Background: Overdose prevention centres (OPCs) have been implemented as a harm reduction response in around 20 countries; with one just opened in the UK. In a context of rising rates of drug-related deaths, this study aimed to assess the need for an OPC in Sandwell, England, by examining the experiences and perspectives of local people who use drugs. Methods: Qualitative data were collected through three focus groups, 20 street-based interviews with people who use drugs, and observations from four ethnographic field sessions. This was a community-based participatory project and included community consultation during study design and peer researcher participation during data collection, analysis and dissemination. Results: Findings evidence how the threat of public and police interaction in semi-public drug use spaces leads to rushed injection practice, hampers poor venous access management, and increases risk of injection-related harms. Participants were enthusiastic about the concept of an OPC and its potential to reduce injecting-related risks, drug-related death, provide safety, and prevent traumatic experiences with police. Participants also highlighted concerns about negative public perceptions of their community, viewing an OPC as a potential solution to improving community relations by reducing drug-related litter. Conclusions: There is an urgent need for OPC implementation, given current risks from rushed injection practices, the lack of safe spaces, and the increasing presence of nitazenes and other unexpected contaminants in the UK drug supply. The assertion from local people who drugs that an OPC would be an appropriate and effective intervention requires prioritisation by policymakers.