"In conclusion, we found that areas where SCS were implemented in Toronto subsequently had significant reductions in overdose mortality incidence, although other areas in the city did not. Furthermore, we found an inverse spatial association between SCS and overdose mortality incident locations, and this association increased in magnitude over time. This finding suggests that the implementation of SCS could contribute to reductions in overdose mortality in proximal areas. Criticisms of SCS have focused on the lack of evidence of their capacity to meaningfully affect population-level overdose mortality.8 Our finding of potential positive community spillover effects of SCS suggests that, beyond their immediate capacity to reverse onsite overdoses among onsite clients, they might also contribute to population-level overdose prevention efforts. As such, the inclusion of population-level metrics to evaluate the effectiveness of SCS is not only warranted but can also inform policy planning regarding SCS service design, implementation, and operation."