Keemink, J.R., Stevens, A. orcid.org/0000-0002-4878-3871, Shirley-Beavan, S. et al. (2 more authors) (2025) Four decades of overdose prevention centres: lessons for the future from a realist review. Harm Reduction Journal, 22. 36. ISSN 1477-7517
Abstract
Background:
Overdose prevention centres (OPCs) are spaces where people can consume previously obtained illicit drugs under the supervision of staff who can intervene to prevent and manage overdose. They have been provided in Europe and elsewhere for nearly 40 years, initially in response to the epidemic of HIV/AIDS. We can learn from their operation history to inform future developments in harm reduction services.
Methods:
We carried out a realist review of 391 documents, reported according to the RAMESES I guidelines, and carried out realist synthesis of these documents.
Results:
We present a full realist programme theory of OPCs, with a diagrammatic logic model, of how the contexts and mechanisms of OPCs combine to produce various outcomes for service users and their communities in different settings. Three specific causal pathways were evidenced through which OPCs produce their outcomes for particular groups in specific contexts of housing status, gender identity and ethnicity, and local drug markets, with frequency of use, legal and political contexts, and stigma as overlapping contextual factors. Key OPC interventions include the provision of a safe and hygienic consumption space, safe consumption education, timely overdose response, and protection from drug scene and gender-based violence. These can trigger the underlying mechanisms of safety, trust, social inclusion, engagement, autonomy, and empowerment when supported with health care and other services, including detoxification and opioid agonist treatment. The combinations of these contexts and mechanisms create important outcomes for individual service users, for the communities they live in, and for wider society. We also describe causal pathways that can lead to unintended, adverse outcomes.
Conclusion:
This review provides useful information for policy makers, practitioners, and researchers on how to implement and evaluate OPCs in future to maximise their benefits; an important task in the context of the ongoing public health crises of drug poisoning deaths in North America and the UK, and the possibility of increasing deaths from synthetic opioids in Europe and elsewhere.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © The Author(s) 2025. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
Keywords: | Harm reduction; Realist review; Overdose prevention centre; Drug consumption room; History |
Dates: |
|
Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Arts and Humanities (Sheffield) > School of Law |
Funding Information: | Funder Grant number National Institute for Health and Care Research NIHR204582 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 21 Mar 2025 10:58 |
Last Modified: | 21 Mar 2025 10:58 |
Status: | Published |
Publisher: | BioMed Central |
Refereed: | Yes |
Identification Number: | 10.1186/s12954-025-01178-z |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:224678 |