County by county estimation of possible deaths averted, infections averted, and cost savings of overdose prevention centers in the United States from July 2019-June 2025.

Overdose prevention centers (OPCs), also known as safer injection facilities (SIFs) or supervised consumption sites (SCSs), are a service that allows people to obtain sterile supplies to use their own drugs in a safe environment that is monitored by professionals trained in overdose response and harm reduction. Though still illegal under federal law in the U.S. ("Maintaining Drug-Involved Premises"; "United States v. Safehouse", 2021), many legal or quasi-legal (including some in the U.S.) OPCs have operated since the 1980s. Using CDC overdose death estimates and U.S. Census Bureau population data, we developed a retrospective, scenario-based modeling tool, estimating that 1329-5316 deaths could have been averted between July 2019 and June 2025 if 1 out of 100-400 injections had taken place at an OPC. Under these assumptions, 26-105 HIV transmissions and 5723-22,892 Hepatitis C transmissions could have been averted. Factoring in both discounted lifetime costs to treat those infections as well as the statistical value of deaths averted, $11.9-47.7 billion could have been saved. These data support OPCs as one viable public health intervention to avert deaths and avoid infections. We created a web application that allows users to explore county-level model results and alter model assumptions, including variables like the percent of injections that occur at an OPC.