The inherent danger of hard drug use is often compounded by the logistics of actually using it. Whether needle-delivered drugs like heroin or overdose-prone pharmaceuticals like fentanyl, a bad injection or tainted batch can be fatal. People taking these drugs, often alone and in precarious places like alleys or the backseats of cars, are taking their lives in their hands.
These dangers can be reduced. In July 2021, Rhode Island became the first state in the US to legalize harm reduction centers, or places where people can safely use drugs. For people dealing with addictions—particularly those addicted to opioids like heroin and fentanyl—safe, supervised spaces to use drugs are rare. Rhode Island’s law seeks to create controlled and resourced spaces where this drug use can happen.
With the US recording more than 100,000 drug overdose deaths during from April 2020 to April 2021, the need for such spaces is clear. What they should look like and how they should function, however, are unresolved questions.
The Rhode Island School of Design set out to provide some answers through a student design studio, Design Beyond Crisis. The studio was led by Justin W. Cook, director of the Center for Complexity at RISD, which focuses on interdisciplinary research and design around complex social challenges, in collaboration with Rhode Island Hospital’s Center of Biomedical Research Excellence on Opioids and Overdose.
The studio’s primary focus is on Rhode Island’s development of harm reduction centers, which provide supervised spaces where people can use drugs in order to reduce their chances of overdose, and eventually help them break their addiction. Cook says the current opioid crisis requires not just physical spaces for safe drug use, but also a complete rethinking of the ways drug use and addiction have been stigmatized. The concepts and design proposals developed in the studio envision a more holistic approach to addiction care that combines elements of healthcare, prevention, and education.
Addiction is part of the human experience. We’re all probably addicted to something, whether it’s a phone or caffeine or exercise. In this case, where we have this exquisitely addictive drug, which is the opioid, [and] If that addiction happens to you, then you become a second-class or third-class citizen,” Cook says.
The studio took a broad view of what harm reduction could mean, exploring the physical design of harm reduction centers, tests that can identify contamination in street drugs, and digital tools for finding and accessing harm reduction services. They’re all issues that have been largely ignored by designers and left in the hands of law enforcement, according to Cook. “There’s an enormous amount of opportunity for designers to become involved and work against the decision that we’ve made as a society to treat this as a criminal problem,” he says.
Rhode Island isn’t totally alone in looking beyond the criminal justice system to tackle questions around drug use and addiction. Supervised injection sites now exist in New York City, and countries like Canada, the United Kingdom, and Australia have long had legal injection sites where people can safely use drugs. But when it comes to the actual design and operation of these spaces, Cook says there are many shortcomings.
“The design solutions are problematic and are the product, though with good intention, of a stigmatized view of drug use,” he says. Many are located in inconvenient places that are on the margins of cities, and pay little regard to the privacy of people who use them. Instead of being spaces that acknowledge the challenge of living with addiction, they tend to be clinical, utilitarian rooms with heavy monitoring and few comforts. “They don’t tend to be spaces that are setting the conditions for well-being or healing,” Cook says.
Designs developed in the RISD studio seek to improve on these conditions. One project by student Mary Byrnes envisions turning a vacant CVS drug store in downtown Providence into a harm reduction center. The project paid specific attention to the center’s entrance and exit, and people’s need for privacy while accessing the center’s services and upon leaving by creating a linear through the facility, dividing its rooms for drug use and social pathway services, and making a nondescript exit at the street. Another project by student Meng Su created modular drug injection rooms that provide privacy while also allowing on-site monitors to ensure drug users aren’t overdose.
Student Amy Qu developed a design for a fentanyl test strip that could detect the opioid in recreational drugs. Embedded into a disposable wristband commonly used at music festivals and nightclubs, the strip would make it easy to ensure that using a drug like cocaine doesn’t unintentionally expose people to a highly addictive opioid.
The studio also developed ideas for improving the effectiveness of addiction treatment and prevention. Student Yangchuan Victor Deng created a simple app, closing what Cook says is a gap in the digital marketplace for harm reduction services. “If you’re interested in birdwatching, for instance, you can go to the app store and find 10,000 apps,” Cooks says. “But if harm reduction is something that you’re concerned about, there’s very little.” Deng’s app centralizes information about how people can access services and help, and securely collects user data to help harm reduction center providers better understand community needs.
Cook says that Infosys, a funder of the Center for Complexity, will be providing development resources to build a prototype of the app. The students have also started creating a design manual for harm reduction that will be completed over the summer and published this fall.
Though Rhode Island’s law has been in effect for nearly a year, no harm reduction centers have yet opened in the state. Cook says several organizations are currently considering potential projects, and he’s hopeful that this design studio can inform those plans.
Time is running out. The state’s law is a two-year pilot programme. “My concern is that, if we don’t do this well, then we will learn the wrong lesson,” Cook says. “I’m hopeful that by many of us working on this experiment, we can find a way of making this pilot suggest that this is an important piece of the care infrastructure. Because this crisis is not going away.”