"A safe place to use": People who use drugs' perceptions and preferences prior to the implementation of Rhode Island's first overdose prevention center.

Introduction: In July 2021, Rhode Island became the first state in the United States (US) to legalize overdose prevention centers (OPCs). To inform the design and implementation of an OPC in Providence, Rhode Island's capital, we explored perceptions of OPCs and programmatic needs among people who use drugs.

Methods: The study conducted in-depth qualitative interviews from December 2023 to March 2024 with 25 people who use drugs. Thematic analysis explored OPC implementation considerations, with a focus on perceived social and structural barriers and facilitators for use. The study shared findings iteratively with the future OPC's operating organization.

Results: Overall, participants were aware of plans to open an OPC locally and were largely supportive. Participant narratives underscored social, spatial, and programmatic needs to facilitate OPC accessibility and uptake, including the site's hours of operation, environment, and ancillary services provided. Participants further underscored concerns and considerations that would affect their willingness to use the site, including police presence, preferred substances and use modalities, use routines, and housing status. These considerations and concerns were grounded in participants' own social locations and levels of structural vulnerability.

Conclusion: Our findings underscore the need for inclusive services that ensure the OPC's accessibility and uptake as a safer environment for a variety of key populations.