Overdose prevention sites and heroin assisted treatment

The current global opioid epidemic is unprecedented, causing big increases in deaths from overdose.1 In 2018 overdose deaths in England and Wales were at a record high of 4359, representing a 16% increase since 2017.2 In the US, fatal overdoses fuelled an increase in overall mortality in 2015, the first in over 15 years.3 Harm reduction interventions—such as distributing sterile syringes (syringe service programmes) and providing medical assisted treatment (such as methadone, buprenorphine)—are cost effective in reducing HIV, hepatitis C, and overdose as well as yielding additional social benefits, including more stable housing among dependent people and lower crime and incarceration rates.4567 Yet the political will, law enforcement support, and wider social tolerance for such interventions have been limited.

Full scale implementation has yet to be realised in many places worldwide. Laws and policies criminalising possession and use of illicit substances have complicated public health …