"That data has to be normalized for the surge in fentanyl use" I agree. "I don't think anybody claims that safe injecting alone can prevent all opioid deaths,

"That data has to be normalized for the surge in fentanyl use" I agree. "I don't think anybody claims that safe injecting alone can prevent all opioid deaths," 'Safe injecting' is not saving any lives and is not doing any 'harm reduction' is my point. The only evidence provided that 'it's working' is the sites data where they say 'we prevented x number of ODs' - but this is not quite valid - just because they think they prevented an OD, does not mean they did. Someone who takes too much on the street can still get an ambulance and emergency services. Someone on the street who does 'way too much' is gong to die one way or another. There's no evidence that the sites actually 'get more people into programs' than otherwise. I believe that more directly interventionist programs might work: if you are caught, high on heroin in public - then you don't go to jail, but you go to a facility of sorts. This facility is basically a 'dry out hotel'. The only thing about this facility is you have zero access to heroin - you have to go through withdrawal and be clean for 30 day. Withdrawal is the unavoidable 'first step' to getting off heroin. There is absolutely no other way, and it must be done. Then programs to help people stay off of it.