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Kennedy MC, Hayashi K, Milloy MJ, Compton M, Kerr T. Health impacts of a scale-up of supervised injection services in a Canadian setting: an interrupted time series analysis. Addiction 2022; 117:986-997. [PMID: 34854162 PMCID: PMC8904318 DOI: 10.1111/add.15717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS In response to a dramatic rise in overdose deaths due to injection drug use, there was a rapid scale-up of low-threshold supervised injection services (SIS), termed 'overdose prevention sites' (OPS), in Vancouver, Canada in December 2016. We measured the potential impact of this intervention on SIS use and related health outcomes among people who inject drugs (PWID). DESIGN Segmented regression analyses of interrupted time series data from two community-recruited prospective cohorts of PWID from January 2015 to November 2018 were used to measure the impact of the OPS scale-up on changes in SIS use, public injection, syringe sharing and addiction treatment participation, controlling for pre-existing secular trends. SETTING Vancouver, Canada. PARTICIPANTS Of 745 PWID, 292 (39.7%) were women, 441 (59.6%) self-reported white ancestry and the median age was 47 years (interquartile range = 38, 53) at baseline. MEASUREMENTS Immediate (i.e. step level) and gradual (i.e. slope) changes in the monthly proportion of participants who self-reported past 6-month SIS use, public injection, syringe sharing and participation in any form of addiction treatment. FINDINGS Post OPS expansion, the monthly prevalence of SIS use immediately increased by an estimated 6.4% [95% confidence interval (CI) = 1.7, 11.2] and subsequently further increased by an estimated 0.7% (95% CI = 0.3, 1.1) per month. The monthly prevalence of addiction treatment participation immediately increased by an estimated 4.5% (95% CI = 0.5, 8.5) following the OPS expansion, while public injection and syringe sharing were estimated to immediately decrease by 5.5% (95% CI = 0.9, 10.0) and 2.5% (95% CI = 0.5, 4.6), respectively. Findings were inconclusive as to whether or not an association was present between the intervention and subsequent gradual changes in public injection, syringe sharing and addiction treatment participation. CONCLUSIONS Scaling-up overdose prevention sites in Vancouver, Canada in December 2016 was associated with immediate and continued gradual increases in supervised injection service engagement and immediate increases in related health benefits.
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | | | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
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Feltmann K, Gripenberg J, Strandberg AK, Elgán TH, Kvillemo P. Drug dealing and drug use prevention - a qualitative interview study of authorities' perspectives on two open drug scenes in Stockholm. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:37. [PMID: 33902645 PMCID: PMC8077961 DOI: 10.1186/s13011-021-00375-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Abstract
Background The use of illicit substances causes various health and social problems globally. Moreover, open drug use and dealing in urban areas, i.e., open drug scenes, can cause public order problems, lead to the recruitment of marginalized and young people for drug use or sale, and induce feelings of insecurity in the general public. Although some international studies have described various ways to manage open drug scenes, such as law enforcement and social interventions, there is limited knowledge about the facilitators and barriers promoting or impeding the implementation of such interventions. The aim of the current study was to explore how different authorities describe the nature of two open drug scenes in Stockholm and to derive authorities’ perspective on facilitators and barriers to implementing interventions to reduce open drug dealing, drug use, and related problems at these locations. Methods Semi-structured interviews with police officers, security staff, social workers, and municipality officials (n = 21) in the municipality of Stockholm were conducted and analyzed by qualitative content analysis. Results The analysis of the interviews generated the following categories: Problems, Interventions, Organizational factors, and External factors, revealing information about the strategic and daily counteracting work occurring at the open drug scenes as well as authorities’ perceptions of facilitators and barriers to implementing interventions to reduce open drug dealing, drug use, and related problems. Facilitators included motivated and skilled professionals and organized collaboration between key actors. Prominent barriers were a lack of resources to maintain personnel continuity at the scenes, policies that impede information sharing and put security staff in danger, and people who use or sell drugs without having residence permits. Conclusions To increase the possibility of successful implementation of interventions to counteract open drug dealing, politicians and authorities should pay attention to collaboration between key actors, sufficient resource allocation, possible modification of policy governing professional duties, and remedies to the vulnerability of individuals without residence permits.
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Affiliation(s)
- Kristin Feltmann
- STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden
| | - Johanna Gripenberg
- STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden
| | - Anna K Strandberg
- STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden
| | - Tobias H Elgán
- STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden
| | - Pia Kvillemo
- STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden.
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Taylor J, Ober AJ, Kilmer B, Caulkins JP, Iguchi MY. Community perspectives on supervised consumption sites: Insights from four U.S. counties deeply affected by opioids. J Subst Abuse Treat 2021; 131:108397. [PMID: 34098293 DOI: 10.1016/j.jsat.2021.108397] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND To address the overdose crisis in the United States, expert groups have been nearly unanimous in calls for increasing access to evidence-based treatment and overdose reversal drugs. In some places there have also been calls for implementing supervised consumption sites (SCSs). Some cities-primarily in coastal urban areas-have explored the feasibility and acceptability of introducing them. However, the perspectives of community stakeholders from more inland and rural areas that have also been hard hit by opioids are largely missing from the literature. METHODS To examine community attitudes about implementing SCSs for people who use opioids (PWUO) in areas with acute opioid problems, the research team conducted in-depth interviews and focus groups in four counties: Ashtabula and Cuyahoga Counties in Ohio, and Carroll and Hillsborough Counties in New Hampshire, two states with high rates of opioid overdose. Participants were policy, treatment, and criminal justice professionals, frontline harm reduction and service providers, and PWUO. RESULTS Key informants noted benefits to SCSs, but also perceived potential drawbacks such as that they may enable opioid use, and potential practical barriers, including lack of desire among PWUO to travel to an SCS after purchasing opioids and fear of arrest. Key informants generally believed their communities likely would not currently accept SCSs due to cultural, resource, and practical barriers. They viewed publication of evidence on SCSs and community education as essential for fostering acceptance. CONCLUSIONS Despite cultural and other barriers, implementation of SCSs may be more feasible in urban communities with existing (and perhaps more long-standing) harm reduction programs, greater treatment resources, and adequate transportation, particularly if there is strong evidence to support them.
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Affiliation(s)
- Jirka Taylor
- Drug Policy Research Center, RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, United States of America.
| | - Allison J Ober
- Drug Policy Research Center, RAND Corporation, 1776 Main St., Santa Monica, CA 90407, United States of America
| | - Beau Kilmer
- Drug Policy Research Center, RAND Corporation, 1776 Main St., Santa Monica, CA 90407, United States of America
| | - Jonathan P Caulkins
- Carnegie Mellon University Heinz College, 5000 Forbes Avenue, Pittsburgh, PA 15213, United States of America
| | - Martin Y Iguchi
- Drug Policy Research Center, RAND Corporation, 1776 Main St., Santa Monica, CA 90407, United States of America
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Barbaglia MG, Parés-Badell O, Villalbí JR, Bartroli M, Gasulla L, Espelt A. Temporal relationship between a sudden disruption of a local illicit drug market in a deprived neighborhood of the Barcelona Metropolitan Area and the number of discarded syringes collected from public space. Drug Alcohol Depend 2021; 218:108400. [PMID: 33250382 DOI: 10.1016/j.drugalcdep.2020.108400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The objective of this study was to describe the temporal relationship between an illicit drug market abrupt disruption and the number of discarded syringes collected from public space in Barcelona. METHODS The monthly number of discarded syringes collected and interrupted time-series analyses were used to analyze changes and trends from January 2014 to December 2017, before and after an illicit drug market disruption comparing three different areas of the city: intervened (A) and not intervened (B) high trafficking areas and, as a reference, a low trafficking area (C). RESULTS After the disruption, a decrease in the average number of syringes collected in area A was observed, although the trend was not significant (p value 0.09). In area B, there was a significant increase with an upward trend in the average number of collected syringes (p value <0.001). A flat trend was observed throughout the period in area C (p value 0.62) The systematic counting of discarded syringes collected from public places is confirmed as a useful indicator to monitor drug dealing and use in urban areas. It may help public health services strengthen safe needle disposal practices and harm reduction interventions in these areas.
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Affiliation(s)
- María Gabriela Barbaglia
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, Barcelona, 08023, Spain; Experimental and Health Sciences Department, Universitat Pompeu Fabra, Dr. Aiguader, 80, Barcelona, 08003, Spain.
| | - Oleguer Parés-Badell
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, Barcelona, 08023, Spain; Experimental and Health Sciences Department, Universitat Pompeu Fabra, Dr. Aiguader, 80, Barcelona, 08003, Spain.
| | - Joan R Villalbí
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, Barcelona, 08023, Spain; Experimental and Health Sciences Department, Universitat Pompeu Fabra, Dr. Aiguader, 80, Barcelona, 08003, Spain; Sant Pau Research Institute, Hospital de la Santa Creu I Sant Pau, St Quintí, 77-79, Barcelona, 08041, Spain; CIBER Epidemiologia y Salud Pública, Spain.
| | - Montse Bartroli
- Agència de Salut Pública de Barcelona, Pl Lesseps 1, Barcelona, 08023, Spain; Experimental and Health Sciences Department, Universitat Pompeu Fabra, Dr. Aiguader, 80, Barcelona, 08003, Spain; Sant Pau Research Institute, Hospital de la Santa Creu I Sant Pau, St Quintí, 77-79, Barcelona, 08041, Spain.
| | - Laia Gasulla
- Subdirecció General de Drogodepedències, Agència de Salut Pública, Roc Boronat 81-93, Barcelona, 08005, Spain.
| | - Albert Espelt
- CIBER Epidemiologia y Salud Pública, Spain; Facultat de Ciències de la Salut de Manresa, Universitat de Vic Universitat Central de Catalunya (UVicUCC), Av. Universitària 46, 08242, Manresa, Spain.
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[Managing pleasures and harms: An ethnographic study of drug consumption in public spaces, homes and drug consumption rooms]. Salud Colect 2020; 16:e2481. [PMID: 33147386 DOI: 10.18294/sc.2020.2481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/16/2020] [Indexed: 11/24/2022] Open
Abstract
Drug consumption rooms (DCR) aim to facilitate consumption in hygienic and safe conditions. However, users also consume drugs in public spaces and homes generating incremental risk for health. To strengthen our understanding of consumption practices, we conducted an ethnographic study in different consumption locations in Barcelona, including DCRs, public spaces, and homes. Focusing on consumption practices and narratives, we conducted participant observation and interviewed 16 DCR users. Our findings show that different consumption spaces allow users to experiment different types of pleasures. In addition, consumption in each type of location is associated with various types of harms, which are managed by users by self-regulating their practices. These aspects, therefore, must be taken into account to design harm reduction action aligned with users' practices.
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Montero-Moraga JM, Garrido-Albaina A, Barbaglia MG, Gotsens M, Aranega D, Espelt A, Parés-Badell O. Impact of 24-hour schedule of a drug consumption room on service use and number of non-fatal overdoses. A quasiexperimental study in Barcelona. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 81:102772. [DOI: 10.1016/j.drugpo.2020.102772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
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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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Bearnot B, Pearson JF, Rodriguez JA. Using Publicly Available Data to Understand the Opioid Overdose Epidemic: Geospatial Distribution of Discarded Needles in Boston, Massachusetts. Am J Public Health 2018; 108:1355-1357. [PMID: 30138067 DOI: 10.2105/ajph.2018.304583] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To use publicly available, crowdsourced data to understand geospatial trends in discarded needles. METHODS We completed multiple geospatial analyses of discarded needles reported through the Boston, Massachusetts, 311 service request system. RESULTS Between May 2015 and August 2017, 4763 discarded needles were reported. The highest concentration of needles were reported in census block groups in the South End and Roxbury neighborhoods. Cumulatively, 78.3% of the needles were reported within 1 kilometer of methadone clinics, safe needle deposit sites, homeless shelters, or hospitals. CONCLUSIONS Publicly reported data can help identify hot spots of discarded needles and examine indicators of spatial association. In Boston, the number of discarded needles being reported is rising, with the highest density of needles found in 2 central neighborhoods with several outlying hot spots. Most needles were found near areas associated with social stress and substance use disorder. Public Health Implications. This analysis represents a novel way of leveraging publicly available information to target community responses to the opioid epidemic. Identifying hot spots of discarded needles may enable public health organizations to target future efforts to encourage safer needle disposal practices and reduce public injection drug use.
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Affiliation(s)
- Benjamin Bearnot
- Benjamin Bearnot is with the Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, and Department of Medicine, Harvard Medical School, Boston. John F. Pearson and Jorge A. Rodriguez are with the Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston. John F. Pearson is also with the Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center
| | - John F Pearson
- Benjamin Bearnot is with the Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, and Department of Medicine, Harvard Medical School, Boston. John F. Pearson and Jorge A. Rodriguez are with the Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston. John F. Pearson is also with the Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center
| | - Jorge A Rodriguez
- Benjamin Bearnot is with the Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, and Department of Medicine, Harvard Medical School, Boston. John F. Pearson and Jorge A. Rodriguez are with the Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston. John F. Pearson is also with the Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center
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