Shaw, L. C., Park, C. J., Pratty, C., Allen, B., Macmadu, A., Cerdá, M., & Marshall, B. D. (2026). Understanding Connectedness: Patterns of safety, belonging, and community among clients utilizing publicly recognized overdose prevention centers in the United States. International Journal of Drug Policy, 158, 105527. https://doi.org/10.1016/j.drugpo.2026.105527
Objective
Overdose prevention centers (OPCs) are supervised spaces where people can use pre-obtained drugs under the supervision of trained staff who can respond in case of an overdose. While research shows OPCs are effective at preventing overdose death and connecting people to other health services, little is known about how clients feel when they visit these spaces. For example, do participants report feeling safe, trusting the staff, and sharing a sense of belonging? This study examined patterns of “connectedness” among clients at some of the first state and city-sanctioned OPCs in the United States, located in New York City and Rhode Island.
Method
OPC clients (N=494) were recruited to participate as part of a larger, ongoing study (SAFER). Participants responded to the following statements about their OPC experience: ‘I am a part of the community,’ ‘I can be myself,’ ‘I can trust the staff,’ ‘I feel safe,’ ‘I feel judged for using drugs.’ We created a composite scale of OPC connectedness, with higher scores indicating greater connectedness. We then built multinomial logistic regression models to compare participants with lower, moderate, and high connectedness scores.
Results
At least 70% of participants reported that they trusted staff, felt safe, and could be themselves “all of the time.” Additionally, most participants reported rarely feeling judged for using drugs while at the OPC. More than a third of participants scored the maximum possible connectedness score of 20. Cisgender women, people who kept naloxone nearby while using, and those who visited the OPC more frequently reported higher connectedness. People who had recently experienced an overdose or overamping event* tended to report lower connectedness compared to participants who did not report a recent overdose or overamping event.
Implications
Findings suggest that the OPCs studied create environments where most clients feel genuinely safe, respected, and connected. Our findings may be due to the fact that these three OPCs are run by long-standing, trusted community-based harm reduction organizations that have built and maintained relationships with the clients they serve long before opening an OPC. As more jurisdictions consider launching OPCs, our results highlight that fostering trust and belonging, not just providing a safe place to use drugs, is important to better engage clients and support ongoing use of these life-saving services.
Takeaway
This is the first study in the US to measure how connected OPC clients feel to these spaces; we found that clients overwhelmingly feel safe, trusted, and accepted. Building OPCs within trusted, community-rooted harm reduction organizations, and working to include clients who have recently experienced an overdose or overamping event, may help new and existing OPCs better support the people who rely on them.
* “Overamping” refers to a time after using stimulants, K2, or ketamine with severe and unexpected physical symptoms – like chest pain, racing heart, nausea or vomiting, extreme sweating or high temperature, convulsions, seizures, cardiac arrest, or stroke – or mental health symptoms – like extreme anxiety, paranoia, fear, hallucinations, or feeling stuck or frozen. Symptoms are more severe than expected, and a person may have been unable to control their behavior or body. These severe symptoms may have lasted for longer than expected.