expansion of OPCs.
We included 16 final studies that were evaluated with the CHEERS and Drummond checklists. Eight studies reported cost-effectiveness results (e.g., cost per overdose avoided or cost per QALY), with six also including cost-benefit; five reported only cost-benefit results, and three cost-offsets. Health outcomes primarily included overdose mortality outcomes and/or HIV/HCV infections averted. Most studies used mathematical modeling and projected OPC outcomes using the experience of a single facility in Vancouver, BC.
OPCs were found to be cost-saving, or to have favorable cost-effectiveness or cost-benefit ratios across all studies. Future studies should incorporate the experience of OPCs established in various settings and employ a greater diversity of modeling designs.
•Overdose prevention centers (OPCs) help to provide a safe space for people who use drugs and provide essential public health services that can help reduce opioid overdose fatalities. There is scant health economic evidence on OPCs and no systematic review.•This systematic review found the optimal number of OPCs varied within the studies, but all suggested opening at least 1 OPC as economically viable.•The findings from this review suggest that jurisdictions looking for strategies to stem the opioid overdose crisis should establish budgets for supporting OPCs in North America as they are projected to result in favorable economic and health impact
