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Killion JA, Jegede OS, Werb D, Davidson PJ, Smith LR, Gaines T, Graff Zivin J, Zúñiga ML, Pines HA, Garfein RS, Strathdee SA, Rivera Saldana C, Martin NK. Modeling the impact of a supervised consumption site on HIV and HCV transmission among people who inject drugs in three counties in California, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 132:104557. [PMID: 39213827 DOI: 10.1016/j.drugpo.2024.104557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Supervised consumption sites (SCS) have been shown to reduce receptive syringe sharing among people who inject drugs (PWID) in the United States and elsewhere, which can prevent HIV and hepatitis C virus (HCV) transmission. PWID are at risk of disease transmission and may benefit from SCS, however legislation has yet to support their implementation. This study aims to determine the potential impact of SCS implementation on HIV and HCV incidence among PWID in three California counties. METHODS A dynamic HIV and HCV joint transmission model among PWID (sexual and injecting transmission of HIV, injecting transmission of HCV) was calibrated to epidemiological data for three counties: San Francisco, Los Angeles, and San Diego. The model incorporated HIV and HCV disease stages and HIV and HCV treatment. Based on United States data, we assumed access to SCS reduced receptive syringe sharing by a relative risk of 0.17 (95 % CI: 0.04-1.03). This model examined scaling-up SCS coverage from 0 % to 20 % of the PWID population within the respective counties and assessed its impact on HIV and HCV incidence rates after 10 years. RESULTS By increasing SCS from 0 % to 20 % coverage among PWID, 21.8 % (95 % CI: -1.2-32.9 %) of new HIV infections and 28.3 % (95 % CI: -2.0-34.5 %) of new HCV infections among PWID in San Francisco County, 17.7 % (95 % CI: -1.0-30.8 %) of new HIV infections and 29.8 % (95 % CI: -2.1-36.1 %) of new HCV infections in Los Angeles County, and 32.1 % (95 % CI: -2.8-41.5 %) of new HIV infections and 24.3 % (95 % CI: -1.6-29.0 %) of new HCV infections in San Diego County could be prevented over ten years. CONCLUSION Our models suggest that SCS is an important intervention to enable HCV elimination and could help end the HIV epidemic among PWID in California. It could also have additional benefits such facilitating pathways into drug treatment programs and preventing fatal overdose.
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Affiliation(s)
- J A Killion
- University of California San Diego, CA, USA; San Diego State University, CA, USA.
| | - O S Jegede
- University of California San Diego, CA, USA; San Diego State University, CA, USA
| | - D Werb
- University of California San Diego, CA, USA; Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | | | - L R Smith
- University of California San Diego, CA, USA
| | - T Gaines
- University of California San Diego, CA, USA
| | | | | | - H A Pines
- University of California San Diego, CA, USA; San Diego State University, CA, USA
| | | | | | | | - N K Martin
- University of California San Diego, CA, USA; University of Bristol, Bristol, UK
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Cousien A, Donadille C, Madrid LB, Maradan G, Jauffret-Roustide M, Lalanne L, Auriacombe M, Roux P, Boyer S. Cost-effectiveness of drug consumption rooms in France: a modelling study. BMC Public Health 2024; 24:1426. [PMID: 38807111 PMCID: PMC11135012 DOI: 10.1186/s12889-024-18909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) experience many health problems which result in a heavy economic and public health burden. To tackle this issue, France opened two drug consumption rooms (DCRs) in Paris and Strasbourg in 2016. This study assessed their long-term health benefits, costs and cost-effectiveness. METHODS We developed a model to simulate two fictive cohorts for each city (n=2,997 in Paris and n=2,971 in Strasbourg) i) PWID attending a DCR over the period 2016-2026, ii) PWID attending no DCR. The model accounted for HIV and HCV infections, skin abscesses and related infective endocarditis, drug overdoses and emergency department visits. We estimated the number of health events and associated costs over 2016-2026, the lifetime number of quality-adjusted life-years (QALYs) and costs, and the incremental cost-effectiveness ratio (ICER). RESULTS The numbers of abscesses and associated infective endocarditis, drug overdoses, and emergency department visits decreased significantly in PWID attending DCRs (-77%, -69%, and -65%, respectively) but the impact on HIV and HCV infections was modest (-11% and -6%, respectively). This resulted in savings of €6.6 (Paris) and €5.8 (Strasbourg) millions of medical costs. The ICER of DRCs was €30,600/QALY (Paris) and €9,200/QALY (Strasbourg). In scenario analysis where drug consumption spaces are implemented inside existing harm reduction structures, these ICERs decreased to €21,400/QALY and €2,500/QALY, respectively. CONCLUSIONS Our findings show that DCRs are highly effective and efficient to prevent harms in PWID in France, and advocate extending this intervention to other cities by adding drug consumption spaces inside existing harm reduction centers.
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Affiliation(s)
- Anthony Cousien
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018, Paris, France.
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Cécile Donadille
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Laélia Briand Madrid
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Gwenaëlle Maradan
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marie Jauffret-Roustide
- Centre d'Etudes des Mouvements Sociaux, Inserm U1276, CNRS UMR 8044, EHESS, Paris, France
- British Columbia Center on Substance Use (BCCSU), Vancouver, Canada
- Baldy Center on Law and Social Policy, Buffalo University, New York, USA
- Institut universitaire sur les dépendances, Université de Sherbrooke, Montréal, Québec, Canada
| | - Laurence Lalanne
- UMR 1329, Team Addictions, Centre de recherche en biomédecine de Strasbourg, Department of addiction medicine, University hospital of Strasbourg, Strasbourg, France
| | - Marc Auriacombe
- UMR 6033, Bordeaux University, SANPSY, CNRS, Bordeaux, France
| | - Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Sylvie Boyer
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Anderson ES, Frazee BW. The Intersection of Substance Use Disorders and Infectious Diseases in the Emergency Department. Emerg Med Clin North Am 2024; 42:391-413. [PMID: 38641396 DOI: 10.1016/j.emc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Substance use disorders (SUDs) intersect clinically with many infectious diseases, leading to significant morbidity and mortality if either condition is inadequately treated. In this article, we will describe commonly seen SUDs in the emergency department (ED) as well as their associated infectious diseases, discuss social drivers of patient outcomes, and introduce novel ED-based interventions for co-occurring conditions. Clinicians should come away from this article with prescriptions for both antimicrobial medications and pharmacotherapy for SUDs, as well as an appreciation for social barriers, to care for these patients.
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Affiliation(s)
- Erik S Anderson
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA; Division of Addiction Medicine, Highland Hospital, Alameda Health System, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Bradley W Frazee
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA
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Behrends CN, Leff JA, Lowry W, Li JM, Onuoha EN, Fardone E, Bayoumi AM, McCollister KE, Murphy SM, Schackman BR. Economic Evaluations of Establishing Opioid Overdose Prevention Centers in 12 North American Cities: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:655-669. [PMID: 38401795 PMCID: PMC11069439 DOI: 10.1016/j.jval.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Overdose prevention centers (OPCs) provide a safe place where people can consume preobtained drugs under supervision so that a life-saving medical response can be provided quickly in the event of an overdose. OPCs are programs that are established in Canada and have recently become legally sanctioned in only a few United States jurisdictions. METHODS We conducted a systematic review that summarizes and identifies gaps of economic evidence on establishing OPCs in North America to guide future expansion of OPCs. RESULTS We included 16 final studies that were evaluated with the Consolidated Health Economic Evaluation Reporting Standards and Drummond checklists. Eight studies reported cost-effectiveness results (eg, cost per overdose avoided or cost per quality-adjusted life-year), with 6 also including cost-benefit; 5 reported only cost-benefit results, and 3 cost offsets. Health outcomes primarily included overdose mortality outcomes or HIV/hepatitis C virus infections averted. Most studies used mathematical modeling and projected OPC outcomes using the experience of a single facility in Vancouver, BC. CONCLUSIONS OPCs were found to be cost-saving or to have favorable cost-effectiveness or cost-benefit ratios across all studies. Future studies should incorporate the experience of OPCs established in various settings and use a greater diversity of modeling designs.
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Affiliation(s)
- Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
| | - Jared A Leff
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Weston Lowry
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jazmine M Li
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Erica N Onuoha
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Erminia Fardone
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed M Bayoumi
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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Greene C, Maier K, Urbanik MM. "It's just not the same": Exploring PWUD' perceptions of and experiences with drug policy and SCS services change in a Canadian City. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103934. [PMID: 36549200 DOI: 10.1016/j.drugpo.2022.103934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Shifting political contexts can significantly alter drug policy approaches and available supports for People Who Use Drugs (PWUD). The purpose of this study was to explore how shifts in provincial drug policy approaches, specifically the replacement of a Safe Consumption Site (SCS) with a smaller mobile Overdose Prevention Site (OPS) in Lethbridge, Alberta Canada, impacted PWUD' access to and experiences with harm reduction services. METHODS We conducted semi-structured interviews with 50 PWUD in the City of Lethbridge, Canada. Through traditional fieldwork, we recruited participants within, and just outside of, downtown Lethbridge. Using a standardized general prompt guide to begin interviews, participants were asked a variety of questions about their experiences with and perceptions of SCS access and changes to SCS provisions. Interviews were audio recorded, then transcribed, coded, and analyzed. RESULTS Participants reported regular and frequent access and overall positive experiences with the SCS, despite also noting certain operational barriers (e.g., long wait times). By contrast, participants reported more limited use of the new OPS compared to the SCS because of three main reasons: (1) concerns about location; (2) smoking room elimination; and (3) lack of social space and activities. Overall, changes to SCS provision produced a range of negative consequences for PWUD in Lethbridge. These relate to perceived increases in drug-related harms (e.g., increased overdoses) as well as negative social impacts (e.g., lack of place to meet other people). CONCLUSION Findings from this study provide preliminary indications of the importance of understanding how contextual and locally-specific elements (location, limits on permitted route administration, and social aspects) can work together to facilitate SCS uptake and even overcome traditional SCS barriers. Conversely, the absence of such elements can hinder SCS uptake. Results show that the value of SCS might differ across locations, pointing to the need for further locally-grounded examinations of harm reduction service uptake and experience.
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Affiliation(s)
- Carolyn Greene
- Athabasca University, 1 University Drive, Athabasca, AB, Canada.
| | - Katharina Maier
- University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba, Canada
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Khezri M, Tavakoli F, Karamouzian M, Sharifi H, Ghalehkhani N, Mousavian G, Mehmandoost S, Bazargani M, Hosseinpour AM, Mahboubi M, Baral S, Shokoohi M. Public injecting and its association with mental health and other drug-related outcomes among people who inject drugs in Iran. J Subst Abuse Treat 2022; 143:108868. [PMID: 36137306 DOI: 10.1016/j.jsat.2022.108868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/16/2022] [Accepted: 08/17/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Injecting in public places may increase the risk of drug and health-related harms among people who inject drugs (PWID). We examined the prevalence of public injecting and associations with non-fatal overdose, needle/syringe sharing, sexual health, and mental health among PWID in Iran. METHODS Using respondent-driven sampling, we recruited 2684 PWID from 11 major cities between July 2019 and March 2020. We defined public injecting as injecting primarily in public places, such as streets, parks, or abandoned buildings. Multivariable logistic regression models assessed public injecting and its associated factors, as well as the association of public injecting with certain health outcomes. RESULTS Of 2388 respondents, 69.6 % reported public injecting in the previous year. Self-identifying as men (adjusted odds ratio [aOR] = 4.21; 95 % confidence intervals [95 % CI]: 2.31, 7.65), homelessness (aOR = 6.81; 95 % CI: 5.10, 9.10), high injection frequency (aOR = 1.58; 95 % CI: 1.03, 2.44), and free needle/syringe uptake (aOR = 1.47; 95 % CI: 1.04, 2.07) were significantly associated with public injecting. Compared to PWID who primarily inject in non-public places, PWID who mostly used public places had significantly greater odds of reporting non-fatal overdose (aOR = 2.02; 95 % CI: 1.01, 4.02), needle/syringe sharing (aOR = 1.77; 95 % CI: 1.08, 2.90), unsafe sexual practices with casual sexual partners (aOR = 2.16; 95 % CI: 1.03, 4.55), suicidal ideation (aOR = 1.50; 95 % CI: 1.02, 2.21), and self-harm (aOR = 1.78; 95 % CI: 1.24, 2.54) in the last three months. CONCLUSION These results suggest the potential utility of a safer injecting environment to mitigate the multiple harms associated with public injecting in Iran. Optimizing health and well-being of PWID necessitates integrating supervised injection facilities into the current harm reduction programs and services in Iran. Future studies should also consider the experiences of additional mental health harms associated with public injecting when exploring adverse health outcomes among PWID.
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Affiliation(s)
- Mehrdad Khezri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States; Centre on Drug Policy Evaluation, Saint Michael's Hospital, Toronto, ON, Canada
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Ghalehkhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ghazal Mousavian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Matin Bazargani
- Center for HIV/STI Control and Prevention, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammad Hosseinpour
- Center for HIV/STI Control and Prevention, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marzieh Mahboubi
- Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Nolan S, Kelian S, Kerr T, Young S, Malmgren I, Ghafari C, Harrison S, Wood E, Lysyshyn M, Holliday E. Harm reduction in the hospital: An overdose prevention site (OPS) at a Canadian hospital. Drug Alcohol Depend 2022; 239:109608. [PMID: 36063622 PMCID: PMC9970047 DOI: 10.1016/j.drugalcdep.2022.109608] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/19/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Substance use management in hospitals can be challenging. In response, a Canadian hospital opened an overdose prevention site (OPS) where community members and hospital inpatients can inject pre-obtained illicit drugs under supervision. This study aims to: (1) describe program utilization patterns; (2) characterize OPS visits; and (3) evaluate overdose events and related outcomes. METHODS A retrospective chart review was completed at one hospital in Vancouver, Canada. All community members and hospital inpatients who visited the OPS between May 2018 and July 2019 were included. Client measures included: hospital inpatient status, use of intravenous access line for drug injection, and substances used. Program measures included: number of visits (daily/monthly), overdose (fatal/non-fatal) events and overdose-related outcomes. RESULTS Overall, 11,673 OPS visits were recorded. Monthly visits increased from 306 to 1198 between May 2018 and July 2019 respectively. On average, 26 visits occurred daily. Among all visits, 20% reported being a hospital inpatient, and 5% reported using a hospital intravenous access line for drug injection. Opioids (56%) and stimulants (24%) were the most common substances used. Overall 39 overdose events occurred - 82% required naloxone reversal, 28% required transfer to the hospital's emergency department and none were fatal. Overdose events were more common among hospital inpatients compared to community clients (6.6 vs 2.2 per 1000 visits respectively; p value = 0.046). CONCLUSIONS This unique OPS is an example of a hospital-based harm reduction initiative. Use of the site increased over time among both groups with no fatal overdose events occurring.
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Affiliation(s)
- Seonaid Nolan
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9 BC, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, V6Z 1Y6 BC, Canada.
| | - Salpy Kelian
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9 BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9 BC, Canada
| | - Samantha Young
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, V6Z 1Y6 BC, Canada; Providence Health Care, 1081 Burrard Street, Vancouver, V6Z 1Y6 BC, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, 155 College Street, 6th floor, Toronto, M5T 3M7 ON, Canada; General Internal Medicine, St. Michael's Hospital, Unity Health, 30 Bond Street, Toronto, M5B 1W8 ON, Canada
| | - Isaac Malmgren
- General Internal Medicine, St. Michael's Hospital, Unity Health, 30 Bond Street, Toronto, M5B 1W8 ON, Canada
| | - Cher Ghafari
- Raincity Housing and Support Society, 616 Powell Street, Vancouver, V6A 1H4 BC, Canada
| | - Scott Harrison
- Providence Health Care, 1081 Burrard Street, Vancouver, V6Z 1Y6 BC, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9 BC, Canada
| | - Mark Lysyshyn
- Vancouver Coastal Health, 800-601 West Broadway, V5Z 4C2 BC, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3 BC, Canada
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Feuerstein-Simon R, Lowenstein M, Dupuis R, Dolan A, Marti XL, Harvey A, Ali H, Meisel ZF, Grande DT, Lenstra N, Cannuscio CC. Substance Use and Overdose in Public Libraries: Results from a Five-State Survey in the US. J Community Health 2022; 47:344-350. [PMID: 35020100 PMCID: PMC8753323 DOI: 10.1007/s10900-021-01048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
In the U.S., overdoses have become a health crisis in both public and private places. We describe the impact of the overdose crisis in public libraries across five U.S. states, and the front-line response of public library workers. We conducted a cross-sectional survey, inviting one worker to respond at each public library in five randomly selected states (CO, CT, FL, MI, and VA), querying participants regarding substance use and overdose in their communities and institutions, and their preparedness to respond. We describe substance use and overdose patterns, as well as correlates of naloxone uptake, in public libraries. Participating library staff (N = 356) reported witnessing alcohol use (45%) and injection drug use (14%) in their libraries in the previous month. Across states surveyed, 12% of respondents reported at least one on-site overdose in the prior year, ranging from a low of 10% in MI to a high of 17% in FL. There was wide variation across states in naloxone uptake at libraries, ranging from 0% of represented libraries in FL to 33% in CO. Prior on-site overdose was associated with higher odds of naloxone uptake by the library (OR 2.5, 95% CI 1.1-5.7). Although 24% of respondents had attended a training regarding substance use in the prior year, over 90% of respondents wanted to receive additional training on the topic. Public health professionals should partner with public libraries to expand and strengthen substance use outreach and overdose prevention efforts.
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Affiliation(s)
- Rachel Feuerstein-Simon
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Anatomy and Chemistry Building, Room 148, Philadelphia, PA, 19104, USA.
| | - Margaret Lowenstein
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Abby Dolan
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Alexandra Harvey
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Anatomy and Chemistry Building, Room 148, Philadelphia, PA, 19104, USA
| | - Heba Ali
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Anatomy and Chemistry Building, Room 148, Philadelphia, PA, 19104, USA
| | - Zachary F Meisel
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - David T Grande
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Noah Lenstra
- Department of Library and Information Science School of Education, The University of North Carolina at Greensboro (UNCG), Greensboro, USA
| | - Carolyn C Cannuscio
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Factors associated with injury and blood-borne infection risk when providing assisted injection among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103297. [PMID: 34077825 PMCID: PMC9844096 DOI: 10.1016/j.drugpo.2021.103297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/22/2021] [Accepted: 05/05/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Prior research has associated assisted injection with risk behaviors, but other risks such as injury, missed veins, and incidental exposures to blood-borne infections during an injection episode have not been assessed. In the following, we present the frequency of these other risks and determine factors associated with missing a vein and incidental blood exposure among people who inject drugs (PWID). METHODS We conducted a cross-sectional analysis of data from PWID who were recruited using targeted sampling in Los Angeles and San Francisco, California, during 2016 and 2017. The analytic sample consist of 336 participants who reported providing injection assistance in the last 6 months. Multivariate logistic regression models were developed for reporting the following risks: missing a vein; getting the recipient's blood on the injection provider; and getting blood on clothes or surfaces. RESULTS In the last 6 months, the most common negative consequences were getting blood on clothes or surfaces (40%), getting the recipient's blood on the injection provider (23%), and missing a vein (17%). In multivariate logistic regression analysis, missing the vein was significantly associated with higher odds of assisting a leg injection while getting the injection recipient's blood on the provider or getting blood on clothes or nearby surfaces was associated with higher odds of assisting a groin injection injecting in the groin. CONCLUSION Providing injection assistance can result in incidental blood exposures and injury, particularly when injecting in sensitive locations on the body. Harm reduction interventions to reduce risks associated with this practice are essential to improving the well-being of PWID.
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Bouzanis K, Joshi S, Lokker C, Pavalagantharajah S, Qiu Y, Sidhu H, Mbuagbaw L, Qutob M, Henedi A, Levine MAH, Lennox R, Tarride JE, Kalina D, Alvarez E. Health programmes and services addressing the prevention and management of infectious diseases in people who inject drugs in Canada: a systematic integrative review. BMJ Open 2021; 11:e047511. [PMID: 34556508 PMCID: PMC8461723 DOI: 10.1136/bmjopen-2020-047511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 08/24/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES People who inject drugs (PWID) experience a high burden of injection drug use-related infectious disease and challenges in accessing adequate care. This study sought to identify programmes and services in Canada addressing the prevention and management of infectious disease in PWID. DESIGN This study employed a systematic integrative review methodology. Electronic databases (PubMed, CINAHL and Web of Science Core Collection) and relevant websites were searched for literature published between 2008 and 2019 (last search date was 6 June 2019). Eligible articles and documents were required to address injection or intravenous drug use and health programmes or services relating to the prevention or management of infectious diseases in Canada. RESULTS This study identified 1607 unique articles and 97 were included in this study. The health programmes and services identified included testing and management of HIV and hepatitis C virus (n=27), supervised injection facilities (n=19), medication treatment for opioid use disorder (n=12), integrated infectious disease and addiction programmes (n=10), needle exchange programmes (n=9), harm reduction strategies broadly (n=6), mobile care initiatives (n=5), peer-delivered services (n=3), management of IDU-related bacterial infections (n=2) and others (n=4). Key implications for policy, practice and future research were identified based on the results of the included studies, which include addressing individual and systemic factors that impede care, furthering evaluation of programmes and the need to provide comprehensive care to PWID, involving medical care, social support and harm reduction. CONCLUSIONS These results demonstrate the need for expanded services across a variety of settings and populations. Our study emphasises the importance of addressing social and structural factors that impede infectious disease care for PWID. Further research is needed to improve evaluation of health programmes and services and contextual factors surrounding accessing services or returning to care. PROSPERO REGISTRATION NUMBER CRD42020142947.
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Affiliation(s)
- Katrina Bouzanis
- Department of Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Siddharth Joshi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Yun Qiu
- School of Health Sciences, Jiangsu Institute of Commerce, Nanjing, Jiangsu, China
| | - Hargun Sidhu
- Department of Undergraduate Medical Education, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Majdi Qutob
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alia Henedi
- Faculty of Pharmacy, Eastern Mediterranean University, Famagusta, North Cyprus, Cyprus
| | - Mitchell A H Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robin Lennox
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Dale Kalina
- Department of Infectious Diseases, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
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11
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McLaughlin A, Sereda P, Brumme CJ, Brumme ZL, Barrios R, Montaner JSG, Joy JB. Concordance of HIV transmission risk factors elucidated using viral diversification rate and phylogenetic clustering. Evol Med Public Health 2021; 9:338-348. [PMID: 34754454 PMCID: PMC8573190 DOI: 10.1093/emph/eoab028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/14/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although HIV sequence clustering is routinely used to identify subpopulations experiencing elevated transmission, it over-simplifies transmission dynamics and is sensitive to methodology. Complementarily, viral diversification rates can be used to approximate historical transmission rates. Here, we investigated the concordance and sensitivity of HIV transmission risk factors identified by phylogenetic clustering, viral diversification rate, changes in viral diversification rate and a combined approach. METHODOLOGY Viral sequences from 9848 people living with HIV in British Columbia, Canada, sampled between 1996 and February 2019, were used to infer phylogenetic trees, from which clusters were identified and viral diversification rates of each tip were calculated. Factors associated with heightened transmission risk were compared across models of cluster membership, viral diversification rate, changes in diversification rate, and viral diversification rate among clusters. RESULTS Viruses within larger clusters had higher diversification rates and lower changes in diversification rate than those within smaller clusters; however, rates within individual clusters, independent of size, varied widely. Risk factors for both cluster membership and elevated viral diversification rate included being male, young, a resident of health authority E, previous injection drug use, previous hepatitis C virus infection or a high recent viral load. In a sensitivity analysis, models based on cluster membership had wider confidence intervals and lower concordance of significant effects than viral diversification rate for lower sampling rates. CONCLUSIONS AND IMPLICATIONS Viral diversification rate complements phylogenetic clustering, offering a means of evaluating transmission dynamics to guide provision of treatment and prevention services. LAY SUMMARY Understanding HIV transmission dynamics within clusters can help prioritize public health resource allocation. We compared socio-demographic and clinical risk factors associated with phylogenetic cluster membership and viral diversification rate, a historical branching rate, in order to assess their relative concordance and sampling sensitivity.
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Affiliation(s)
- Angela McLaughlin
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Department of Bioinformatics, University of British Columbia, Genome Sciences Centre, British Columbia Cancer Agency, 100-570 West 7th Avenue, Vancouver, BC V5Z 4S6, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Chanson J Brumme
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, 452D, Heather Pavilion East, Vancouver General Hospital, 2733 Heather Street, Vancouver, BC V5Z 3J5, Canada
| | - Zabrina L Brumme
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, 452D, Heather Pavilion East, Vancouver General Hospital, 2733 Heather Street, Vancouver, BC V5Z 3J5, Canada
| | - Jeffrey B Joy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Department of Bioinformatics, University of British Columbia, Genome Sciences Centre, British Columbia Cancer Agency, 100-570 West 7th Avenue, Vancouver, BC V5Z 4S6, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, 452D, Heather Pavilion East, Vancouver General Hospital, 2733 Heather Street, Vancouver, BC V5Z 3J5, Canada
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12
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Thakarar K, Nenninger K, Agmas W. Harm Reduction Services to Prevent and Treat Infectious Diseases in People Who Use Drugs. Infect Dis Clin North Am 2021; 34:605-620. [PMID: 32782104 DOI: 10.1016/j.idc.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article reviews the principles of harm reduction, evidence-based harm reduction strategies such as syringe service programs and supervised injection facilities, and provides approaches to integrating a harm reduction approach into clinical practice. As providers strive to increase capacity to treat underlying substance use disorder, we must also recognize that some people may continue to use drugs. In this setting, providers can still deliver nonjudgmental, individualized care, and advocate for the health and safety of people who inject drugs.
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Affiliation(s)
- Kinna Thakarar
- Infectious Disease and Addiction Medicine, Maine Medical Center/Tufts University School of Medicine, 50 Foden Road, South Portland, ME 04106, USA.
| | - Katherine Nenninger
- Preventive Medicine, Maine Medical Center/Tufts University School of Medicine, 22 Bramhall Street, Portland, ME 04102, USA
| | - Wollelaw Agmas
- Infectious Disease, Maine Medical Center/Tufts University School of Medicine, 22 Bramhall Street, Portland, ME 04102, USA
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Xavier J, Rudzinski K, Guta A, Carusone SC, Strike C. Rules and Eligibility Criteria for Supervised Consumption Services Feasibility Studies - A Scoping Review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:103040. [PMID: 33220597 DOI: 10.1016/j.drugpo.2020.103040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Supervised consumption services (SCS) reduce HIV risks and overdose for people who use drugs (PWUD) and are known to have wide-ranging public health benefits. Feasibility studies are often conducted as part of program/implementation development. We conducted a scoping review of SCS feasibility/pre-implementation studies to answer: what is known about stakeholders' opinions of SCS rules and eligibility criteria? METHODS Using the PRISMA-ScR guidelines, we searched Medline, PsychINFO, Embase, CINAHL, and SCOPUS databases for: (a) empirical research, (b) reported in English, (c) focused on SCS, (d) pre-implementation feasibility studies (research conducted prior to implementation of SCS in a given context), (e) examining SCS operational rules and eligibility criteria. Abstracts were reviewed to verify appropriateness; full articles/reports were retrieved; data were extracted and charted. RESULTS Of the 1,268 data sources identified/reviewed, 19 sources, were included. Manuscripts showed the following criteria that might be considered when determining who can and cannot use SCS: age, pregnancy status, and opioid substitution treatment status. To govern behaviours at SCS, manuscripts focused on: acceptable modes of drug consumption, assisted injections, sharing drugs on-site, pill injecting, and mandatory hand washing, etc. Stakeholders generally agreed that; eligibility restrictions and site rules should be minimal to establish low-barrier services. SCS are often forced to contend with the tension between adhering to a medical or public health model and creating low-barrier services. SCS rules are at the center of this intersection because rules and eligibility criteria implemented to mirror other health services may not align with the needs of PWUD. CONCLUSION Given the public health significance of SCS, establishing best practices for service delivery is critical for increasing access and addressing implementation issues. Future research should examine other operational elements of SCS, such as design elements, staffing models, and ancillary services. Additional research should also focus on supervised smoking services.
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Affiliation(s)
- Jessica Xavier
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - Katherine Rudzinski
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON, N9A 0C5, Canada
| | - Soo Chan Carusone
- Casey House, 119 Isabella St, Toronto, ON, M4Y 1P2, Canada; Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main Street West 2C Area, Hamilton, ON, L8S 4K, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, Toronto, ON M5B 1T8, Canada.
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Ondocsin J, Mars SG, Howe M, Ciccarone D. Hostility, compassion and role reversal in West Virginia's long opioid overdose emergency. Harm Reduct J 2020; 17:74. [PMID: 33046092 PMCID: PMC7549084 DOI: 10.1186/s12954-020-00416-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/24/2020] [Indexed: 12/04/2022] Open
Abstract
Background West Virginia is a largely rural state with strong ties of kinship, mutual systems of support and charitable giving. At the same time, wealth inequalities are extreme and the state’s drug overdose fatality rate stands above all others in the USA at 51.5/100,000 in 2018, largely opioid-related. In recent years, harm reduction services have been active in the state but in 2018 Charleston’s needle and syringe program was forced to close. This paper considers the risk environment in which the state’s drug-related loss of life, and those attempting to prevent it, exist. Methods This rapid ethnographic study involved semi-structured interviews (n = 21), observation and video recordings of injection sequences (n = 5), initially recruiting people who inject heroin/fentanyl (PWIH) at the Charleston needle and syringe program. Snowball sampling led the research team to surrounding towns in southern West Virginia. Telephone interviews (n = 2) with individuals involved in service provision were also carried out. Results PWIH in southern West Virginia described an often unsupportive, at times hostile risk environment that may increase the risk of overdose fatalities. Negative experiences, including from some emergency responders, and fears of punitive legal consequences from calling these services may deter PWIH from seeking essential help. Compassion fatigue and burnout may play a part in this, along with resentment regarding high demands placed by the overdose crisis on impoverished state resources. We also found low levels of knowledge about safe injection practices among PWIH. Conclusions Hostility faced by PWIH may increase their risk of overdose fatalities, injection-related injury and the risk of HIV and hepatitis C transmission by deterring help-seeking and limiting the range of harm reduction services provided locally. Greater provision of overdose prevention education and naloxone for peer distribution could help PWIH to reverse overdoses while alleviating the burden on emergency services. Although essential for reducing mortality, measures that address drug use alone are not enough to safeguard longer-term public health. The new wave of psychostimulant-related deaths underline the urgency of addressing the deeper causes that feed high-risk patterns of drug use beyond drugs and drug use.
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Affiliation(s)
- Jeff Ondocsin
- Heroin in Transition Study, UCSF Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, Milberry Union East, 3rd Floor, San Francisco, CA, 94143, USA
| | - Sarah G Mars
- Heroin in Transition Study, UCSF Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, Milberry Union East, 3rd Floor, San Francisco, CA, 94143, USA
| | - Mary Howe
- Homeless Youth Alliance, PO Box 170427, San Francisco, CA, 94117, USA
| | - Daniel Ciccarone
- Heroin in Transition Study, UCSF Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, Milberry Union East, 3rd Floor, San Francisco, CA, 94143, USA.
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15
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Sevigny EL, Meylakhs P, Feizollahi MJ, Amini MR. Development of a global index measuring national policy commitments to HIV prevention and treatment among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102877. [PMID: 32717705 DOI: 10.1016/j.drugpo.2020.102877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/29/2020] [Accepted: 07/14/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND People who inject drugs (PWID) around the world are disproportionately affected by the HIV epidemic. National policy responses to the epidemic heavily influence risk factors for HIV acquisition among this key group. Prior efforts to monitor national policy responses to HIV/AIDS among PWID were limited both in scope and coverage. In this paper we develop and validate the HIV-PWID Policy Index (HPPI) to benchmark and monitor national commitments to HIV prevention and treatment among PWID. METHODS Composite indicator was constructed employing fuzzy multilayer data envelopment analysis (FMLDEA). Model inputs based on data from 105 countries included 27 variables measured across six conceptual domains, including needle and syringe programs, opioid substitution treatment, testing and counseling, information and education, monitoring and evaluation, and legal and policy climate. RESULTS According to the HPPI, which ranges from 0 to 1, the top performing countries in policy commitments to HIV prevention and treatment among PWID were Spain (0.988), Switzerland (0.982), Luxembourg (0.970), Moldova (0.970), and Kyrgyzstan (0.945), whereas the poorest performing included Nicaragua (0.094), Japan, (0.094), Cape Verde (0.097), Syria (0.174), and Benin (0.185). Regionally, commitment to HIV services targeting PWID was highest among European countries (0.81) and lowest among African countries (0.50), with Oceania (0.76), Asia (0.66), and the Americas (0.56) in the mid-range. Subregional differences were even more prominent, with West and Central European nations (0.84) and Central American nations (0.22) earning the highest and lowest HPPI scores, respectively. CONCLUSIONS The HPPI documented substantial national and regional variation in policy responses to the HIV epidemic among PWID. Our analysis also revealed that many countries have limited HIV/AIDS data collection and monitoring capabilities. Continued enhancement and standardization of global HIV/AIDS monitoring efforts are therefore vital to articulated national and international benchmarking and performance assessment goals.
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Affiliation(s)
- Eric L Sevigny
- Department of Criminal Justice and Criminology, Georgia State University, Atlanta, GA, USA.
| | - Peter Meylakhs
- Laboratory for Comparative Social Research, National Research University Higher School of Economics, St. Petersburg, Russian Federation
| | | | - Mohamad Reza Amini
- Systems Management, Management and Economic Department, Tarbiat Modares University, Tehran, Iran
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16
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Nowell M, Masuda JR. "You need to just provide health services:" navigating the politics of harm reduction in the twin housing and overdose crises in Vancouver, BC. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102774. [PMID: 32512342 DOI: 10.1016/j.drugpo.2020.102774] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Since harm reduction's origins as a grassroots, activist movement, cooperation and compromise among people who use drugs, bureaucrats, politicians, and other actors have been critical to its advancement in Canada. Critics have argued, however, that the institutionalization of harm reduction practice within the context of a politically sensitive environment has eroded its radical potential. The overdose crisis in Vancouver's Downtown Eastside (DTES) community has led to innovative harm reduction organizing that has been replicated globally. In this paper, we explore how one such intervention, the Tenant Overdose Response Organizers (TORO) program, has supported a resurgence in tenant-led harm reduction organizing in Single Room Occupancy (SRO) buildings in the DTES. METHODS We draw on 15 months of ethnographic fieldwork conducted between May 2017 and August 2018, over 100 hours of participant observation of TORO activities, and 15 semi-structured interviews with key stakeholders in the program. RESULTS TORO's leaders attempted to mobilize harm reduction intervention towards collective action on SRO risk environments underlying drug-related harms, but their efforts were constrained by the necessity of meeting practical expectations of funders regarding health education and supply distribution. Navigating these constraints ultimately shaped the development of the TORO program, helping to secure its longevity but also limiting its ability to organize a coordinated harm reduction and tenants' rights response to the dual housing and overdose crises. CONCLUSION Our examination of TORO demonstrates how the harm reduction movement continues to be shaped by conflict, cooperation, and compromise between the state and grassroots groups. Even as actors strive to work collaboratively, the unequal distribution of power inherent in this relationship may contribute to the reinscription of a depoliticized harm reduction approach. We discuss the potential role of the risk environment framework in lending political legitimacy to grassroots harm reduction initiatives.
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Affiliation(s)
- Magnus Nowell
- Centre for Environmental Health Equity (CEHE), School of Kinesiology and Health Studies, Queen's University, 28 Division St, Kingston, ON, K7L 3N6, Canada.
| | - Jeffrey R Masuda
- Centre for Environmental Health Equity (CEHE), School of Kinesiology and Health Studies, Queen's University, 28 Division St, Kingston, ON, K7L 3N6, Canada
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- Downtown Eastside SRO Collaborative Society (SRO-C), 203-268 Keefer St, Vancouver, BC, V6A 1×5, Canada
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17
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Caulkins JP, Pardo B, Kilmer B. Supervised consumption sites: a nuanced assessment of the causal evidence. Addiction 2019; 114:2109-2115. [PMID: 31309637 DOI: 10.1111/add.14747] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/24/2019] [Accepted: 07/05/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Supervised consumption sites (SCS) operate in more than 10 countries. SCS have mostly emerged as a bottom-up response to crises, first to HIV/AIDS and now overdose deaths, in ways that make rigorous evaluation difficult. Opinions vary about how much favorable evidence must accumulate before implementation. Our aim was to assess the nature and quality of evidence on the consequences of implementing SCS. METHODS We reviewed the higher-quality SCS literature, focusing on articles evaluating natural experiments and mathematical modeling studies that estimate costs and benefits. We discuss the evidence through the lens of three types of decision-makers and from three intellectual perspectives. RESULTS Millions of drug use episodes have been supervised at SCS with no reported overdose deaths; however, uncertainties remain concerning the magnitude of the population-level effects. The published literature on SCS is large and almost unanimous in its support, but limited in nature and the number of sites evaluated. It can also overlook four key distinctions: (1) between outcomes that occur within the facility and possible spillover effects on behavior outside the SCS; (2) between effects of supervising consumption and the effects of other services offered, such as syringe or naloxone distribution; (3) between association and causation; and (4) between effectiveness and the cost-effectiveness of SCS compared to other interventions. CONCLUSIONS The causal evidence for favorable outcomes of supervised consumption sites is minimal, but there appears to be little basis for concern about adverse effects. This raises the question of how context and priors can affect how high the bar is set when deciding whether to endorse supervised consumption sites. The literature also understates distinctions and nuances that need to be appreciated to gain a rich understanding of how a range of stakeholders should interpret and apply that evidence to a variety of decisions.
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Affiliation(s)
- Jonathan P Caulkins
- RAND Drug Policy Research Center, RAND, Santa Monica, CA, USA.,Heinz College, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Bryce Pardo
- RAND Drug Policy Research Center, RAND, Santa Monica, CA, USA
| | - Beau Kilmer
- RAND Drug Policy Research Center, RAND, Santa Monica, CA, USA
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Roth AM, Kral AH, Mitchell A, Mukherjee R, Davidson P, Lankenau SE. Overdose Prevention Site Acceptability among Residents and Businesses Surrounding a Proposed Site in Philadelphia, USA. J Urban Health 2019; 96:341-352. [PMID: 31168733 PMCID: PMC6565835 DOI: 10.1007/s11524-019-00364-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Overdose prevention sites (OPS) are places where people use previously obtained drugs under the supervision of a health professional. They have been proposed in six United States (US) cities, including Philadelphia, to help reduce opioid-related overdose deaths and public injection. Philadelphia has the highest overdose rate among large cities in the US, which has led a local community-based organization to plan the implementation of OPS. Kensington, a neighborhood with the highest drug mortality overdose rates in the city, is a likely site for the proposed OPS. Given the dearth of research systematically assessing public opinion towards OPS prior to implementation, we enrolled 360 residents and 79 business owners/staff in the Kensington neighborhood in a cross-sectional acceptability study. Face-to-face surveys assessed participant characteristics, experiences with drug-related social problems, and OPS acceptability. Using descriptive statistics, we estimated factors associated with favorability towards opening an OPS in the Kensington neighborhood. Ninety percent of residents were in favor of an OPS opening in Kensington. Support was significantly higher among unstably housed individuals and persons who currently use opioids. In the business sample, 63% of owners/staff were in favor of opening an OPS in Kensington. A greater proportion of Asian/Pacific Islanders, Hispanic/Latinx respondents, and non-Hispanic/Latinx Black respondents were in favor of an OPS opening in Kensington compared with white respondents (p < 0.04). While details about implementation are still being considered, results indicate general acceptability among Kensington residents and businesses for an OPS, especially if it can deliver benefits that curb drug-related social problems. Should an OPS be implemented in Philadelphia, it would be important to monitor changes in drug-related social problems and acceptability post implementation.
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Affiliation(s)
- Alexis M Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA.
| | - Alex H Kral
- Behavioral Health Research Division, RTI International, San Francisco, CA, USA
| | - Allison Mitchell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA
| | - Rohit Mukherjee
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA
| | - Peter Davidson
- Department of Medicine, University of California, San Diego, CA, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA
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Belackova V, Salmon AM, Day CA, Ritter A, Shanahan M, Hedrich D, Kerr T, Jauncey M. Drug consumption rooms: A systematic review of evaluation methodologies. Drug Alcohol Rev 2019; 38:406-422. [PMID: 30938025 DOI: 10.1111/dar.12919] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 01/27/2023]
Abstract
ISSUES Drug consumptions rooms (DCR) and supervised injecting facilities (SIF) are expanding internationally. Previous reviews have not systematically addressed evaluation methodologies. APPROACH Results from systematic searches of scientific databases in English until June 2017 were coded for paper type, country and year of publication. For evaluation papers, study outcome, methodology/study design and main indicators of DCR/SIF 'exposure' were recorded. KEY FINDINGS Two hundred and nineteen eligible peer-reviewed papers were published since 1999: the majority from Canada (n = 117 papers), Europe (n = 36) and Australia (n = 32). Fifty-six papers reported evaluation outcomes. Ecological study designs (n = 10) were used to assess the impact on overdose, public nuisance and crime; modelling techniques (n = 6) estimated impact on blood-borne diseases, overdose deaths and costs. Papers using individual-level data included four prospective cohorts (n = 28), cross-sectional surveys (n = 7) and service records (n = 5). Individual-level data were used to assess safer injecting practice, uptake into health and social services and all the other above outcomes except for impact on crime and costs. Four different indicators of DCR/SIF attendance were used to measure service 'exposure'. IMPLICATIONS Research around DCRs/SIFs has used ecological, modelling, cross-sectional and cohort study designs. Further research could involve systematic inclusion of a control group of people who are eligible but do not access SIFs, validation of self-reported proportion of injections at SIFs or a stepped-wedge or a cluster trial comparing localities. CONCLUSIONS Methodologies appropriate for DCR/SIF evaluation have been established and can be readily replicated from the existing literature. Research on operational aspects, implementation and transferability is also warranted.
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Affiliation(s)
| | - Allison M Salmon
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Carolyn A Day
- Central Clinical School, Addiction Medicine, University of Sydney, Royal Prince Albert Hospital, Sydney, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, UNSW Sydney, Sydney, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Hood JE, Behrends CN, Irwin A, Schackman BR, Chan D, Hartfield K, Hess J, Banta-Green C, Whiteside L, Finegood B, Duchin J. The projected costs and benefits of a supervised injection facility in Seattle, WA, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 67:9-18. [PMID: 30802842 DOI: 10.1016/j.drugpo.2018.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 12/06/2018] [Accepted: 12/30/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND As one strategy to improve the health and survival of people who inject drugs, the King County Heroin & Opioid Addiction Task Force recommended the establishment of supervised injection facilities (SIF) where people can inject drugs in a safe and hygienic environment with clinical supervision. Analyses for other sites have found them to be cost-effective, but it is not clear whether these findings are transferable to other settings. METHODS We utilized local estimates and other data sources deemed appropriate for our setting to implement a mathematical model that assesses the impact of a hypothetical SIF on overdose deaths, non-fatal overdose health service utilization, skin and soft tissue infections, bacterial infections, viral infections, and enrollment in medication assisted treatment (MAT). We estimated the costs and savings that would occur on an annual basis for a small-scale pilot site given current overdose rates, as well as three other scenarios of varying scale and underlying overdose rates. RESULTS Assuming current overdose rates, a hypothetical Seattle SIF in a pilot phase is projected to annually reverse 167 overdoses and prevent 6 overdose deaths, 45 hospitalizations, 90 emergency department visits, and 92 emergency medical service deployments. Additionally, the site would facilitate the enrollment of 41 SIF clients in medication assisted treatment programs. These health benefits correspond to a monetary value of $5,156,019. The annual estimated cost of running the SIF is $1,222,332. The corresponding cost-benefit ratio suggests that the pilot SIF would generate $4.22 for every dollar spent on SIF operational costs. The pilot SIF is projected to save the healthcare system $534,453. If Seattle experienced elevated overdose rates and Seattle SIF program were scaled up, the health benefits and financial value would be considerably greater. CONCLUSION This analysis suggests that a SIF program in Seattle would save lives and result in considerable health benefits and cost savings.
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Affiliation(s)
- J E Hood
- Public Health - Seattle & King County, 401 Fifth Avenue, Suite 1250, Seattle, WA, United States.
| | - C N Behrends
- Weill Cornell Medical College, 1300 York Ave. Box 65, New York, NY, 10065, United States
| | - A Irwin
- Law Enforcement Action Partnership, Silver Spring, MD, United States
| | - B R Schackman
- Weill Cornell Medical College, 1300 York Ave. Box 65, New York, NY, 10065, United States
| | - D Chan
- King County Department of Community and Health Services, 401 Fifth Avenue, Suite 500, Seattle, WA, United States; University of Washington, School of Public Health, 1959 NE Pacific St, Seattle, WA, 98195, United States
| | - K Hartfield
- Public Health - Seattle & King County, 401 Fifth Avenue, Suite 1250, Seattle, WA, United States
| | - J Hess
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, United States
| | - C Banta-Green
- University of Washington, School of Public Health, 1959 NE Pacific St, Seattle, WA, 98195, United States
| | - L Whiteside
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, United States
| | - B Finegood
- King County Department of Community and Health Services, 401 Fifth Avenue, Suite 500, Seattle, WA, United States
| | - J Duchin
- Public Health - Seattle & King County, 401 Fifth Avenue, Suite 1250, Seattle, WA, United States; University of Washington, School of Public Health, 1959 NE Pacific St, Seattle, WA, 98195, United States; University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, United States
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21
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Cleirec G, Fortias M, Bloch V, Clergue-Duval V, Bellivier F, Dusouchet T, Debaulieu C, Vorspan F. Opinion of health professionals and drug users before the forthcoming opening of the first drug consumption room in Paris: a quantitative cross-sectional study. Harm Reduct J 2018; 15:53. [PMID: 30359272 PMCID: PMC6202864 DOI: 10.1186/s12954-018-0260-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/17/2018] [Indexed: 12/16/2022] Open
Abstract
Background On the brink of the opening of the first French drug consumption room in Paris, the general opinion of the local involved health care professionals and drug users was not known. The objective of this study was to determine their expectations and to search for influencing factors. Method We carried out a quantitative cross-sectional study. A multiple choice questionnaire was proposed to the surrounding willing general practitioners (GPs) and pharmacists, to the emergency doctors of Lariboisière hospital, and to the professionals of the harm reduction facilities and their drug users (PWUD). For each question, there was a choice between seven answers, from “− 3” (very negative impact) to “+ 3” (very positive impact). The influence of the characteristics of each group on its mean answers was explored by Mann-Whitney, Kruskal-Wallis, and Spearman’s tests. Results The median expectations among the groups of responding GPs (N = 62), other health care professionals (N = 82), and PWUD (N = 57) were mainly positive. They thought that the drug consumption room (DCR) would improve the health of PWUD, reduce their at-risk behaviors, would not increase drug use or drug dealing in the neighborhood, and would reduce nuisance in the public space. Only the group of GPs expressed that the DCR could decrease the quietness of the neighborhood, and only the group of PWUD had higher expectations that the DCR would decrease the number of arrests and the number of violent behavior. GPs’ expectations were significantly better in terms of health improvement of PWUD and reducing their precariousness if they had a previous experience in addiction medicine (Mann-Whitney, p = 0.004 and p = 0.019), with a longer practice (Spearman’s rho, p = 0.021 and p = 0.009), and if they were currently prescribing opioid substitution treatments (Mann-Whitney, p = 0.030 and p = 0.002). Among non-GPs, those who were working in addiction medicine centers had significantly better expectations than pharmacists, and the professionals of the local emergency department had intermediate expectations. Conclusions Health care professionals and drug users had a positive opinion of the to-be-created Parisian drug consumption room. Experience in addiction medicine influenced positively health professionals’ expectations.
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Affiliation(s)
- Grégoire Cleirec
- Service de médecine addictologique, Hôpital René Muret, APHP, Sevran, France
| | - Maeva Fortias
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France
| | - Vanessa Bloch
- Inserm Umrs1144 Variabilité de Réponse aux Psychotropes, Paris, France
| | - Virgile Clergue-Duval
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France.,Faculté de Médecine, Université Paris Diderot, Paris, France.,Inserm Umrs1144 Variabilité de Réponse aux Psychotropes, Paris, France
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France.,Faculté de Médecine, Université Paris Diderot, Paris, France.,Inserm Umrs1144 Variabilité de Réponse aux Psychotropes, Paris, France
| | | | | | - Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France. .,Faculté de Médecine, Université Paris Diderot, Paris, France. .,Inserm Umrs1144 Variabilité de Réponse aux Psychotropes, Paris, France.
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Fairgrieve C, Fairbairn N, Samet JH, Nolan S. Nontraditional Alcohol and Opioid Agonist Treatment Interventions. Med Clin North Am 2018; 102:683-696. [PMID: 29933823 PMCID: PMC6650149 DOI: 10.1016/j.mcna.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Despite the availability of effective medications and psychosocial interventions for the management of a substance use disorder, some individuals repeatedly fail the most aggressive treatment regimens. For such individuals, alternative treatment options exist seeking to mitigate the negative consequences of the use of harmful substances. Participation in a managed alcohol program, or the use of sustained-release oral morphine or injectable opioid agonist treatment or the creation of safe injecting facilities, are examples of such nonstandard approaches. This article reviews the available evidence of these treatment modalities.
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Affiliation(s)
- Christopher Fairgrieve
- Department of Family Medicine, University of British Columbia, St. Paul's Hospital, Room 553, 5th Floor Burrard Building, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; British Columbia Centre on Substance Use, Providence Health Care, St. Paul's Hospital, Room 553, 5th Floor Burrard Building, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Providence Health Care, St. Paul's Hospital, Room 553, 5th Floor Burrard Building, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Room 553, 5th Floor Burrard Building, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Jeffrey H Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA; Department of Community Health Sciences, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, Providence Health Care, St. Paul's Hospital, Room 553, 5th Floor Burrard Building, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Room 553, 5th Floor Burrard Building, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
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23
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Duncan T, Duff C, Sebar B, Lee J. 'Enjoying the kick': Locating pleasure within the drug consumption room. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 49:92-101. [PMID: 28893455 DOI: 10.1016/j.drugpo.2017.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/06/2017] [Accepted: 07/10/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Harm reduction policy and praxis has long struggled to accommodate the pleasures of alcohol and other drug use. Whilst scholars have consistently highlighted this struggle, how pleasure might come to practically inform the design and delivery of harm reduction policies and programs remains less clear. The present paper seeks to move beyond conceptual critiques of harm reduction's 'pleasure oversight' to more focused empirical analysis of how flows of pleasure emerge, circulate and, importantly, may be reoriented in the course of harm reduction practice. METHODS We ground our analysis in the context of detailed ethnographic research in a drug consumption room in Frankfurt, Germany. Drawing on recent strands of post-humanist thought, the paper deploys the concept of the 'consumption event' to uncover the manner in which these facilities mediate the practice and embodied experience of drug use and incite or limit bodily potentials for intoxication and pleasure. RESULTS Through the analysis, we mapped a diversity of pleasures as they emerged and circulated through events of consumption at the consumption room. Beyond the pleasurable intensities of intoxication's kick, these pleasures were expressed in a range of novel capacities, practices and drug using bodies. In each instance, pleasure could not be reduced to a simple, linear product of drug use. Rather, it arose for our participants through distinctive social and affective transformations enabled through events of consumption at the consumption room and the generative force of actors and associations of which these events were composed. CONCLUSION Our research suggests that the drug consumption room serves as a conduit through which its clients can potentially enact more pleasurable, productive and positive relations to both themselves and their drug use. Acknowledging the centrality of pleasure to client engagement with these facilities, the paper concludes by drawing out the implications of these findings for the design and delivery of consumption room services.
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Affiliation(s)
- Tristan Duncan
- School of Medicine, Griffith University, 58 Parklands Dr, Southport, QLD 4215, Australia.
| | - Cameron Duff
- Centre for People, Organisation and Work, Royal Melbourne Institute of Technology, 445 Swanston St, Melbourne, VIC 3000, Australia
| | - Bernadette Sebar
- School of Medicine, Griffith University, 58 Parklands Dr, Southport, QLD 4215, Australia
| | - Jessica Lee
- School of Medicine, Griffith University, 58 Parklands Dr, Southport, QLD 4215, Australia
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24
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Myer AJ, Belisle L. Highs and Lows: An Interrupted Time-Series Evaluation of the Impact of North America’s Only Supervised Injection Facility on Crime. JOURNAL OF DRUG ISSUES 2017. [DOI: 10.1177/0022042617727513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
North America is currently experiencing an opioid crisis. One proposed solution to combat problems associated with injection drug use is the use of supervised injection facilities. These facilities provide drug users a space to inject pre-obtained drugs without any legal repercussions. Research on these facilities has focused on public health outcomes, and generally found positive results. Far fewer studies have investigated the impact supervised injection facilities have on crime. The current study provides an interrupted time-series analysis on the impact of North America’s only supervised injection facility on crime. Analyses of city wide crime data evidence no impact of the supervised injection facility on crime. Disaggregated analyses indicate a significant decrease in crimes in the district where the supervised injection facility is located. Implications of the findings are discussed.
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25
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Public Health and Public Order Outcomes Associated with Supervised Drug Consumption Facilities: a Systematic Review. Curr HIV/AIDS Rep 2017; 14:161-183. [DOI: 10.1007/s11904-017-0363-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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26
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Katz N, Leonard L, Wiesenfeld L, Perry JJ, Thiruganasambandamoorthy V, Calder L. Support of supervised injection facilities by emergency physicians in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 49:26-31. [PMID: 28886562 DOI: 10.1016/j.drugpo.2017.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/10/2017] [Accepted: 07/10/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite evidence supporting the implementation of supervised injection facilities (SIFs) by multiple stakeholders, no evaluation of emergency physicians' attitudes has ever been documented towards such facilities in Canada or internationally. The primary goal of our study was to determine the opinions and perceptions of emergency physicians regarding the implementation of SIFs in Canada. METHODS We conducted a national electronic survey of staff and resident emergency physicians in Canada using an iteratively designed survey tool in consultation with content experts. Invitations to complete the survey were sent via email by the Canadian Association of Emergency Physicians. Inclusion criteria required respondents to have treated an adult patient in a Canadian emergency department within the preceding 6 months. The primary measure was the proportion of respondents who would support, not support or were unsure of supporting SIFs in their community with the secondary measure being the likelihood of respondents to refer patients to a SIF if available. RESULTS We received 280 responses out of 1353 eligible physicians (20.7%), with the analysis conducted on 250 responses that met inclusion criteria (18.5%). The majority of respondents stated they would support the implementation of SIFs in their community (N=172; 74.5%) while 10.8% (N=25) would not and 14.7% (N=34) did not know. The majority of respondents said they would refer their patients to SIFs (N=198; 84.6%), with 4.3% (N=10) who would not and 11.1% (N=26) who were unsure. CONCLUSION The findings from our study demonstrate that the majority of emergency physician respondents in Canada support the implementation of such sites (74.5%) while 84.6% of respondents would refer patients from the emergency department to such sites if they did exist. Given that many Canadian cities are actively pursuing the creation of SIFs or imminently opening such sites, it appears that our sample population of emergency physicians would both support this approach and would utilize such facilities in an effort to improve patient-centered outcomes for this often marginalized population.
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Affiliation(s)
- Noam Katz
- University of Ottawa, Department of Emergency Medicine, Canada.
| | - Lynne Leonard
- University of Ottawa, Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, Canada
| | | | - Jeffrey J Perry
- University of Ottawa, Department of Emergency Medicine, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada; University of Ottawa, Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, Canada
| | - Venkatesh Thiruganasambandamoorthy
- University of Ottawa, Department of Emergency Medicine, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada; University of Ottawa, Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, Canada
| | - Lisa Calder
- University of Ottawa, Department of Emergency Medicine, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada; University of Ottawa, Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, Canada
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27
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Irwin A, Jozaghi E, Weir BW, Allen ST, Lindsay A, Sherman SG. Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facility. Harm Reduct J 2017; 14:29. [PMID: 28532488 PMCID: PMC5441005 DOI: 10.1186/s12954-017-0153-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/05/2017] [Indexed: 12/14/2022] Open
Abstract
Background In Baltimore, MD, as in many cities throughout the USA, overdose rates are on the rise due to both the increase of prescription opioid abuse and that of fentanyl and other synthetic opioids in the drug market. Supervised injection facilities (SIFs) are a widely implemented public health intervention throughout the world, with 97 existing in 11 countries worldwide. Research has documented the public health, social, and economic benefits of SIFs, yet none exist in the USA. The purpose of this study is to model the health and financial costs and benefits of a hypothetical SIF in Baltimore. Methods We estimate the benefits by utilizing local health data and data on the impact of existing SIFs in models for six outcomes: prevented human immunodeficiency virus transmission, Hepatitis C virus transmission, skin and soft-tissue infection, overdose mortality, and overdose-related medical care and increased medication-assisted treatment for opioid dependence. Results We predict that for an annual cost of $1.8 million, a single SIF would generate $7.8 million in savings, preventing 3.7 HIV infections, 21 Hepatitis C infections, 374 days in the hospital for skin and soft-tissue infection, 5.9 overdose deaths, 108 overdose-related ambulance calls, 78 emergency room visits, and 27 hospitalizations, while bringing 121 additional people into treatment. Conclusions We conclude that a SIF would be both extremely cost-effective and a significant public health and economic benefit to Baltimore City.
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Affiliation(s)
- Amos Irwin
- Law Enforcement Action Partnership, Silver Spring, MD, USA. .,Criminal Justice Policy Foundation, Silver Spring, MD, USA.
| | - Ehsan Jozaghi
- British Columbia Centre for Disease Control, University of British Columbia, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Baltimore, MD, USA
| | - Brian W Weir
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sean T Allen
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew Lindsay
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan G Sherman
- Criminal Justice Policy Foundation, Amherst College, Silver Spring, MD, USA
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28
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Irwin A, Jozaghi E, Bluthenthal RN, Kral AH. A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/0022042616679829] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supervised injection facilities (SIFs) have been shown to reduce infection, prevent overdose deaths, and increase treatment uptake. The United States is in the midst of an opioid epidemic, yet no sanctioned SIF currently operates in the United States. We estimate the economic costs and benefits of establishing a potential SIF in San Francisco using mathematical models that combine local public health data with previous research on the effects of existing SIFs. We consider potential savings from five outcomes: averted HIV and hepatitis C virus (HCV) infections, reduced skin and soft tissue infection (SSTI), averted overdose deaths, and increased medication-assisted treatment (MAT) uptake. We find that each dollar spent on a SIF would generate US$2.33 in savings, for total annual net savings of US$3.5 million for a single 13-booth SIF. Our analysis suggests that a SIF in San Francisco would not only be a cost-effective intervention but also a significant boost to the public health system.
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Affiliation(s)
- Amos Irwin
- Criminal Justice Policy Foundation, Silver Spring, MD, USA
- Law Enforcement Against Prohibition, Medford, MA, USA
| | - Ehsan Jozaghi
- BC Centre for Disease Control, University of British Columbia, Vancouver, Canada
| | | | - Alex H. Kral
- Research Triangle Institute, San Francisco, CA, USA
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29
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Csete J, Kamarulzaman A, Kazatchkine M, Altice F, Balicki M, Buxton J, Cepeda J, Comfort M, Goosby E, Goulão J, Hart C, Kerr T, Lajous AM, Lewis S, Martin N, Mejía D, Camacho A, Mathieson D, Obot I, Ogunrombi A, Sherman S, Stone J, Vallath N, Vickerman P, Zábranský T, Beyrer C. Public health and international drug policy. Lancet 2016; 387:1427-1480. [PMID: 27021149 PMCID: PMC5042332 DOI: 10.1016/s0140-6736(16)00619-x] [Citation(s) in RCA: 307] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms.
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Affiliation(s)
| | | | - Michel Kazatchkine
- UN Special Envoy, HIV in Eastern Europe and Central Asia, Geneva, Switzerland
| | | | | | | | - Javier Cepeda
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Eric Goosby
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Carl Hart
- Columbia University, New York City, NY, USA
| | - Thomas Kerr
- University of British Columbia, Center of Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | - Susan Sherman
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Nandini Vallath
- Trivandrum Institute of Palliative Sciences, Trivandrum, India
| | | | | | - Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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30
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Jongbloed K, Friedman AJ, Pearce ME, Van Der Kop ML, Thomas V, Demerais L, Pooyak S, Schechter MT, Lester RT, Spittal PM. The Cedar Project WelTel mHealth intervention for HIV prevention in young Indigenous people who use illicit drugs: study protocol for a randomized controlled trial. Trials 2016; 17:128. [PMID: 26957103 PMCID: PMC4784291 DOI: 10.1186/s13063-016-1250-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/23/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Despite successes in preventing and treating HIV, Indigenous people in Canada continue to face disproportionately high rates of HIV infection. Programs that support healing from lifetime trauma, support connection to culture, and reduce drug-related harms are critical to preventing HIV among young Indigenous people who use drugs. The Cedar Project WelTel mHealth intervention proposed here is a structured mobile-phone initiative to connect young Indigenous people who use drugs with Cedar Case Managers in a community-based setting. The intervention consists of a package of supports, including a mobile phone and cellular plan, weekly two-way text messaging, and support from Cedar Case Managers. METHODS The Cedar Project WelTel mHealth study is a multi-site Zelen pre-randomized trial to measure the effect of a two-way supportive text-message intervention to reduce HIV vulnerability among young Indigenous people who use illicit drugs in two Canadian cities. The trial is nested within the Cedar Project, an ongoing cohort study addressing HIV and hepatitis C vulnerability among young Indigenous people who use drugs in Vancouver and Prince George, British Columbia. The Cedar Project Partnership, an independent body of Indigenous Elders, leaders, and health/social service experts, governs all aspects of the study. Two hundred participants will be followed over a 16-month period, with HIV propensity score at 6 months as the primary outcome. Secondary outcomes include HIV propensity at 1 year, HIV risk, resilience, psychological distress, access to drug-related services, and connection to culture measured at 6 months and 1 year. Primary analysis is by intention to treat. DISCUSSION Culturally safe interventions that address barriers to HIV prevention while supporting the strength of young Indigenous people who use drugs are urgently needed. Despite presenting a tremendous opportunity to connect young, highly transient Indigenous people who use drugs to prevention services, supportive two-way mHealth programs have yet to be tested for HIV prevention in a community-based setting with this population. TRIAL REGISTRATION ClinicalTrials.gov NCT02437123 https://clinicaltrials.gov/show/NCT02437123 (registered 4 May 2015). Protocol version: 24 July 2015.
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Affiliation(s)
- Kate Jongbloed
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Anton J Friedman
- The Cedar Project, Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Margo E Pearce
- The Cedar Project, Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Mia L Van Der Kop
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18a, Campus Solna, Stockholm, 171 77, Sweden. .,Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, 566-828 West 10th Avenue, Vancouver, BC, V5Z 1L8, Canada.
| | - Vicky Thomas
- The Cedar Project, Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Lou Demerais
- Vancouver Native Health Society, 455 Hastings Street E, Vancouver, BC, V6A 1P5, Canada.
| | - Sherri Pooyak
- Canadian Aboriginal AIDS Network, 6520 Salish Drive, Vancouver, BC, V6N 2C7, Canada.
| | - Martin T Schechter
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Richard T Lester
- Neglected Global Diseases Initiative, Faculty of Medicine, University of British Columbia, 564-828 West 10th Avenue, Vancouver, BC, V5Z 1L8, Canada.
| | - Patricia M Spittal
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
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Enns EA, Zaric GS, Strike CJ, Jairam JA, Kolla G, Bayoumi AM. Potential cost-effectiveness of supervised injection facilities in Toronto and Ottawa, Canada. Addiction 2016; 111:475-89. [PMID: 26616368 DOI: 10.1111/add.13195] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 06/15/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Supervised injection facilities (legally sanctioned spaces for supervised consumption of illicitly obtained drugs) are controversial public health interventions. We determined the optimal number of facilities in two Canadian cities using health economic methods. DESIGN Dynamic compartmental model of HIV and hepatitis C transmission through sexual contact and sharing of drug use equipment. SETTING Toronto and Ottawa, Canada. PARTICIPANTS Simulated population of each city. INTERVENTIONS Zero to five supervised injection facilities. MEASUREMENTS Direct health-care costs and quality-adjusted life-years (QALYs) over 20 years, discounted at 5% per year; incremental cost-effectiveness ratios. FINDINGS In Toronto, one facility cost $4.1 million and resulted in a gain of 385 QALYs over 20 years, for an incremental cost-effectiveness ratio (ICER) of $10,763 per QALY [95% credible interval (95CrI): cost-saving to $278,311]. Establishing one facility in Ottawa had an ICER of $6127 per QALY (95CrI: cost-saving to $179,272). At a $50,000 per QALY threshold, three facilities would be cost-effective in Toronto and two in Ottawa. The probability that establishing three, four, or five facilities in Toronto was cost-effective was 17, 21, and 41%, respectively. Establishing one, two, or three facilities in Ottawa was cost-effective with 13, 35, and 41% probability, respectively. Establishing no facility was unlikely to be the most cost-effective option (14% in Toronto and 10% in Ottawa). In both cities, results were robust if the reduction in needle-sharing among clients of the facilities was at least 50% and fixed operating costs were less than $2.0 million. CONCLUSIONS Using a $50,000 per quality-adjusted life-years threshold for cost-effectiveness, it is likely to be cost-effective to establish at least three legally sanctioned spaces for supervised injection of illicitly obtained drugs in Toronto, Canada and two in Ottawa, Canada.
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Affiliation(s)
- Eva A Enns
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Gregory S Zaric
- Ivey Business School, Western University, London, ON, Canada
| | - Carol J Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Center for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Jennifer A Jairam
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Gillian Kolla
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ahmed M Bayoumi
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of General Internal Medicine, St Michael's Hospital, Toronto, ON, Canada
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Fairbairn N, Evanwood. Commentary on Enns et al. (2016): Supervised injection facilities as a cost-effective intervention. Addiction 2016; 111:490-1. [PMID: 26860246 PMCID: PMC5279864 DOI: 10.1111/add.13242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 01/08/2023]
Abstract
The authors build upon evidence for expanded access to supervised injection facilities (SIFs) based on a growing body of cost-effectiveness literature that evaluates estimable costs and costs avoided from infectious diseases. Future directions for economic evaluations of SIFs should seek to examine broader SIF benefits and costs that encompass increased access to addiction treatment and other key health and social outcomes.
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Affiliation(s)
- Nadia Fairbairn
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada.
| | - Evanwood
- Urban Health Research Initiative, British Columbia Centre for Excellence in
HIV/AIDS, St Paul’s Hospital, Vancouver, British Columbia, Canada,Department of Medicine, University of British Columbia, Vancouver, British
Columbia, Canada
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Jozaghi E. Exploring the role of an unsanctioned, supervised peer driven injection facility in reducing HIV and hepatitis C infections in people that require assistance during injection. HEALTH & JUSTICE 2015; 3:16. [PMCID: PMC5151785 DOI: 10.1186/s40352-015-0028-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/17/2015] [Indexed: 07/28/2023]
Abstract
Background Supervised consumption rooms or supervised injection facilities (SIFs) are venues that have reduced the risk of needle sharing and deaths caused by drug overdose among people who inject drugs (PWID). As a result of such a decline in the mortality rate, numerous studies have been able to illustrate its cost-effectiveness. However, studies have neglected to examine the same phenomena for unsanctioned SIFs that are run by peer drug users and provide assisted injections. Methods The current study will determine whether the former unsanctioned SIF, that provided assisted injection and was operated by the grass root organization called Vancouver Area Network of Drug Users (VANDU), cost less than the health care consequences of not having such a program in Vancouver, Canada. By analyzing data gathered in 2013, this paper relies on two mathematical models to estimate the number of new HIV and HCV infections prevented by the former unsanctioned facility in Vancouver’s Downtown Eastside. Results A conservative estimate indicates that the SIF location that provided assisted injections has a benefit-cost ratio of 33.1:1 due to its low operational cost. At the baseline sharing rate, the facility, on an average, reduced 81 HCV and 30 HIV cases among PWID each year. Such reductions in blood borne infections among PWID resulted in annual savings worth CAN$4.3 million dollars in health care expenditure. In addition to this, the current paper relies on a sensitivity analysis based on different needle sharing rate scenarios. Conclusions The sensitivity analysis and the baseline rates indicate that funding SIF facilities operated by peer drug users that facilitate assisted injection appear to be an efficient and effective use of financial resources in the public health domain since they lead to a significant decline in the rate of mortality within a vulnerable population.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, Burnaby, British Columbia Canada
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Jozaghi E, Jackson A. Examining the potential role of a supervised injection facility in Saskatoon, Saskatchewan, to avert HIV among people who inject drugs. Int J Health Policy Manag 2015; 4:373-9. [PMID: 26029896 DOI: 10.15171/ijhpm.2015.73] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/25/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Research predicting the public health and fiscal impact of Supervised Injection Facilities (SIFs), across different cities in Canada, has reported positive results on the reduction of HIV cases among People Who Inject Drugs (PWID). Most of the existing studies have focused on the outcomes of Insite, located in the Vancouver Downtown Eastside (DTES). Previous attention has not been afforded to other affected areas of Canada. The current study seeks to address this deficiency by assessing the cost-effectiveness of opening a SIF in Saskatoon, Saskatchewan. METHODS We used two different mathematical models commonly used in the literature, including sensitivity analyses, to estimate the number of HIV infections averted due to the establishment of a SIF in the city of Saskatoon, Saskatchewan. RESULTS Based on cumulative cost-effectiveness results, SIF establishment is cost-effective. The benefit to cost ratio was conservatively estimated to be 1.35 for the first two potential facilities. The study relied on 34% and 14% needle sharing rates for sensitivity analyses. The result for both sensitivity analyses and the base line estimates indicated positive prospects for the establishment of a SIF in Saskatoon. CONCLUSION The opening of a SIF in Saskatoon, Saskatchewan is financially prudent in the reduction of tax payers' expenses and averting HIV infection rates among PWID.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, Burnaby, BC, Canada
| | - Asheka Jackson
- School of Criminology, Simon Fraser University, Burnaby, BC, Canada
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Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend 2014; 145:48-68. [PMID: 25456324 DOI: 10.1016/j.drugalcdep.2014.10.012] [Citation(s) in RCA: 319] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Supervised injection services (SISs) have been developed to promote safer drug injection practices, enhance health-related behaviors among people who inject drugs (PWID), and connect PWID with external health and social services. Nevertheless, SISs have also been accused of fostering drug use and drug trafficking. AIMS To systematically collect and synthesize the currently available evidence regarding SIS-induced benefits and harm. METHODS A systematic review was performed via the PubMed, Web of Science, and ScienceDirect databases using the keyword algorithm [("supervised" or "safer") and ("injection" or "injecting" or "shooting" or "consumption") and ("facility" or "facilities" or "room" or "gallery" or "centre" or "site")]. RESULTS Seventy-five relevant articles were found. All studies converged to find that SISs were efficacious in attracting the most marginalized PWID, promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency. SISs were not found to increase drug injecting, drug trafficking or crime in the surrounding environments. SISs were found to be associated with reduced levels of public drug injections and dropped syringes. Of the articles, 85% originated from Vancouver or Sydney. CONCLUSION SISs have largely fulfilled their initial objectives without enhancing drug use or drug trafficking. Almost all of the studies found in this review were performed in Canada or Australia, whereas the majority of SISs are located in Europe. The implementation of new SISs in places with high rates of injection drug use and associated harms appears to be supported by evidence.
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Affiliation(s)
- Chloé Potier
- Department of Addiction Medicine, CHRU de Lille, Univ Lille Nord de France, F-59037 Lille, France; University of Lille 2, Faculty of Medicine, F-59045 Lille, France.
| | - Vincent Laprévote
- CHU Nancy, Maison des Addictions, Nancy F-54000, France; CHU Nancy, Centre d'Investigation Clinique CIC-INSERM 9501, Nancy F-54000, France
| | - Françoise Dubois-Arber
- Institute of Social and Preventive Medicine, University Hospital Center and University of Lausanne, Chemin de la Corniche 10, 1010 Lausanne, Switzerland
| | - Olivier Cottencin
- Department of Addiction Medicine, CHRU de Lille, Univ Lille Nord de France, F-59037 Lille, France; University of Lille 2, Faculty of Medicine, F-59045 Lille, France
| | - Benjamin Rolland
- Department of Addiction Medicine, CHRU de Lille, Univ Lille Nord de France, F-59037 Lille, France; University of Lille 2, Faculty of Medicine, F-59045 Lille, France
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Jozaghi E. A cost-benefit/cost-effectiveness analysis of an unsanctioned supervised smoking facility in the Downtown Eastside of Vancouver, Canada. Harm Reduct J 2014; 11:30. [PMID: 25395278 PMCID: PMC4251950 DOI: 10.1186/1477-7517-11-30] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/03/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Smoking crack involves the risk of transmitting diseases such as HIV and hepatitis C (HCV). The current study determines whether the formerly unsanctioned supervised smoking facility (SSF)-operated by the grassroot organization, Vancouver Area Network of Drug Users (VANDU) for the last few years-costs less than the costs incurred for health-care services as a direct consequence of not having such a program in Vancouver, Canada. METHODS The data pertaining to the attendance at the SSF was gathered in 2012-2013 by VANDU. By relying on this data, a mathematical model was employed to estimate the number of HCV infections prevented by the former facility in Vancouver's Downtown Eastside (DTES). RESULTS The DTES SSF's benefit-cost ratio was conservatively estimated at 12.1:1 due to its low operating cost. The study used 70% and 90% initial pipe-sharing rates for sensitivity analysis. At 80% sharing rate, the marginal HCV cases prevented were determined to be 55 cases. Moreover, at 80% sharing rate, the marginal cost-effectiveness ratio ranges from $1,705 to $97,203. The results from both the baseline and sensitivity analysis demonstrated that the establishment of the SSF by VANDU on average had annually saved CAD$1.8 million dollars in taxpayer's money. CONCLUSIONS Funding SSFs in Vancouver is an efficient and effective use of financial resources in the public health domain; therefore, Vancouver Coastal Health should actively participate in their establishment in order to reduce HCV and other blood-borne infections such as HIV within the non-injecting drug users.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
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Jozaghi E, Reid AA, Andresen MA, Juneau A. A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Ottawa, Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:31. [PMID: 25091704 PMCID: PMC4123501 DOI: 10.1186/1747-597x-9-31] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 07/28/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Supervised injection facilities (SIFs) are venues where people who inject drugs (PWID) have access to a clean and medically supervised environment in which they can safely inject their own illicit drugs. There is currently only one legal SIF in North America: Insite in Vancouver, British Columbia, Canada. The responses and feedback generated by the evaluations of Insite in Vancouver have been overwhelmingly positive. This study assesses whether the above mentioned facility in the Downtown Eastside of Vancouver needs to be expanded to other locations, more specifically that of Canada's capital city, Ottawa. METHODS The current study is aimed at contributing to the existing literature on health policy by conducting cost-benefit and cost-effective analyses for the opening of SIFs in Ottawa, Ontario. In particular, the costs of operating numerous SIFs in Ottawa was compared to the savings incurred; this was done after accounting for the prevention of new HIV and Hepatitis C (HCV) infections. To ensure accuracy, two distinct mathematical models and a sensitivity analysis were employed. RESULTS The sensitivity analyses conducted with the models reveals the potential for SIFs in Ottawa to be a fiscally responsible harm reduction strategy for the prevention of HCV cases--when considered independently. With a baseline sharing rate of 19%, the cumulative annual cost model supported the establishment of two SIFs and the marginal annual cost model supported the establishment of a single SIF. More often, the prevention of HIV or HCV alone were not sufficient to justify the establishment cost-effectiveness; rather, only when both HIV and HCV are considered does sufficient economic support became apparent. CONCLUSIONS Funded supervised injection facilities in Ottawa appear to be an efficient and effective use of financial resources in the public health domain.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
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Uusküla A, Des Jarlais DC, Raag M, Pinkerton SD, Feelemyer J. Combined prevention for persons who inject drugs in the HIV epidemic in a transitional country: the case of Tallinn, Estonia. AIDS Care 2014; 27:105-11. [PMID: 25054646 DOI: 10.1080/09540121.2014.940271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The study was undertaken to assess the potential effectiveness of combined HIV prevention on the very high seroprevalence epidemic among persons who inject drugs (PWID) in Tallinn, Estonia, a transitional country. Data from community-based cross-sectional (respondent-driven sampling) surveys of PWID in 2005, 2007, 2009, and 2011 were used together with mathematical modeling of injection-associated HIV acquisition to estimate changes in injection-related HIV incidence during these periods. Utilization of one, two, or three of the interventions available in the community (needle and syringes exchange program, antiretroviral treatment [ART], HIV testing, opioid substitution treatment) was reported by 42.5%, 30.5%, and 11.5% of HIV+ and 34.7%, 36.4%, and 5.7% of HIV- PWIDs, respectively, in 2011. The modeling results suggest that the combination of needle/syringe programs and provision of ART to PWID in Tallinn substantially reduced the incidence of HIV infection in this population, from an estimated 20.7/100 person-years in 2005 to 7.5/100 person-years in 2011. In conclusion, combined prevention targeting HIV acquisition and transmission-related risks among PWID in Tallinn has paralleled the downturn of the HIV epidemic in this population.
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Affiliation(s)
- Anneli Uusküla
- a Department of Public Health , University of Tartu , Tartu , Estonia
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Reducing the adverse impact of injection drug use in Canada. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2013; 23:106-7. [PMID: 23997772 DOI: 10.1155/2012/297530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jozaghi E, Reid AA, Andresen MA. A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Montreal, Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:25. [PMID: 23837814 PMCID: PMC3710233 DOI: 10.1186/1747-597x-8-25] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 07/03/2013] [Indexed: 11/16/2022]
Abstract
Background This paper will determine whether expanding Insite (North America’s first and only supervised injection facility) to more locations in Canada such as Montreal, cost less than the health care consequences of not having such expanded programs for injection drug users. Methods By analyzing secondary data gathered in 2012, this paper relies on mathematical models to estimate the number of new HIV and Hepatitis C (HCV) infections prevented as a result of additional SIF locations in Montreal. Results With very conservative estimates, it is predicted that the addition of each supervised injection facility (up-to a maximum of three) in Montreal will on average prevent 11 cases of HIV and 65 cases of HCV each year. As a result, there is a net cost saving of CDN$0.686 million (HIV) and CDN$0.8 million (HCV) for each additional supervised injection site each year. This translates into a net average benefit-cost ratio of 1.21: 1 for both HIV and HCV. Conclusions Funding supervised injection facilities in Montreal appears to be an efficient and effective use of financial resources in the public health domain.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada V5A 1S6.
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30 Years on Selected Issues in the Prevention of HIV among Persons Who Inject Drugs. Adv Prev Med 2013; 2013:346372. [PMID: 23840957 PMCID: PMC3694369 DOI: 10.1155/2013/346372] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 03/11/2013] [Accepted: 05/18/2013] [Indexed: 11/17/2022] Open
Abstract
After 30 years of extensive research on human immunodeficiency virus (HIV) among persons who inject drugs (PWID), we now have a good understanding of the critical issues involved. Following the discovery of HIV in 1981, epidemics among PWID were noted in many countries, and consensus recommendations for interventions for reducing injection related HIV transmission have been developed. While high-income countries have continued to develop and implement new Harm Reduction programs, most low-/middle-income countries have implemented Harm Reduction at very low levels. Modeling of combined prevention programming including needle exchange (NSP) and antiretroviral therapy (ARV) suggests that NSP be given the highest priority. Future HIV prevention programming should continue to provide Harm Reduction programs for PWID coupled with interventions aimed at reducing sexual transmission. As HIV continues to spread in low- and middle-income countries, it is important to achieve and maintain high coverage of Harm Reduction programs in these locations. As PWID almost always experience multiple health problems, it will be important to address these multiple problems within a comprehensive approach grounded in a human rights perspective.
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Hyshka E, Bubela T, Wild TC. Prospects for scaling-up supervised injection facilities in Canada: the role of evidence in legal and political decision-making. Addiction 2013; 108:468-76. [PMID: 23286831 DOI: 10.1111/add.12064] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 10/22/2012] [Accepted: 11/13/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND North America's first supervised injection facility-Insite-opened in Vancouver in 2003 under a special federal legal exemption. Insite has faced significant political and legal opposition, which culminated in a recent Supreme Court of Canada ruling that ordered the federal Minister of Health to extend the facility's exemption and cited evidence that the facility is life-preserving and does not increase public disorder. Officials in several other cities have initiated or accelerated preparations for new facilities due to speculation that the ruling provides sufficient legal basis to expand supervised injection in Canada. However, a comprehensive assessment of the barriers and facilitators to supervised injection facility scale-up is lacking. METHODS This policy case study reviews a corpus of jurisprudence, legislation, scientific research and media texts to: describe the role of evidence in legal and political decision-making around Insite; analyze the implications of the Insite decision for new facilities; and discuss alternative avenues for supervised injection facility expansion. RESULTS The Insite decision does not simplify the path towards new supervised injection facilities, but nor does it does pose an insurmountable hurdle. Whether new facilities will be established depends largely upon how the Minister of Health interprets the ruling, the proponents' ability to demonstrate need and support from municipal and provincial governments and community members. Formally defining supervised injection as within nurses' scope of practice could further efforts to establish new facilities. CONCLUSION Additional court action may be required to establish a stable legal and policy basis for supervised injection facilities in Canada.
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Affiliation(s)
- Elaine Hyshka
- Addiction and Mental Health Research Laboratory, School of Public Health, University of Alberta, Edmonton, AB, Canada.
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