Overdose Prevention Centers and Neighborhood Commercial Activity in New York City.

Importance: Overdose prevention centers (OPCs) are interventions to reduce overdose mortality and support health care engagement. In the US, concerns have been raised that OPCs may be associated with reduced economic activity in their surrounding neighborhoods. Objective: To evaluate changes in the local economic activity in New York City (NYC), measured by neighborhood-level foot traffic and consumer spending, following the opening of the first 2 publicly recognized OPCs in the US. Design, Setting, and Participants: This cohort study used anonymized mobility and spending data from June 1, 2021, to June 13, 2022, for the areas surrounding the East Harlem and Washington Heights OPCs in NYC. These neighborhoods were defined using 5-minute and 10-minute walking buffers and Business Improvement Districts (BIDs). Synthetic control donors included walking buffers and BIDs around syringe service programs without OPCs and opioid treatment programs that were operational as of OPCs' opening. Analyses were conducted from February to July 2025. Exposures: Opening of the 2 NYC OPCs on November 30, 2021. Main Outcomes and Measures: Primary outcomes were foot traffic and in-person consumer spending within 10-minute walking buffers. Secondary analyses considered 5-minute walking buffers and BIDs. Augmented synthetic control models were adjusted for neighborhood-level demographic and socioeconomic features, with fit assessed using root mean squared error before OPC opening. Permutation tests and conformal inference were used to assess significance. Results: A total of 27 biweekly observations (13 in pre-OPC and 14 in post-OPC periods) were analyzed. The 10-minute walking buffer analyses captured 1259 consumer spending sites and 7816 foot traffic sites across 2 treated buffers and 56 donor buffers. In East Harlem, the average treatment effect on the treated (ATT) estimate (SE) was -$21.96 ($40.53) for consumer spending (P = .16) and 1.28 (5.40) visits for foot traffic (P = .19). In Washington Heights, ATT (SE) estimates were $14.94 ($37.38) for consumer spending (P = .13) and 0.44 (3.54) visits for foot traffic (P = .97). Secondary analyses produced consistent results. No statistically significant results were observed at any post-OPC time point. Conclusions and Relevance: This cohort study found that OPC opening was not associated with significant changes in local economic activity. Given the absence of observed economic harms, policy debates should instead focus on the public health implications of OPCs.