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R.I. is first to legalize safe injection sites

Sites will be first in the country to test harm reduction rather than criminalization

Rhode Island had the 15th highest in opioid death rate in 2019 with 29.5 deaths per 100,000 people.
Rhode Island had the 15th highest in opioid death rate in 2019 with 29.5 deaths per 100,000 people.

Governor Daniel McKee signed a bill into law to create safe injection sites for drug users in order to combat the opioid crisis July 7. Now, plans to open such sites are underway.

The sites would allow those with an addiction to use drugs such as heroin and methamphetamine in a supervised, controlled environment. The sites would also offer tests for potentially fatal doses of fentanyl in drugs, needle exchanges and recovery support. These measures will help battle the ongoing opioid crisis, which killed an estimated nationwide record 93,331 people last year. The situation is dire in Rhode Island, which ranked 15th highest in opioid death rates by state with 29.5 drug-overdose related deaths per 100,000 people in 2019. 

“We have a seriously rising level of fatalities with opiates,” said Rhode Island State Senator Joshua Miller (D-Cranston/Providence), the bill’s sponsor. “Everything we’ve done over the last several years has not led to any improvement in the rate of fatalities or addiction.” Miller said that supervised injection facilities have worked in other countries, like Canada, and that harm was greatly reduced, “especially when fentanyl is involved.” Rhode Island is the first state in the country to implement such a program.

Safe injection sites, also called harm reduction centers, are “designed to make communities safer and have less fatalities, and to provide more access to treatment,” Miller said. “I hope that communities in Rhode Island, when they are given the option to have a site in their community,” look at the success of safe injection sites in other countries.


Dr. James McDonald, the medical director of the Rhode Island Department of Health, said that “we want to make sure that people who have a chronic disease, whether it’s opiate use disorder or substance dependence, have a safe place to consume their drugs.” He said that it is crucial that users “feel welcome, feel observed in a non-threatening manner and, if they need a referral for treatment, they feel like that is a possibility.”

“We’ve been at this for a long time in the state,” McDonald added. “What we’re doing is not working quickly enough, so we are not staying ahead of the disease, and we’re seeing an increase in overdose deaths.” He specifically cited the increase in opioid potency and the increase in contaminated opioids as reasons why Rhode Island needs the sites.

Communities that have implemented these projects, such as those in Canada and Europe, tend to see reduced crime, safer consumption and fewer drug overdoses and deaths, he added. 

Rebecca Kislak, state representative for Rhode Island’s District 4, supported the bill in the House. Harm reduction centers “help people with substance abuse disorders connect with resources and support,” she said.  

“I don’t think anybody wants to suffer from addiction,” Kislak said when asked about critics who believe such sites may increase drug use. “We see people whose addiction has cut them off from their community and their support network. (The sites) are a way for people to start reconnecting” and to get recovery services, she said.

The need to decriminalize drug use, through concrete measures such as the creation of safe injection sites, is long overdue, Kisalk said. “For far too long we have treated addiction and drug use as a crime. It is important to offer support to everybody, whatever their illness or issue is. We should have done this a long time ago,” Kislak said. Private grants, rather than tax dollars, will pay for the program, she added.

“The (Rhode Island) Department of Health has until March to finalize the rules and (regulations) around” where and when sites will open, Miller said. Once these details have been finalized, providers will be able to apply to become an approved safe-injection site and a part of the two-year pilot program.

The state legislature has passed several other bills to combat the state’s opioid crisis, Miller said, such as “decriminalization of (the drug) suboxone, better access to care and better coverage.” Miller expressed confidence that “more will be coming in the next legislative session.”

McDonald added that the state has done work in drug education, improving access to treatment and recovery coaches, but more work is still needed. The safe-injection sites are a step in the right direction, providing people a treatment option while allowing them to safely use drugs, he said.

“That’s what a harm reduction center is about: to make sure that people have an opportunity to get treatment,” he said. 


“Since (the bill) passed,” Miller said, “we’ve gotten inquiries from several states including New York and California, who are interested in monitoring how our state’s roll out happens.”

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