In 2021, more than 107 000 people died from a drug overdose in the US, 1 a 15% increase from 2020.Deaths involving cocaine increased 23%, and deaths involving methamphetamines or other stimulants increased 34%. 1 Death rates are increasing the most rapidly among people experiencing homelessness 2 and among American Indian or Native American, Black, and Latinx individuals. 3 These staggering numbers demonstrate an urgent need for immediate action. In recent years, there has been expansion of proven harm reduction strategies to reduce overdose deaths. Harm reduction is a way of approaching and caring for people who use drugs that centers people's dignity, humanity, and autonomy to reduce harms associated with substance use. It uses practical strategies to meet people where they are to improve individual and community well-being and health. Decades of robust research on harm reduction strategies, specifically syringe services and naloxone distribution, demonstrate that these strategies are associated with reduced morbidity, mortality, and transmission of infectious diseases and improved individual health outcomes and services engagement and that they have high cost-effectiveness.The use of overdose prevention centers (OPCs) is an evidence-based harm-reduction intervention that, until recently, has not been available in the US. OPCs, which are sometimes referred to as supervised consumption centers, are places where people can consume preobtained drugs in a monitored setting where staff can immediately intervene in the event of an overdose.

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In July 2021, a statewide measure to create Harm Reduction Centers (also known as safe consumption sites [SCS]) was signed into law in Rhode Island. Convincing evidence shows that SCS can reduce premature death in the surrounding neighborhood. Although SCS have had success around the globe for approaching 40 years, implementing a harm reduction center of this kind in the United States requires consideration of this country's unique racial and geographic politics. In this manuscript, we describe a series of discussions at the Regulations Committee meetings in Rhode Island around the question of whether or not to mandate the presence of inhalation rooms. Through this vignette, we aim to convey how, at the highest level of government, citizens of Rhode Island were able to promote and prioritize racial equity.