INTRODUCTION: The overdose crisis is one of the most serious public health challenges in North America. Supervised consumption sites (SCSs) effectively prevent onsite overdose deaths and connect people to health services, but their association with population - level overdose mortality remains unclear.

METHODS: We searched Embase, Global Health and MEDLINE databases for studies examining associations between SCSs and population-level overdose mortality during the post-2016 overdose crisis (January 2016 to November 2024). Two reviewers, working independently, screened studies, extracted data and assessed study quality using standardized tools (PROSPERO CRD42023406080).

RESULTS: Six studies, all from Canada, met the inclusion criteria. In the four quasi experimental studies, two large-scale analyses of local health areas or public health units found no significant associations between SCS measures and overdose mortality within provinces. Some analyses of smaller urban areas showed protective associations, although this finding was not consistent across studies. Two observational studies suggested associations between SCS and lower mortality rates, though with methodological limitations.

CONCLUSION: Province-wide analyses generally did not detect significant associations between areas with and without SCSs and population-level overdose mortality. Analyses suggest that SCSs in some smaller urban contexts were associated with less overdose mortality, though findings were inconsistent. Further research is needed to understand how geographic scale, implementation context and limited service coverage may influence the detection and magnitude of potential effects of SCSs on overdose mortality.