Episode 40
Rhode Island's Response to the Overdose Crisis
This episode of Humans in Public Health features Professor Alex Macmadu, an epidemiologist who has spent her career studying the opioid and overdose crisis. She shares insights on Rhode Island’s bold step in opening the first state-approved overdose prevention center in the U.S. and what her research reveals about community attitudes toward harm reduction. Listen in to learn how evidence, advocacy and compassion are shaping the future of public health responses to drug use.
Transcript
In the past few years, the field of public health has become more visible than ever before, but it's always played a crucial role in our daily lives. Each month, we talk to someone who makes this work possible. Today, Alex Macmadu.
emic, which has killed nearly:Alex is a professor at Brown University's School of Public Health and a member of the People, Place and Health Collective. Together with her PPHC colleagues, she's been involved in some of the efforts to open the Overdose Prevention Center. Recently she published a study that tried to understand how people living near the center feel about it. So we brought Alex into the studio to explain.
[:[00:01:22] Alex Macmadu: It's a delight to be here. Thanks for having me.
[:[00:01:37] Alex Macmadu: Totally. I'd be happy to. So, overdose Prevention Centers or OPCs, also known as supervised consumption sites – there's lots of different names out there. So they are community based spaces where the primary purpose is to reverse overdoses and to save lives. So at these facilities, staff are ready to intervene if someone overdoses, when using the drugs that they bring with them to the facility. So these programs also connect folks to health and social services, including to drug treatment, to harm reduction resources, medical care, mental health resources, social support – They really have a lot of wraparound services generally.
[:[00:02:22] Alex Macmadu: Yeah, so if you walk through the door at the OPC here in Rhode Island, you'd go up to the second floor. You'd speak with the folks there and you would then be directed to a table and a nice clean surface where there's, you know, nice comfortable lights and a mirror, so that folks who are staffing the OPC can check in on you, and that's about it.
[:[00:02:53] Alex Macmadu: Exactly. So they provide clean syringes. And in the event that someone should overdose, trained staff members, many of whom are people with lived experience themselves, are there to quickly intervene and to prevent overdose deaths and to save lives.
The idea is that these spaces are intended to be spaces of no judgment and spaces where you're seen and treated with dignity like the human and the person that you are. So many people who use drugs and people belonging to like other vulnerable and marginalized groups, you know, particularly also like people who are homeless, tend to have experiences out in the world that are deeply marginalizing and stigmatizing and othering. And these spaces are meant to be a warm welcome and a warm embrace of folks.
[:[00:04:04] Megan Hall: You've been around in Rhode Island for a while, so tell me a little bit about the movement. I mean, what did you observe about what made Rhode Island so effective advocating for this?
[:There's just really incredible people. They're passionate, they approached us as researchers about the data.They wanted to know what OPCs look like in other countries. What does the data tell us about the impacts of these programs? And they wanted this information so that they could advocate more effectively. And I was really excited as a researcher to get to partner with these really fabulous folks and share the information that we know.
[:[00:05:05] Alex Macmadu: So I'm originally from West Virginia, and as some of your listeners may know, West Virginia has really been at the epicenter of the overdose crisis in the US. Much of the burden of overdose is actually in Southern West Virginia, which is where I grew up. The opioid epidemic and the overdose crisis just felt so pervasive.
I remember my mom would read the newspaper back when people had print newspapers and look at the obituaries because, I’m from a really small town, so often you knew the people who were listed in the papers and over and over again, you would see people in their forties, their thirties, and their twenties listed as having died of natural causes. Because, you know, there's a great deal of stigma, of course, like the actual cause of death of overdose was rarely if ever listed.
I also had several friends and some family members who had opioid use disorder. So I feel like I definitely saw some of these struggles firsthand as well.
[:[00:06:22] Alex Macmadu: Right. I would say that regardless of someone's path to a substance use disorder, that people who use drugs are people.
[:[00:06:34] Alex Macmadu: Exactly. Yeah. I mean, we don't bat an eye when someone has diabetes or heart disease or anything else. So I think the moralizing around substance use is something I'd really love to see change over the course of my lifetime.
[:[00:06:55] Alex Macmadu: One of my earliest research experiences was conducting interviews with people who used drugs in my hometown. And that experience was so unbelievably fulfilling because I had the opportunity to chat with people in my community, and talked with them about how they use, what they use, what their safer use strategies were, and talked to them about the resources that they needed to keep themselves safe. At that time, there was very little naloxone availability, in that region of the state and having the opportunity to talk with people from my own community and to build the evidence for expanding access to resources for my own community was really incredible.
[:[00:07:55] Alex Macmadu: Yeah, so members of our research team, they went to the community and they knocked on doors, they entered businesses, and they spoke with pedestrians in the area. And we interviewed people who were over the age of 18 and who lived or worked in the neighborhood of the OPC. And we asked them for their perspectives.
[:[00:08:18] Alex Macmadu: So we found overall that 74% of the people we spoke with supported an OPC opening in their neighborhood. And an even greater proportion, 81% supported an OPC in the opening in another neighborhood in the city.
[:[00:08:34] Alex Macmadu: I was pleasantly surprised to see the high levels of community acceptability, although I would say that this research contributes to a growing body of research that communities are broadly accepting of OPCs in their neighborhood.
[:[00:08:54] Alex Macmadu: So I think that a lot of politicians cite a lack of community support for OPCs as their personal reason for being in opposition to it. And this really stands in contrast to that narrative. We found that broadly this community was very supportive of an OPC opening in their neighborhood.
[:[00:09:24] Alex Macmadu: I don't have any initial findings, but I can say from speaking with some of the folks who operate the OPC, that things are going about as smoothly as you could imagine. I'm really happy to hear that they've been continuing to enroll clients in the program and that everything seems to be going really, really well, which is awesome.
[:[00:09:55] Alex Macmadu: That's a great question. And I think that the findings from this research will essentially be guiding that outcome. So if we find that overdose prevention centers are associated with reductions in overdose and better health outcomes for people who use drugs, without any adverse community effects, I think that other communities will be eager to replicate these programs nationwide.
[:[00:10:39] Alex Macmadu: Well, first I would like to emphatically encourage folks who would like to learn more about OPCs to go to opcinfo.org. Our team at the PPHC helped to pull this resource together and it provides loads and loads of information about what the research says about overdose prevention centers. And I think it's a really wonderful resource for folks who'd like to learn more. And I would say that OPCs provide a safe space for people to use drugs, and right now people are using in spaces that are really unsafe and in situations that are unsafe. So if we can help keep more people alive, that's the dream.
[:[00:11:23] Alex Macmadu: Thank you so much.
[:Humans in Public Health is a monthly podcast brought to you by Brown University School of Public Health. This episode was produced by Nat Hardy and recorded at the podcast studio at CIC Providence.
I'm Megan Hall. Talk to you next month!
