Do Supervised Drug Injection Sites Save Lives? Evidence from America's First Overdose Prevention Centers

Abstract

Do supervised drug injection sites reduce overdose mortality? I exploit the November 2021 opening of America's first two government-sanctioned overdose prevention centers (OPCs) in New York City to estimate causal effects on local drug overdose deaths. Using de-meaned synthetic control methods—necessary because the treated neighborhoods have substantially higher baseline overdose rates than any control unit—with neighborhood-level mortality data from 2015–2024, I find small negative point estimates that are not statistically distinguishable from zero. The estimated difference-in-differences effect is approximately $-$2.2 deaths per 100,000 (p = 0.90), representing roughly 3 percent of baseline rates. De-meaned event study specifications show relatively flat pre-trends but imprecise post-treatment coefficients. Randomization inference based on MSPE ratios yields p-values of 0.83, indicating East Harlem's post-treatment trajectory is not anomalous relative to placebo units. While the point estimates suggest modest mortality reductions, the wide confidence intervals cannot rule out either substantial benefits or null effects. These findings highlight the methodological challenges of evaluating place-based interventions with few treated units and substantial baseline heterogeneity. The results neither confirm nor refute the hypothesis that OPCs reduce overdose deaths—a longer post-treatment period and additional OPC openings will be needed for definitive conclusions.