PROJECT SUMMARY The drug overdose crisis has claimed more than one million lives in the United States over the past two decades. In response to this crisis, New York City has implemented the nation’s first publicly recognized overdose prevention centers (OPCs), which are facilities that permit clients to consume pre-obtained controlled substances under the supervision of personnel who are trained to intervene in the event of an overdose. Staff at OPCs also provide safer drug consumption education, access to sterile drug use supplies, offer other health and ancillary services, and provide referrals to other treatment, health, and recovery services. In July 2021, Rhode Island became the first state to authorize overdose prevention centers (OPCs), with plans to open in March 2022. While studies from other countries have demonstrated that OPCs have individual and community benefits, there exist no evaluations of sanctioned OPCs in the United States. The proposed research is of high public health and policy significance, since this project will, for the first time, determine the potential benefits and unintended consequences of sanctioned OPCs in the US. As a first step, we will evaluate immediate, post[1]OPC implementation changes in measures of drug-related public disorder (e.g., drug use in public, drug-related litter) and compare these changes to trends in control neighborhoods that do not contain OPCs (Aim 1). We will also establish the feasibility of recruiting and retaining a prospective cohort of clients who use an OPC in New York City and Rhode Island to examine a range of behavioral, health, and linkage to care outcomes (Aim 2). If successful, this preliminary research will lay the foundation for a robust, multi-component, longer-term study to evaluate the breadth of individual and community-level outcomes associated with OPC implementation in these two jurisdictions.