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Stevens A, Keemink JR, Shirley-Beavan S, Khadjesari Z, Artenie A, Vickerman P, Southwell M, Shorter GW. Overdose prevention centres as spaces of safety, trust and inclusion: A causal pathway based on a realist review. Drug Alcohol Rev 2024; 43:1573-1591. [PMID: 39104059 DOI: 10.1111/dar.13908] [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: 02/10/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 08/07/2024]
Abstract
ISSUES Overdose prevention centres (OPC) are non-residential spaces where people can use illicit drugs (that they have obtained elsewhere) in the presence of staff who can intervene to prevent and manage any overdoses that occur. Many reviews of OPCs exist but they do not explain how OPCs work. APPROACH We carried out a realist review, using the RAMESES reporting standards. We systematically searched for and then thematically analysed 391 documents that provide information on the contexts, mechanisms and outcomes of OPCs. KEY FINDINGS Our retroductive analysis identified a causal pathway that highlights the feeling of safety - and the immediate outcome of not dying - as conditions of possibility for the people who use OPCs to build trust and experience social inclusion. The combination of safety, trust and social inclusion that is triggered by OPCs can - depending on the contexts in which they operate - generate other positive outcomes, which may include less risky drug use practices, reductions in blood borne viruses and injection-related infections and wounds, and access to housing. These outcomes are contingent on relevant contexts, including political and legal environments, which differ for women and people from racialised minorities. CONCLUSIONS OPCs can enable people who live with structural violence and vulnerability to develop feelings of safety and trust that help them stay alive and to build longer term trajectories of social inclusion, with potential to improve other aspects of their health and living conditions.
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Affiliation(s)
- Alex Stevens
- Social Policy, Sociology and Social Research, University of Kent, Medway, UK
| | - Jolie R Keemink
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Sam Shirley-Beavan
- Social Policy, Sociology and Social Research, University of Kent, Medway, UK
| | | | | | | | | | - Gillian W Shorter
- Drug and Alcohol Research Network, Queen's University Belfast, Belfast, UK
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Lim J, Panagiotoglou D. The effect of Montreal's supervised consumption sites on injection-related infections among people who inject drugs: An interrupted time series. PLoS One 2024; 19:e0308482. [PMID: 39190638 PMCID: PMC11349102 DOI: 10.1371/journal.pone.0308482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Between June and November 2017, four supervised consumption sites (SCS) began operating in Montreal, Quebec. Earlier studies on SCS focused on examining their effects on blood-borne viral infections and overdose mortality. Our objective was to examine the effect of Montreal's SCS on the incidence, health service use and outcomes of injection-related infections (IRI) in people who inject drugs. METHODS We used Quebec's provincial administrative health data to identify people who inject drugs in Montreal and calculated the incidence of IRI in this population between December 2014 and December 2019. We conducted a retrospective, population-based interrupted time series to estimate the effect of Montreal's four SCS on the monthly incidence rates of IRI-related hospitalizations, emergency department (ED) visits, physician visits, and mortality. We also examined the effects of SCS on average length of IRI-related hospitalizations and incidence of hospitalizations involving surgery. RESULTS The average age of Montreal's people who inject drugs was 41.84 years, and 66.41% were male. After the implementation of SCS, there was a positive level change in the incidence of hospitalizations (0.97; 95% confidence interval [CI]: 0.26, 1.68) for IRI. There was also a significant post-intervention decline in hospitalization trends (-0.05; 95% CI: -0.08, -0.02), with modest trend changes in ED visits (-0.02; 95% CI: -0.05, 0.02). However, post-intervention changes in level (0.72; 95% CI: -3.85, 5.29) and trend (0.06; 95% CI: -0.23, 0.34) for physician visits remained limited. SCS had no effect on the average length of hospitalizations, but there was a decreasing post-intervention trend in hospitalizations involving surgery (-0.03; 95% CI: -0.06, 0.00). CONCLUSION Following the opening of the SCS, there was a moderate decline in the rate of hospitalizations to treat IRI, but the impact of the sites on the rate of physician visits remained limited. These findings suggest that SCS may mitigate the incidence of more serious and complicated IRI over time.
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Affiliation(s)
- Jihoon Lim
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Dunham K, Hill K, Kazal H, Butner JL, Hull I, Sue K, Li L, Doneski K, Dinges B, Rife-Pennington T, Kung S, Thakarar K. In Support of Overdose Prevention Centers: Position Statement of AMERSA, Inc (Association for Multidisciplinary Education and Research in Substance Use and Addiction). SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:328-336. [PMID: 38747578 DOI: 10.1177/29767342241252590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Given increasing rates of fatal overdoses in the United States and the rapidly changing drug supply, overdose prevention centers (OPCs; also known as safe consumption sites) have been identified as a vital, evidence-based strategy that provide people who use drugs (PWUD) the opportunity to use drugs safely and receive immediate, life-saving overdose support from trained personnel. In addition to providing a safe, supervised space to use drugs, OPCs can house further essential harm reduction drop-in services such as sterile supplies, social services, and medical care. There are established national and international data demonstrating the lifesaving services provided by OPCs, inspiring a groundswell of advocacy efforts to expand these programs in the United States. Thus, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) endorses OPCs, in addition to other harm reduction strategies that protect PWUD. Ultimately, it is imperative to increase access to OPCs across the United States and support key policy changes at the local, state, and federal levels that would facilitate urgent expansion.
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Affiliation(s)
- Katherine Dunham
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Katherine Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Hannah Kazal
- Division of Addiction Medicine, Department of Family Medicine, Maine Medical Center, Portland, ME, USA
| | - Jenna L Butner
- Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Ilana Hull
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kimberly Sue
- Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Li Li
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin Doneski
- Harm Reduction Program/Needle Exchange, Portland Public Health, Portland, ME, USA
| | - Beth Dinges
- Pharmacy Service, Veteran Affairs Illiana Healthcare System, Danville, IL, USA
| | - Tessa Rife-Pennington
- Pharmacy Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- School of Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Sunny Kung
- Mass General Brigham Community Physicians, Haverhill, MA, USA
| | - Kinna Thakarar
- Center for Interdisciplinary Population and Health Research/Maine, Portland, ME, USA
- Department of Medicine, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
- Maine Medical Partners Adult Infectious Diseases, South Portland, ME, USA
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Koehm K, Rosen JG, Yedinak Gray JL, Tardif J, Thompson E, Park JN. "Politics Versus Policy": Qualitative Insights on Stigma and Overdose Prevention Center Policymaking in the United States. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241253663. [PMID: 38804608 DOI: 10.1177/29767342241253663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Federal, state, and municipal governments in the United States have been reluctant to authorize overdose prevention centers (OPCs), which are evidence-based approaches for preventing overdose deaths and blood-borne pathogen transmission. METHODS From July 2022 to February 2023, we explored how stigma manifests in OPC policymaking by conducting in-depth interviews with 17 advocates, legislators, service providers, and researchers involved with OPC advocacy and policymaking in Rhode Island, California, Pennsylvania, and New York. RESULTS We found that although jurisdictions differed in their OPC policymaking experiences, stigma manifested throughout the process, from planning to authorization. Participants described OPCs as a tool for destigmatizing overdose and substance use, yet confronted institutionalized stigma and discriminatory attitudes toward people who use drugs (PWUD) and harm reduction from multiple sources (eg, politicians, media, and members of the public). Opposition toward OPCs and harm reduction approaches more broadly intersected with public discourse on crime, homelessness, and public disorder. Employed stigma-mitigation strategies included humanizing PWUD, publicizing the benefits of OPCs to the wider community, and strategically engaging media. CONCLUSION These findings illustrate the importance of understanding stigma at different stages of the policymaking process to better facilitate authorization and eventual implementation of OPCs in the United States.
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Affiliation(s)
- Kristin Koehm
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jesse L Yedinak Gray
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Jessica Tardif
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI, USA
| | - Erin Thompson
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI, USA
| | - Ju Nyeong Park
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- Harm Reduction Innovation Lab, Rhode Island Hospital, Providence, RI, USA
- Division of General Internal Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, USA
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Grisamore SP, DeMatteo D. Overcoming stigma: Community support for overdose prevention sites. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104415. [PMID: 38593517 DOI: 10.1016/j.drugpo.2024.104415] [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: 11/30/2023] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
Overdose prevention sites (OPS) are beginning to be examined for their feasibility of implementation in the United States to curb the fatality of overdoses. Support for these sites varies greatly and can impact local policy, implementation, and the long-term viability of such programs. This study examined two communications strategies - research and anecdotal evidence - and their effect on public support for an OPS. One group (n= 106) was presented with a summary of research evidence for the efficacy of implementing an OPS in their community. The other group (n= 109) received similar information framed as personal anecdotes from people who use drugs (PWUD), people who work with PWUD, and community members of neighborhoods with an OPS. Communicating the efficacy of OPS as research evidence was associated with increased support for implementation and a decreased belief that an OPS will attract crime. Lower stigma towards PWUD was also associated with increased support. However, neither condition was associated with changes in stigma towards PWUD. Jurisdictions implementing OPS should utilize research evidence in communicating the program proposal to the public. Further research is needed regarding best practices for reducing stigma towards PWUD and the subsequent support for the implementation of an OPS.
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Affiliation(s)
- Simone P Grisamore
- Department of Psychological and Brain Sciences, Drexel University, United States.
| | - David DeMatteo
- Department of Psychological and Brain Sciences, Drexel University, United States; Thomas R. Kline School of Law, Drexel University, United States
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Wenger LD, Morris T, Knight KR, Megerian CE, Davidson PJ, Suen LW, Majano V, Lambdin BH, Kral AH. Radical hospitality: Innovative programming to build community and meet the needs of people who use drugs at a government-sanctioned overdose prevention site in San Francisco, California. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104366. [PMID: 38492432 PMCID: PMC11160962 DOI: 10.1016/j.drugpo.2024.104366] [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: 10/09/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND The Tenderloin Center (TLC), a multi-service center where people could receive or be connected to basic needs, behavioral health care, housing, and medical services, was open in San Francisco for 46 weeks in 2022. Within a week of operation, services expanded to include an overdose prevention site (OPS), also known as safe consumption site. OPSs have operated internationally for over three decades, but government-sanctioned OPSs have only recently been implemented in the United States. We used ethnographic methods to understand the ways in which a sanctioned OPS, situated in a multi-service center, impacts the lives of people who use drugs (PWUD). METHODS We conducted participant observation and in-depth interviews June-December 2022. Extensive field notes and 39 in-depth interviews with 24 TLC guests and 15 TLC staff were analyzed using an inductive analysis approach. Interviewees were asked detailed questions about their experiences using and working at the TLC. RESULTS TLC guests and staff described an atmosphere where radical hospitality-welcoming guests with extraordinary warmth, generosity, and unconditional acceptance-was central to the culture. We found that the co-location of an OPS within a multi-service agency (1) allowed for the culture of radical hospitality to flourish, (2) yielded a convenient one-stop shop model, (3) created a space for community building, and (4) offered safety and respite to guests. CONCLUSIONS The co-location of an OPS within a multi-service drop-in center is an important example of how such an organization can build positive sociality among PWUD while protecting autonomy and reducing overdose mortality. Overdose response and reversal is an act of relational accountability in which friends, peers, and even strangers intervene to protect and revive one another. This powerful intervention was operationalized as an anti-oppressive, horizontal activity through radical hospitality with a built environment that allowed PWUD to be both social and safe.
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Affiliation(s)
- Lynn D Wenger
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States.
| | - Terry Morris
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Kelly R Knight
- University of California, San Francisco, San Francisco, CA, United States
| | - Cariné E Megerian
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Peter J Davidson
- Univerity of California, San Diego, San Francisco, CA, United States
| | - Leslie W Suen
- University of California, San Francisco, San Francisco, CA, United States
| | - Veronica Majano
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Barrot H Lambdin
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Alex H Kral
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
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7
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Long C, Guimond T, Bayoumi AM, Firestone M, Strike C. The multiple makings of a supervised consumption service in a hospital setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104260. [PMID: 38035448 DOI: 10.1016/j.drugpo.2023.104260] [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: 02/05/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Whereas supervised consumption services (SCSs) are common in many community settings, they are seldomly found in acute care hospitals. As hospitals present unique circumstances that can shape the impacts of an SCS, careful consideration of local implementation contexts and practices is required. We explored the pre-implementation stage of an SCS, to examine how an SCS is made and made differently in relation to the material-discursive context of the hospital. METHODS We conducted 11 focus groups with 83 staff and clinicians at an inner-city hospital in Toronto, Canada. Data analysis followed principles of grounded theory and was informed by an 'evidence making interventions' framework. RESULTS While most participants indicated they would support the establishment of an SCS at the hospital, multiple enactments of an SCS emerged. An SCS was enacted: as a means to reduce drug-related risks for all people who use drugs, as an opportunity to intervene on patients' drug use, as a means to centralize drug use, and as a transformative intervention for the hospital. In our findings, harm reduction, abstinence, security, and risk mitigation goals existed closely together, yielding overlaying realities. CONCLUSION Our findings revealed various enactments of an SCS, some of which are likely to negatively affect people who use drugs and service access. As more hospitals consider the implementation of an SCS, understanding how an SCS is made in practice will be key to building a service that focuses on the needs of people who use drugs.
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Affiliation(s)
- Cathy Long
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.
| | - Tim Guimond
- Addictions Division, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, ON, M5S 3H2, Canada
| | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, ON, M5S 3H2, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7 Canada; Division of General Internal Medicine, Department of Medicine, St. Michael's Hospital, 36 Queen Street East, Toronto, ON, M5B 1W8
| | - Michelle Firestone
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Carol Strike
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7 Canada
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Dahm G, Roschel K, Marson C, Bourmaud A, Macedo J, Lupo M, Fauchet L, Allar C, Schaaf R, Schneider S. Consumer expectations, drug effects, price and purity of heroin and cocaine purchased at drug consumption rooms. Harm Reduct J 2023; 20:106. [PMID: 37542248 PMCID: PMC10403934 DOI: 10.1186/s12954-023-00837-3] [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: 05/10/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Drug consumption rooms offer heroin and cocaine consumers a secure and hygienic environment including medical and social guidance. Despite the support and mentoring, only sparse information is available about how drug quality, drug prices and user expectations match at these locations. The present study reports analysis of these three parameters in two drug consumption rooms in Luxembourg. METHODS Drug users were invited to participate in the project by handing in a few milligrams of the product they planned to consume for chemical analysis and filling out a short questionnaire about the price and their expectations. After consumption, they were asked to report the experienced effects. Drug quality was accessed using LC-Q-ToF and HPLC-UV, and a statistical analysis was carried out of the questionnaires that were correctly filled out. RESULTS A total of 513 drug samples have been analyzed. Most consumers were looking for the relaxing/calming effects of heroin and the stimulating effects of cocaine, but they generally overestimated heroin potency and underestimated cocaine potency. No strong correlation based on Spearman's ρ between drug user estimations, drug prices and drug quality was found. CONCLUSION To the best of our knowledge, this study is the first to combine drug analysis with heroin and cocaine user feedback about expectation, drug prices and drug effects. The analytical results were of great interest for users and the staff working at the drug consumption rooms. They may be a strong supplementary communication tool for health care workers when discussing effects and risks of highly toxic substance consumption.
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Affiliation(s)
- Georges Dahm
- Service de Toxicologie Analytique - Chimie Pharmaceutique, Laboratoire National de Santé, 1, Rue Louis Rech, 3555, Dudelange, Luxembourg.
| | - Karin Roschel
- Service de Toxicologie Analytique - Chimie Pharmaceutique, Laboratoire National de Santé, 1, Rue Louis Rech, 3555, Dudelange, Luxembourg
| | - Claude Marson
- Service de Toxicologie Analytique - Chimie Pharmaceutique, Laboratoire National de Santé, 1, Rue Louis Rech, 3555, Dudelange, Luxembourg
| | - Adèle Bourmaud
- Service de Toxicologie Analytique - Chimie Pharmaceutique, Laboratoire National de Santé, 1, Rue Louis Rech, 3555, Dudelange, Luxembourg
| | - Jennifer Macedo
- Contact Esch, 130, Rue de Luxembourg, 4344, Esch-sur-Alzette, Luxembourg
| | - Mauro Lupo
- Contact Esch, 130, Rue de Luxembourg, 4344, Esch-sur-Alzette, Luxembourg
| | - Lionel Fauchet
- Abrigado, 8, Route de Thionville, 2610, Luxembourg, Luxembourg
| | - Claudia Allar
- Abrigado, 8, Route de Thionville, 2610, Luxembourg, Luxembourg
| | - Raoul Schaaf
- Abrigado, 8, Route de Thionville, 2610, Luxembourg, Luxembourg
| | - Serge Schneider
- Service de Toxicologie Analytique - Chimie Pharmaceutique, Laboratoire National de Santé, 1, Rue Louis Rech, 3555, Dudelange, Luxembourg
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Tabanelli R, Brogi S, Calderone V. Targeting Opioid Receptors in Addiction and Drug Withdrawal: Where Are We Going? Int J Mol Sci 2023; 24:10888. [PMID: 37446064 DOI: 10.3390/ijms241310888] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
This review article offers an outlook on the use of opioids as therapeutics for treating several diseases, including cancer and non-cancer pain, and focuses the analysis on the opportunity to target opioid receptors for treating opioid use disorder (OUD), drug withdrawal, and addiction. Unfortunately, as has been well established, the use of opioids presents a plethora of side effects, such as tolerance and physical and physiological dependence. Accordingly, considering the great pharmacological potential in targeting opioid receptors, the identification of opioid receptor ligands devoid of most of the adverse effects exhibited by current therapeutic agents is highly necessary. To this end, herein, we analyze some interesting molecules that could potentially be useful for treating OUD, with an in-depth analysis regarding in vivo studies and clinical trials.
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Affiliation(s)
- Rita Tabanelli
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Simone Brogi
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
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Dos Santos M, Girard G, Briand Madrid L, Perreaut L, Olenine A, Roux P. "The Slums Have To Be Shown": Documenting Drug Injection in Public Spaces Ahead of the Opening of a Drug Consumption Room in Marseille. QUALITATIVE HEALTH RESEARCH 2023:10497323231169607. [PMID: 37271754 DOI: 10.1177/10497323231169607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
EPOSIM is a community-based participatory research study which used the Photovoice method with people who inject drugs (PWID) ahead of a possible opening of a drug consumption room (DCR) in Marseille, France. It aimed to identify the strategies used by PWID when injecting, and the risks they take when they have no safe private space to inject in the area they live in. A total of 7 PWID participated in the full study process. The 189 photographs they took provided us with a good understanding of their injection practices in public places. The main results highlighted the spatiality and materiality of injecting experience in a context where no DCR was available. They also showed the relevance of Photovoice to valorize the voices of PWID when implementing a DCR. Through the showcasing of their photographs at various public exhibitions, the participants seized the opportunity to use Photovoice to make their voices heard beyond the group formed for the study, in order to show the different forms of stigma and insalubrious contexts which they faced on a daily basis. Furthermore, the photographs taken demonstrated that having only health and safety records is not enough to fully understand PWID injection practices. Future studies must take into account PWID perceptions of their relationship with injecting in public spaces and with the management of stigma. The questions of pleasure and comfort must also be explored in evaluation studies of harm reduction measures, for example, DCR.
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Affiliation(s)
- Marie Dos Santos
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Faculté de médecine, Marseille, France
| | - Gabriel Girard
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Faculté de médecine, Marseille, France
| | - Laélia Briand Madrid
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Faculté de médecine, Marseille, France
| | - Lola Perreaut
- Asud Mars Say Yeah Harm Reduction, Marseille, France
| | | | - Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Faculté de médecine, Marseille, France
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Briand Madrid L, Donadille C, Célerier I, Gutowski M, Grelli N, Maradan G, Jauffret-Roustide M, Lalanne L, Auriacombe M, Roux P. [Drug Consumption Rooms : Opinion and willingness among people who inject drugs in Marseille, France]. Rev Epidemiol Sante Publique 2023; 71:101421. [PMID: 36571957 DOI: 10.1016/j.respe.2022.101421] [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: 04/04/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In France, people who inject drugs (PWID) are still one of the most at risk population for contracting hepatitis C virus (HCV). Drug consumption rooms (DCR) have shown their effectiveness on HCV risk behaviors abroad and in France, where they have been recently evaluated with the COSINUS study. In France, two DCRs opened in 2016, one in Paris and another in Strasbourg. The objective of this sub-analysis was to explore the willingness to use a DCR in PWID living in Marseille, where no DCR is opened. METHODS The COSINUS study is a prospective multicenter cohort that included 665 PWID recruited in Bordeaux, Marseille, Paris and Strasbourg between 2016 and 2019. Investigators administered questionnaires face-to-face at regular intervals at baseline, 3 months, 6 months and 12 months. In Marseille, 199 PWID were recruited. A multivariable logistic regression model was performed to assess factors associated with willingness to use DCR among this population. RESULTS Among 545 observations corresponding to 195 distinct participants selected for analyses, 57% declared they were willing to attend a DCR. The main reason given was "to consume more cleanly". Receiving allowances (OR = 2.38; 95% confidence interval (CI) (95% CI) = 1.17-4.81), not having health insurance (OR = 3.61; 95% CI = 1.49-8.75), injecting daily (OR = 1.97; 95% CI = 1.05-3.70) and in a public space (OR = 2.66; 95% CI = 1.29-5.47) were all positively associated with willingness to use a DCR. CONCLUSIONS DCR are devices that target PWID exposed to high sanitary or social risks, i.e. people living in precarious conditions, who have to inject in public spaces, in deleterious sanitary environments and with rapid gestures in order not to be seen. These analyzes highlight that the people who most want to attend a DCR are aware of the harms associated with their practices and show a desire to seek protection from street-based drug scenes.
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Affiliation(s)
- L Briand Madrid
- Aix Marseille Université, Inserm, IRD, SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France.
| | - C Donadille
- Aix Marseille Université, Inserm, IRD, SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
| | | | | | - N Grelli
- Nouvelle Aube, Marseille, France
| | - G Maradan
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - M Jauffret-Roustide
- British Columbia Center on Substance Use (BCCSU), Vancouver, Canada; Baldy Center on Law and Social Policy, Buffalo University, New York, USA; Centre d'étude des mouvements sociaux, Inserm U1276/CNRS UMR 8044/EHESS, Paris, France
| | - L Lalanne
- Inserm 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de médecine translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France; Department of Addictology, University Hospital of Strasbourg, Fédération de médecine translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France
| | - M Auriacombe
- Bordeaux University, SANPSY, CNRS UMR 6033, Bordeaux, France; Addiction Clinic (Pôle interétablissement d'addictologie), CHU Bordeaux and CH Charles Perrens, Bordeaux, France
| | - P Roux
- Aix Marseille Université, Inserm, IRD, SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, ISSPAM, Marseille, France
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12
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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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13
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Cassie R, Hayashi K, DeBeck K, Milloy MJ, Cui Z, Strike C, West J, Kennedy MC. Difficulty accessing supervised consumption services during the COVID-19 pandemic among people who use drugs in Vancouver, Canada. Harm Reduct J 2022; 19:126. [PMID: 36401299 PMCID: PMC9675060 DOI: 10.1186/s12954-022-00712-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The overdose crisis in Canada has worsened since the emergence of the COVID-19 pandemic. Although this trend is thought to be driven in part by closures or reduced capacity of supervised consumption services (SCS), little is known about the factors that may impede access to such services during the COVID-19 pandemic among people who use drugs. This study sought to characterize the prevalence and correlates of having difficulty accessing SCS during the COVID-19 pandemic among people who use drugs in Vancouver, Canada. METHODS Cross-sectional data from two open prospective cohorts of people who use drugs were collected via phone or videoconferencing interviews conducted between July 2020 and November 2020. Multivariable logistic regression analyses were used to examine factors associated with experiencing difficulty accessing SCS. RESULTS Among the 428 people who use drugs who participated in the study, 223 (54.7%) self-identified as men and the median age was 51 years (1st to 3rd quartile: 42-58). A total of 58 (13.6%) participants reported experiencing difficulty accessing SCS. In a multivariable analysis, factors positively associated with difficulty accessing SCS included daily crystal methamphetamine use (Adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI] 1.28-5.30), active injection drug use (AOR = 4.06; 95% CI 1.38-11.90), recent non-fatal overdose (AOR = 2.45; 95% CI 1.24-4.85), and unstable housing (AOR = 2.14; 95% CI 1.08-4.23). Age was inversely associated with the outcome (AOR = 0.96; 95% CI 0.93-0.99) in multivariable analyses. The most commonly reported reasons for experiencing difficulty accessing SCS were: COVID-19-related site closure or shortened hours (42.9%) and having to wait too long to use a site (39.3%). CONCLUSIONS We found that people who use drugs with markers of structural vulnerability and drug-related risk were more likely to experience difficulty accessing SCS during the COVID-19 pandemic. These findings point to the need for strategies to support access to such services as part of pandemic response efforts.
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Affiliation(s)
- Rachel Cassie
- grid.17089.370000 0001 2190 316XSchool of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave., Edmonton, AB T6G 1C9 Canada
| | - Kanna Hayashi
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Kora DeBeck
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.61971.380000 0004 1936 7494School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - M.-J. Milloy
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, St. Paul’s Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Zishan Cui
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Carol Strike
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7 Canada ,grid.415502.7La Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St., Toronto, ON M5B 1T8 Canada
| | - Jeff West
- grid.498786.c0000 0001 0505 0734Vancouver Coastal Health, 828 W 10th Ave., Vancouver, BC V5Z 1L8 Canada
| | - Mary Clare Kennedy
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830School of Social Work, University of British Columbia - Okanagan, 1147 Research Road (ARTS Building), Kelowna, BC V1V 1V7 Canada
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14
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Matheson C, Robertson R. An avoidable crisis. Harm Reduct J 2022; 19:98. [PMID: 36038934 PMCID: PMC9422131 DOI: 10.1186/s12954-022-00680-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
In Scotland drug policy and consequently the progress of evidence-based treatment options has been struggling for many years. Political inaction is brought about by a complex chain of legal and operational obstructions with local authorities deferring to national Government which in turn is paralysed by international convention. Scotland represents a case study demonstrating the adverse consequences of management by non medical requirements rather than implementation of a clinically proven progressive policy. The difficulty of translating theory and evidence into practice is acknowledged but suggestions are made for pragmatic and humanitarian initiatives.
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15
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Roux P, Jauffret-Roustide M, Donadille C, Briand Madrid L, Denis C, Célérier I, Chauvin C, Hamelin N, Maradan G, Carrieri MP, Protopopescu C, Lalanne L, Auriacombe M. Impact of drug consumption rooms on non-fatal overdoses, abscesses and emergency department visits in people who inject drugs in France: results from the COSINUS cohort. Int J Epidemiol 2022; 52:562-576. [PMID: 35690956 DOI: 10.1093/ije/dyac120] [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: 06/30/2021] [Accepted: 05/17/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The effectiveness of drug consumption rooms (DCRs) for people who inject drugs (PWID) has been demonstrated for HIV and hepatitis C virus risk practices, and access to care for substance use disorders. However, data on other health-related complications are scarce. Using data from the French COSINUS cohort, we investigated the impact of DCR exposure on non-fatal overdoses, abscesses and emergency department (ED) visits, all in the previous 6 months. METHODS COSINUS is a 12-month prospective cohort study of 665 PWID in France studying DCR effectiveness on health. We collected data from face-to-face interviews at enrolment, and at 6 and 12 months of follow-up. After adjusting for other correlates (P-value < 0.05), the impact of DCR exposure on each outcome was assessed using a two-step Heckman mixed-effects probit model, allowing us to adjust for potential non-randomization bias due to differences between DCR-exposed and DCR-unexposed participants, while taking into account the correlation between repeated measures. RESULTS At enrolment, 21%, 6% and 38% of the 665 participants reported overdoses, abscesses and ED visits, respectively. Multivariable models found that DCR-exposed participants were less likely to report overdoses [adjusted coefficient (95% CI): -0.47 (-0.88; -0.07), P = 0.023], abscesses [-0.74 (-1.11; -0.37), P < 0.001] and ED visits [-0.74 (-1.27; -0.20), P = 0.007]. CONCLUSION This is the first study to show the positive impact of DCR exposure on abscesses and ED visits, and confirms DCR effectiveness in reducing overdoses, when adjusting for potential non-randomization bias. Our findings strengthen the argument to expand DCR implementation to improve PWID injection environment and health.
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Affiliation(s)
- P Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - M Jauffret-Roustide
- Cermes3, Inserm U988/CNRS UMR 8211/EHESS/Université de Paris, Paris, France
- British Columbia Center on Substance Use, Vancouver, Canada
- Baldy Center on Law and Social Policy, Buffalo University, Buffalo, NY, USA
| | - C Donadille
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - L Briand Madrid
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - C Denis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Univ. Bordeaux, Bordeaux, France
- Sleep, Addiction and Neuropsychiatry research laboratory (SANPSY), CNRS UMR 6033, Bordeaux, France
- Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - I Célérier
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - C Chauvin
- Cermes3, Inserm U988/CNRS UMR 8211/EHESS/Université de Paris, Paris, France
| | - N Hamelin
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - G Maradan
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - M P Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - C Protopopescu
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - L Lalanne
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
- Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - M Auriacombe
- Univ. Bordeaux, Bordeaux, France
- Sleep, Addiction and Neuropsychiatry research laboratory (SANPSY), CNRS UMR 6033, Bordeaux, France
- Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
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16
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Suen LW, Davidson PJ, Browne EN, Lambdin BH, Wenger LD, Kral AH. Effect of an Unsanctioned Safe Consumption Site in the United States on Syringe Sharing, Rushed Injections, and Isolated Injection Drug Use: A Longitudinal Cohort Analysis. J Acquir Immune Defic Syndr 2022; 89:172-177. [PMID: 34723925 DOI: 10.1097/qai.0000000000002849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV and other medical complications of drug use, including overdose, are rising among people who inject drugs in the United States (US). Risk of complications and mortality increase with injection behaviors such as syringe sharing, rushing injections, and injecting in isolated places. Studies suggest safe consumption sites (SCS) reduce high-risk injection behaviors by offering sterile syringes and a safe, supervised space to consume drugs, although this has yet to be evaluated in the US. SETTING An unsanctioned SCS in an undisclosed US location. METHODS From 2018 to 2019, we recruited people who inject drugs using targeted sampling methods (N = 494) and conducted interviews at baseline, 6-, and 12-months. We sought to determine associations of past-month SCS use with past-month receptive syringe sharing, rushed injections, and injections in isolated places. We analyzed data using inverse probability of treatment weighted Poisson regression models. Generalized estimating equations accounted for repeated measures. RESULTS Fifty-two (11%) participants had past-month SCS use. Participants with past-month SCS use had decreased rates of receptive syringe sharing (Incident rate ratio [IRR] 0.17, 95% CI: 0.03 to 1.02) and injecting in an isolated location (IRR 0.77, 95% CI: 0.54 to 1.27) compared with those without past-month SCS use, although results were not statistically conclusive. Rate of rushed injections was only slightly lower (IRR 0.94, 95% CI: 0.70 to 1.30). CONCLUSION SCS may show benefit in reducing high-risk injection practices, and legal sanctioning of an SCS may offer further advantages. SCS implementation should be considered to help reduce the spread of HIV, overdose mortality, and prevent other medical complications of injection drug use.
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Affiliation(s)
- Leslie W Suen
- National Clinician Scholars Program, Philip R. Lee Institute for Health Policy, University of California, San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
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17
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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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18
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Improved syringe disposal practices associated with unsanctioned safe consumption site use: A cohort study of people who inject drugs in the United States. Drug Alcohol Depend 2021; 229:109075. [PMID: 34654588 DOI: 10.1016/j.drugalcdep.2021.109075] [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: 05/19/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Community opposition to safe consumption sites often centers around improper syringe disposal. People are concerned these sites might attract people who inject drugs to the neighborhood, which might in turn lead to more used syringes left in public settings. METHODS We evaluated an unsanctioned safe consumption site in an undisclosed United States city in 2018-2020 to assess whether use of the site was associated with improper syringe disposal practices. We recruited people who inject drugs (N=494) using targeted sampling methods, and interviewed participants at baseline, 6 months, and 12 months. We employed a quasi-experimental design involving inverse probability of treatment weighting using propensity scores. We used generalized estimating equations and Poisson models to calculate relative risk and incidence rate ratios of improper syringe disposal. RESULTS The risk of any improper syringe disposal was comparable among people who used and did not use the unsanctioned safe consumption site in prior 30 days (relative risk 1.03; 95% confidence interval=0.53, 1.17). The rate of improperly disposed syringes per number of injections in prior 30 days was significantly lower among people who had used the unsanctioned safe consumption site during the same period (incident rate ratio 0.42; 95% confidence interval=0.18, 0.88). CONCLUSION When people used this unsanctioned safe consumption site, they disposed of significantly fewer syringes in public places, including streets, sidewalks, parks, or parking lots, than people not using the site. This study helps allay concerns that implementing safe consumption sites in the US would lead to increases in improperly disposed syringes.
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Tran V, Reid SE, Roxburgh A, Day CA. Assessing Drug Consumption Rooms and Longer Term (5 Year) Impacts on Community and Clients. Risk Manag Healthc Policy 2021; 14:4639-4647. [PMID: 34815725 PMCID: PMC8604650 DOI: 10.2147/rmhp.s244720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Drug consumption rooms (DCRs) and supervised injecting facilities (SIFs) provide a safe environment in which people who inject drugs (PWIDs) can inject under hygienic and supervised conditions. Numerous reviews have documented the benefits of these facilities; however, there is a lack of clarity surrounding their long-term effects. PURPOSE To conduct, with a systematic approach, a literature review, of published peer-reviewed literature assessing the long-term impacts of DCRs/SIFs. METHODS A systematic search of the PubMed and Embase database was performed using the keywords: ("SUPERVISED" OR "SAFE*") AND ("CONSUMPTION" OR "INJECT*" OR "SHOOTING") AND ("FACILITY*" OR "ROOM*" OR "GALLERY*" OR "CENTRE*" OR "CENTER*" OR "SITE*"). Included studies were original articles reporting outcomes for five or more years and addressed at least one of the following client or community outcomes; (i) drug-related harms; (ii) access to substance use treatment and other health services; (iii) impact on local PWID population; (iv) impact on public drug use, drug-related crime and violence; and (v) local community attitudes to DCRs. RESULTS Four publications met our inclusion criteria, addressing four of the five outcomes. Long-term data suggested that while the health of PWID naturally declined over time, DCRs/SIFs helped reduce injecting-related harms. The studies showed that DCRs/SIFs facilitate drug treatment, access to health services and cessation of drug injecting. Local residents and business owners reported less public drug use and public syringe disposal following the opening of a DCR/SIF. CONCLUSION Long-term evidence on DCRs/SIFs is consistent with established short-term research demonstrating the benefits of these facilities. A relative paucity of studies was identified, with most evidence originating from Sydney and Vancouver. The overall body of evidence would be improved by future studies following outcomes over longer periods and being undertaken in a variety of jurisdictions and models of DCRs/SIFs.
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Affiliation(s)
- Vincent Tran
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sharon E Reid
- Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Amanda Roxburgh
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
- National Drug and Alcohol Research Centre, UNSW, Randwick, New South Wales, Australia
- Monash Addiction Research Centre, Monash University, Clayton, Victoria, Australia
| | - Carolyn A Day
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, New South Wales, Australia
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Supervised Injection Facilities as Harm Reduction: A Systematic Review. Am J Prev Med 2021; 61:738-749. [PMID: 34218964 PMCID: PMC8541900 DOI: 10.1016/j.amepre.2021.04.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/29/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022]
Abstract
CONTEXT Supervised injection facilities are harm reduction interventions that allow people who inject drugs to use previously obtained substances under the supervision of health professionals. Although currently considered illegal under U.S. federal law, several U.S. cities are considering implementing supervised injection facilities anyway as a response to the escalating overdose crisis. The objective of this review is to determine the effectiveness of supervised injection facilities, compared with that of control conditions, for harm reduction and community outcomes. EVIDENCE ACQUISITION Studies were identified from 2 sources: a high-quality, broader review examining supervised injection facility-induced benefits and harms (from database inception to January 2014) and an updated search using the same search strategy (January 2014‒September 2019). Systematic review methods developed by the Guide to Community Preventive Services were used (screening and analysis, September 2019‒December 2020). EVIDENCE SYNTHESIS A total of 22 studies were included in this review: 16 focused on 1 supervised injection facility in Vancouver, Canada. Quantitative synthesis was not conducted given inconsistent outcome measurement across the studies. Supervised injection facilities in the included studies (n=number of studies per outcome category) were mostly associated with significant reductions in opioid overdose morbidity and mortality (n=5), significant improvements in injection behaviors and harm reduction (n=7), significant improvements in access to addiction treatment programs (n=7), and no increase or reductions in crime and public nuisance (n=7). CONCLUSIONS For people who inject drugs, supervised injection facilities may reduce the risk of overdose morbidity and mortality and improve access to care while not increasing crime or public nuisance to the surrounding community.
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Scheim AI, Sniderman R, Wang R, Bouck Z, McLean E, Mason K, Bardwell G, Mitra S, Greenwald ZR, Thavorn K, Garber G, Baral SD, Rourke SB, Werb D. The Ontario Integrated Supervised Injection Services Cohort Study of People Who Inject Drugs in Toronto, Canada (OiSIS-Toronto): Cohort Profile. J Urban Health 2021; 98:538-550. [PMID: 34181179 PMCID: PMC8237772 DOI: 10.1007/s11524-021-00547-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
The Ontario Integrated Supervised Injection Services cohort in Toronto, Canada (OiSIS-Toronto) is an open prospective cohort of people who inject drugs (PWID). OiSIS-Toronto was established to evaluate the impacts of supervised consumption services (SCS) integrated within three community health agencies on health status and service use. The cohort includes PWID who do and do not use SCS, recruited via self-referral, snowball sampling, and community/street outreach. From 5 November 2018 to 19 March 2020, we enrolled 701 eligible PWID aged 18+ who lived in Toronto. Participants complete interviewer-administered questionnaires at baseline and semi-annually thereafter and are asked to consent to linkages with provincial healthcare administrative databases (90.2% consented; of whom 82.4% were successfully linked) and SCS client databases. At baseline, 86.5% of participants (64.0% cisgender men, median ([IQR] age= 39 [33-49]) had used SCS in the previous 6 months, of whom most (69.7%) used SCS for <75% of their injections. A majority (56.8%) injected daily, and approximately half (48.0%) reported fentanyl as their most frequently injected drug. As of 23 April 2021, 291 (41.5%) participants had returned for follow-up. Administrative and self-report data are being used to (1) evaluate the impact of integrated SCS on healthcare use, uptake of community health agency services, and health outcomes; (2) identify barriers and facilitators to SCS use; and (3) identify potential enhancements to SCS delivery. Nested sub-studies include evaluation of "safer opioid supply" programs and impacts of COVID-19.
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Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.,Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ruby Sniderman
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Zachary Bouck
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Elizabeth McLean
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada
| | - Kate Mason
- South Riverdale Community Health Centre, Toronto, ON, Canada
| | - Geoff Bardwell
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.,British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, Canada
| | - Sanjana Mitra
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, 2357 Main Mall, Vancouver, BC, 270, V6T 1Z4, Canada
| | - Zoë R Greenwald
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Gary Garber
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, 501 Smyth Box, Ottawa, ON, Canada
| | - Stefan D Baral
- Department of Epidemiology, John Hopkins University School of Public Health, Baltimore, MD, USA
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA.
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22
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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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24
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Scheim AI, Bouck Z, Tookey P, Hopkins S, Sniderman R, McLean E, Garber G, Baral S, Rourke SB, Werb D. Supervised consumption service use and recent non-fatal overdose among people who inject drugs in Toronto, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 87:102993. [PMID: 33160158 DOI: 10.1016/j.drugpo.2020.102993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/21/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aiming to reducing overdose mortality, over 40 supervised drug consumption services (SCS) presently operate in Canada. Arguments against SCS include the potential for increased non-fatal overdoses mediated by risk compensation. This study estimates associations between SCS use and recent non-fatal overdose among people who inject drugs (PWID). METHODS We analyzed cross-sectional baseline data collected between November 2018 and March 2020 from a cohort of adult PWID in Toronto, Canada. Recent non-fatal overdose was self-reported over the previous six months. The primary exposure was frequency of SCS use, self-reported as the proportion of injections performed at an SCS (all or most [75-100%], some [26-74%], few [≤25%], or none) in the previous six months. The prevalence of recent overdose was compared between all unique pairs of groups based on their frequency of SCS use and expressed as covariate-adjusted prevalence ratios (PR) estimated using modified Poisson regression. RESULTS Among 701 PWID (median [IQR] age, 40 [33 to 49]; 64.3% cisgender men; 56.8% injecting daily), most reported SCS use (all/most, 26.2%; some, 30.9%; few, 29.4%) versus no use (13.5%), with 38.6% reporting a recent overdose. From adjusted regression analyses, more frequent SCS use was not statistically significantly associated with overdose when compared to either no SCS use or less frequent use. Associations between SCS use frequency and overdose were notably smaller among SCS clients compared to associations between SCS clients and non-users (e.g., all/most versus none: PR, 1.43 [95% CI, 0.93 to 2.21]; all/most versus some: PR, 0.94 [95% CI, 0.75 to 1.17]; all/most versus few: PR, 1.15 [95% CI, 0.89 to 1.48]). CONCLUSION Findings did not indicate statistically significant associations between SCS use frequency and recent non-fatal overdose, particularly among SCS clients who may be more comparable. Nevertheless, overdose was common, underscoring the need to prevent non-fatal overdose and associated morbidity.
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Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States; Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - Zachary Bouck
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paula Tookey
- South Riverdale Community Health Centre, Toronto, ON, Canada
| | | | - Ruby Sniderman
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Elizabeth McLean
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, United States
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, United States
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Rouhani S, White RH, Park JN, Sherman SG. High willingness to use overdose prevention sites among female sex workers in Baltimore, Maryland. Drug Alcohol Depend 2020; 212:108042. [PMID: 32416474 PMCID: PMC9426862 DOI: 10.1016/j.drugalcdep.2020.108042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Overdose Prevention Sites (OPS) operate worldwide as spaces where people can consume previously purchased drugs under supervision, and are linked to reductions in HIV/HCV transmission and fatal overdoses. As the United States weighs their merits and legality, research is needed to estimate acceptability and use among populations at high risk for overdose. We examine willingness to use OPS among street-based female sex workers (FSW) with prevalent drug use and associated morbidities. METHODS We describe self-reported willingness, barriers and conditions around use of a hypothetical OPS among 141 FSW engaged in active drug use in Baltimore City, and describe trends using Pearson's χ2 and Fisher's exact tests. RESULTS Most women had history of overdose (55 %) and were likely to use OPS (77 %). Willingness was higher among women who: were sexual minorities (97 %;P=0.002),experienced homelessness (82 %;P=0.019), injected drugs (82 %;P=0.013), shared syringes (82 %;P=0.007), experienced sexual violence (92 %;P=0.045) or reported heroin use (83 %;P=0.039) in the past 3 months. Common anticipated barriers included transportation (45 %) and fear of arrest (41 %). CONCLUSIONS This study highlights a population of uniquely high-risk women who would benefit from an OPS integrated with other services. Conditions and barriers discussed are informative for planning and implementation.
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Affiliation(s)
- Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, United States; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, United States.
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
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26
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Russell C, Imtiaz S, Ali F, Elton-Marshall T, Rehm J. 'Small communities, large oversight': The impact of recent legislative changes concerning supervised consumption services on small communities in Ontario, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102822. [PMID: 32563756 DOI: 10.1016/j.drugpo.2020.102822] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/10/2023]
Abstract
The opioid epidemic continues to exert a large toll on public health across Canada, with the province of Ontario specifically experiencing exceptionally high opioid-related hospitalizations and overdoses in 2019. As a key evidence-based public health intervention to reduce these harms, over the past few years supervised consumption services (SCS), including temporary and flexible unsanctioned models, have been implemented in select cities across the province. However, in March 2019, the newly elected Ontario provincial government replaced SCS regulations with a 'streamlined' model that introduced additional bureaucratic and administrative requirements for application approval and funding, while placing a cap on the number of sites allowed. Only a select few sites were approved, despite the ability of numerous cities across the province to demonstrate a need for SCS in their community. Importantly, many small communities throughout Ontario have been experiencing opioid-related harms at rates which far outpace those of larger cities. Several of these communities have been actively working towards securing SCS sites, but have been unable to do so as they do not have the resources to meet stringent application requirements. These regulatory changes therefore hinder the feasibility of small communities to implement necessary and life-saving SCS, which will affect lives. This is a major oversight.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, Ontario, Canada, M5S 2S1.
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, Ontario, Canada, M5S 2S1
| | - Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, Ontario, Canada, M5S 2S1
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, Ontario, Canada, M5S 2S1; Dalla School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, Canada, M5T 3M7; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, Ontario, Canada, M6A 5C1
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, Ontario, Canada, M5S 2S1; Dalla School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, Canada, M5T 3M7; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College St., Toronto, Ontario, Canada, M5T 1R8; Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada, M5S 1A8; Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada, M5S 1A8; Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19с1, Moscow, Russian Federation 119146
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Klein KS, Glick SN, Mauro PM. Anticipated use of a supervised drug consumption site among syringe services program clients in King County, Washington: Assessing the role of opioid overdose and injection behavior. Drug Alcohol Depend 2020; 213:108121. [PMID: 32585421 DOI: 10.1016/j.drugalcdep.2020.108121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND US jurisdictions are considering implementing supervised drug consumption sites (SCSs) to combat the overdose epidemic. No sanctioned SCS exists in the US, but King County, Washington has proposed Community Health Engagement Locations (CHELs), which would include supervised drug consumption. We assessed characteristics of people engaged in syringe services programs (SSPs) who anticipated SCS use. METHODS We estimated prevalence of anticipated SCS use in a 2017 cross-sectional sample of King County SSP participants (N = 377). We used Poisson regression with robust standard errors to estimate likelihood of anticipated SCS use by overdose history (experienced, witnessed only, neither), public injection frequency (always, some/most times, never), drug use behaviors, and sociodemographic characteristics. RESULTS The sample was primarily male (66.8 %), white (69.5 %), and averaged 37 years old. Almost two-thirds of participants witnessed or experienced an overdose in the past year (43.2 % witnessed only; 19.6 % experienced overdose). Four in five SSP participants (83.0 %) anticipated any SCS use. Anticipated SCS use was higher among participants who experienced an overdose (risk ratio [RR] = 1.14, 95 % CI = 1.04, 1.24) than those with no overdose experience. In multivariable analyses, anticipated SCS use was higher among people reporting injecting publicly (e.g., always vs. never: aRR = 1.26, 95 % CI = 1.11, 1.43), and lower among people primarily using methamphetamine (aRR = 0.80, 95 % CI = 0.67, 0.96) compared to people primarily using opioids. CONCLUSIONS In King County, SCS services would be used by people at high risk of overdose, including SSP participants reporting injecting in public. SCSs could be an important step to promote health and safety across communities.
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Affiliation(s)
- Kathryn S Klein
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th St., New York, NY, 10032, United States.
| | - Sara N Glick
- University of Washington School of Medicine, Division of Allergy and Infectious Diseases, 325 9th Ave., Box 359777, Seattle, WA, 98104, United States; Public Health--Seattle & King County, HIV/STD Program, 401 5th Ave., Seattle, WA, 98104, United States
| | - Pia M Mauro
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th St., New York, NY, 10032, United States
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Factors Associated With the Use of Supervised Consumption Facilities Among Women Who Inject Drugs in a Canadian Setting. J Addict Med 2020; 14:e226-e232. [PMID: 32142059 DOI: 10.1097/adm.0000000000000646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Supervised consumption facilities (SCFs) are evidence-based harm reduction interventions that have been shown to reduce the risk of social and health-related harms associated with injection drug use. Previous qualitative studies have highlighted important motivations for SCF use among women who use drugs. However, factors associated with SCF use among women have not previously been evaluated. METHODS Data were obtained from 2 longitudinal community-recruited cohorts of people who use drugs in Vancouver, Canada between 2003 and 2017. Multivariable generalized estimating equations were used to calculate the odds of SCF use associated with social and structural risk factors for drug-related harm among women who reported injection drug use in the preceding 6-months. RESULTS A total of 795 participants were included in the study, contributing to 6302 interviews, with 602 participants (76%) reporting SCF use in at least one interview. Multivariable analysis demonstrated daily heroin and crystal methamphetamine injection (Adjusted Odds Ratio [AOR] = 1.32 and 1.65, respectively), injecting in public (AOR = 1.77), binge injection (AOR = 1.22) and lack of housing (AOR = 1.74) to be associated with SCF use. CONCLUSIONS The current study demonstrates higher intensity patterns of drug use, including daily heroin and crystal methamphetamine injection, injecting in public and binge injection, as well as homelessness to be associated with SCF use among women. Future research should identify barriers to SCF use among women to minimize the risk of overdose and other drug-related harms.
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Nandakumar R, Gollakota S, Sunshine JE. Opioid overdose detection using smartphones. Sci Transl Med 2020; 11:11/474/eaau8914. [PMID: 30626717 DOI: 10.1126/scitranslmed.aau8914] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/05/2018] [Indexed: 12/20/2022]
Abstract
Early detection and rapid intervention can prevent death from opioid overdose. At high doses, opioids (particularly fentanyl) can cause rapid cessation of breathing (apnea), hypoxemic/hypercarbic respiratory failure, and death, the physiologic sequence by which people commonly succumb from unintentional opioid overdose. We present algorithms that run on smartphones and unobtrusively detect opioid overdose events and their precursors. Our proof-of- concept contactless system converts the phone into a short-range active sonar using frequency shifts to identify respiratory depression, apnea, and gross motor movements associated with acute opioid toxicity. We develop algorithms and perform testing in two environments: (i) an approved supervised injection facility (SIF), where people self-inject illicit opioids, and (ii) the operating room (OR), where we simulate rapid, opioid-induced overdose events using routine induction of general anesthesia. In the SIF (n = 209), our system identified postinjection, opioid-induced central apnea with 96% sensitivity and 98% specificity and identified respiratory depression with 87% sensitivity and 89% specificity. These two key events commonly precede fatal opioid overdose. In the OR, our algorithm identified 19 of 20 simulated overdose events. Given the reliable reversibility of acute opioid toxicity, smartphone-enabled overdose detection coupled with the ability to alert naloxone-equipped friends and family or emergency medical services (EMS) could hold potential as a low-barrier, harm reduction intervention.
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Affiliation(s)
- Rajalakshmi Nandakumar
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA 98195, USA
| | - Shyamnath Gollakota
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA 98195, USA.
| | - Jacob E Sunshine
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA 98195, USA.
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Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: A cohort study. PLoS Med 2019; 16:e1002964. [PMID: 31770391 PMCID: PMC6879115 DOI: 10.1371/journal.pmed.1002964] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) experience elevated rates of premature mortality. Although previous studies have demonstrated the role of supervised injection facilities (SIFs) in reducing various harms associated with injection drug use, including accidental overdose death, the possible impact of SIF use on all-cause mortality is unknown. Therefore, we examined the relationship between frequent SIF use and all-cause mortality among PWID in Vancouver, Canada. METHODS AND FINDINGS Data were derived from 2 prospective cohort studies of PWID in Vancouver, Canada, between December 2006 and June 2017. Every 6 months, participants completed questionnaires that elicited information regarding sociodemographic characteristics, substance use patterns, social-structural exposures, and use of health services including SIFs. These data were confidentially linked to the provincial vital statistics database to ascertain mortality rates and causes of death. We used multivariable extended Cox regression analyses to estimate the independent association between frequent (i.e., at least weekly) SIF use and all-cause mortality. Of 811 participants, 278 (34.3%) were women, and the median age was 39 years (IQR 33-46) at baseline. In total, 432 (53.3%) participants reported frequent SIF use at baseline, and 379 (46.7%) did not. At baseline, frequent SIF users were on average younger than nonfrequent users, and a higher proportion of frequent SIF users than nonfrequent users were unstably housed, resided in the Downtown Eastside neighbourhood, injected in public, had a recent non-fatal overdose, used prescription opioids at least daily, injected heroin at least daily, injected cocaine at least daily, and injected crystal methamphetamine at least daily. A lower proportion of frequent SIF users than nonfrequent users were HIV positive and enrolled in addiction treatment at baseline. The median duration of follow-up among study participants was 72 months (IQR 24-123). In total, 112 participants (13.8%) died during the study period, yielding a crude mortality rate of 22.7 (95% CI 18.7-27.4) deaths per 1,000 person-years. The median years of potential life lost per death was 34 (IQR 27-42) years. In a time-updated multivariable model, frequent SIF use was inversely associated with risk of all-cause mortality after adjusting for potential confounders, including age, sex, HIV seropositivity, unstable housing, at least daily cocaine injection, public injection, incarceration, enrolment in addiction treatment, and calendar year of interview (adjusted hazard ratio 0.46, 95% CI 0.26-0.80, p = 0.006). The main study limitations are the limited generalizability of findings due to non-random sampling, the potential for reporting biases due to reliance on some self-reported information, and the possibility that residual confounding influenced findings. CONCLUSIONS We observed a high burden of premature mortality among a community-recruited cohort of PWID. Frequent SIF use was associated with a lower risk of death, independent of relevant confounders. These findings support efforts to enhance access to SIFs as a strategy to reduce mortality among PWID. Further analyses of individual-level data are needed to determine estimates of, and potential causal pathways underlying, associations between SIF use and specific causes of death.
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Scheim A, Werb D. Integrating supervised consumption into a continuum of care for people who use drugs. CMAJ 2019; 190:E921-E922. [PMID: 30087127 DOI: 10.1503/cmaj.180824] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Ayden Scheim
- Centre on Drug Policy Evaluation (Scheim, Werb), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Division of Infectious Diseases and Global Public Health (Scheim, Werb), University of California San Diego School of Medicine, La Jolla, Calif.; Institute of Health Policy, Management and Evaluation (Werb), University of Toronto, Toronto, Ont.
| | - Dan Werb
- Centre on Drug Policy Evaluation (Scheim, Werb), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Division of Infectious Diseases and Global Public Health (Scheim, Werb), University of California San Diego School of Medicine, La Jolla, Calif.; Institute of Health Policy, Management and Evaluation (Werb), University of Toronto, Toronto, Ont
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Park JN, Sherman SG, Rouhani S, Morales KB, McKenzie M, Allen ST, Marshall BDL, Green TC. Willingness to Use Safe Consumption Spaces among Opioid Users at High Risk of Fentanyl Overdose in Baltimore, Providence, and Boston. J Urban Health 2019; 96:353-366. [PMID: 31168735 PMCID: PMC6565790 DOI: 10.1007/s11524-019-00365-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Safe consumption spaces (SCS) are evidence-based interventions that reduce drug-related morbidity and mortality operating in many countries. However, SCS are yet to be widely implemented in the USA despite the escalating overdose epidemic. The aim of this multi-city study was to identify the factors associated with willingness to use a SCS among people who use drugs (PWUD) in Baltimore, Providence, and Boston, stratified by injection drug use status. Our secondary aim was to characterize the anticipated barriers to accessing SCS if they were to be implemented in these cities. PWUD were invited to complete a cross-sectional survey in 2017. The analysis was restricted to 326 opioid users (i.e., heroin, fentanyl, and non-medical opioid pill use). The majority (77%) of participants expressed willingness to use a SCS (Baltimore, 78%; Providence, 68%; Boston. 84%). Most respondents were male (59%), older than 35 years (76%), non-white (64%), relied on public/semi-public settings to inject (60%), had a history of overdose (64%), and recently suspected fentanyl contamination of their drugs (73%). A quarter (26%) preferred drugs containing fentanyl. Among injectors, female gender, racial minority status, suspicion of drugs containing fentanyl, and drug use in public/semi-public settings were associated with higher willingness to use a SCS; prior arrest was associated with lower willingness. Among non-injectors, racial minority status, preference for fentanyl, and drug use in public/semi-public settings were associated with higher willingness, whereas recent overdose held a negative association. The most commonly anticipated barriers to accessing a SCS in the future were concerns around arrest (38%), privacy (34%), confidentiality/trust/safety (25%), and cost/time/transportation (16%). These data provide evidence of high SCS acceptability among high-risk PWUD in the USA, including those who prefer street fentanyl. As SCS are implemented in the USA, targeted engagement efforts may be required to reach individuals exposed to the criminal justice system.
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Affiliation(s)
- Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saba Rouhani
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth B Morales
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle McKenzie
- Miriam Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sean T Allen
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Emergency Medicine, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Navarro S, Kral AH, Strike CS, Simpson K, Wenger L, Bluthenthal RN. Factors Associated with Frequency of Recent Initiation of Others into Injection Drug Use Among People Who Inject Drugs in Los Angeles and San Francisco, CA, USA, 2016-17. Subst Use Misuse 2019; 54:1715-1724. [PMID: 31046508 PMCID: PMC6863088 DOI: 10.1080/10826084.2019.1608252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Drug injection initiation is often assisted by a person who injects drugs (PWID). How often PWID provide this assistance has not been examined. We examine frequency of injection initiation assistance and factors associated with high (4+) and low frequency (1-3) initiation assistance as compared to no initiation assistance among PWID. Methods: Participants were 979 Californian PWID. PWID were interviewed about providing injection initiation assistance in the last 6 months among other items. Multinomial regression analysis was used to examine factors associated with levels of frequency of injection initiation assistance. Results: Among participants, 132 (14%) had initiated 784 people into injection (mean = 5.94 [standard deviation = 20.13]; median = 2, interquartile range = 1,4) in the last 6 months. PWID engaged in high frequency initiation (26% of sample) assisted 662 new initiates (84% of total). Using multinomial regression analysis with no initiating as the referent group, we found that high frequency initiating was statistically associated with higher injection frequency, having a paying sex partner, taking someone to a shooting gallery, and providing injection assistance. Lower frequency initiation was statistically associated with having a paying sex partner, illegal income source, and providing injection assistance. Conclusion: Differences between high and low frequency initiators were not found. Sex work and assisting with drug injection were linked to initiating others. Individual-level interventions that reduce this behavior among PWID and structural interventions such as safe consumption sites and opioid medication treatments that interrupt the social process of injection initiation should be considered as ways to reduce injection initiations.
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Affiliation(s)
- Stephanie Navarro
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033
| | - Alex H. Kral
- Behavioral Health Research Division, RTI International, 351 California Street, Suite 500, San Francisco, CA 94104
| | - Carol S. Strike
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada M5T 3M7
| | - Kelsey Simpson
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N Soto St, 3rd floor, Los Angeles, CA 90033
| | - Lynn Wenger
- Behavioral Health Research Division, RTI International, 351 California Street, Suite 500, San Francisco, CA 94104
| | - Ricky N. Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N Soto St, 3rd floor, Los Angeles, CA 90033
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Bardwell G, Strike C, Altenberg J, Barnaby L, Kerr T. Implementation contexts and the impact of policing on access to supervised consumption services in Toronto, Canada: a qualitative comparative analysis. Harm Reduct J 2019; 16:30. [PMID: 31046759 PMCID: PMC6498561 DOI: 10.1186/s12954-019-0302-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/17/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Supervised consumption services (SCS) are being implemented across Canada in response to a variety of drug-related harms. We explored the implementation context of newly established SCS in Toronto and the role of policing in shaping program access by people who inject drugs (PWID). METHODS We conducted one-to-one qualitative semi-structured interviews with 24 PWID. Participants were purposively recruited. Ethnographic observations were conducted at each of the study sites as well as in their respective neighbourhoods. Relevant policy documents were also reviewed. RESULTS Policing was overwhelmingly discussed by participants from both SCS sites. However, participant responses varied depending on the site in question. Subthemes from participant responses on policing at site #1 described neighbourhood police presence and fears of police harassment and drug arrests before, during, or after accessing SCS. Conversely, subthemes from participant responses on policing at site #2 described immunity and protection from police while using the SCS, as well as a lack of police presence or fears of police harassment and arrests. These differences in implementation contexts were largely shaped by differences in local neighbourhoods and drug scenes. Police policies highlighted federal laws protecting PWID within SCS, but also the exercise of discretion when applying the rule of law outside of these settings. CONCLUSIONS Participants' perspectives on, and experiences with, policing as they relate to accessing SCS were shaped by the implementation contexts of each SCS site and how neighbourhoods, drug scenes, and differences in policing practices affected service use. Our findings also demonstrate the disconnect between the goals of policing and those of SCS. Until larger structural barriers are addressed (e.g. criminalization), future SCS programming should consider the impact of policing on the SCS implementation context to improve client experience with, and access to, SCS.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Carol Strike
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3 M7, Canada
| | - Jason Altenberg
- South Riverdale Community Health Centre, 955 Queen Street East, Toronto, ON, M4M 3P3, Canada
| | - Lorraine Barnaby
- Parkdale Queen West Community Health Centre, 168 Bathurst Street, Toronto, ON, M5V 2R4, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
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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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Kennedy-Hendricks A, Bluestein J, Kral AH, Barry CL, Sherman SG. Establishing Sanctioned Safe Consumption Sites in the United States: Five Jurisdictions Moving the Policy Agenda Forward. Psychiatr Serv 2019; 70:294-301. [PMID: 30755131 DOI: 10.1176/appi.ps.201800398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Safe consumption sites enable use of preobtained drugs in hygienic settings where trained staff are available to respond to overdoses and connect individuals with health and social services. This study examined efforts to advance policies to establish safe consumption sites in the United States, where no sanctioned sites exist. METHODS Between April and July 2018, the authors conducted 25 telephone interviews with a purposive sample of key informants in five communities considering safe consumption site implementation. Participants included organizers and advocates, government officials, and personnel with social service and health organizations. Interview notes were analyzed by using hybrid inductive-deductive coding. RESULTS Key strategies for organizing support for safe consumption sites included involving people who use drugs, engaging diverse partners, supporting allies in related causes, and using various tactics to garner support from policy makers. Major barriers to adoption included identifying the right locations, uncertainty about the federal response, mistrust arising from racial injustice in drug policy, and financing. Participants identified facilitators of progress toward safe consumption site adoption, such as building on existing harm reduction programs, securing political champions, and exposing community officials to programs operating internationally. CONCLUSIONS A window of opportunity may be opening to advance policy related to safe consumption sites; whether sanctioned sites become part of the broader policy strategy for addressing drug use and overdose in the United States will depend on the experiences of the first sites. Organizing around this issue may facilitate engagement among people who use drugs in broader conversations about drug policy.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
| | - Jenna Bluestein
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
| | - Alex H Kral
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
| | - Colleen L Barry
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
| | - Susan G Sherman
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
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Mitra S, Rachlis B, Krysowaty B, Marshall Z, Olsen C, Rourke S, Kerr T. Potential use of supervised injection services among people who inject drugs in a remote and mid-size Canadian setting. BMC Public Health 2019; 19:284. [PMID: 30849946 PMCID: PMC6408761 DOI: 10.1186/s12889-019-6606-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 02/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While supervised injection services (SIS) feasibility research has been conducted in large urban centres across North America, it is unknown whether these services are acceptable among people who inject drugs (PWID) in remote, mid-size cities. We assessed willingness to use SIS and expected frequency of SIS use among PWID in Thunder Bay, a community in Northwestern, Ontario, Canada, serving people from suburban, rural and remote areas of the region. METHODS Between June and October 2016, peer research associates administered surveys to PWID. Sociodemographic characteristics, drug use and behavioural patterns associated with willingness to use SIS and expected frequency of SIS use were estimated using bivariable and multivariable logistic regression models. Design preferences and amenities identified as important to provide alongside SIS were assessed descriptively. RESULTS Among 200 PWID (median age, IQR: 35, 28-43; 43% female), 137 (69%) reported willingness to use SIS. In multivariable analyses, public injecting was positively associated with willingness to use (Adjusted Odds Ratio (AOR): 4.15; 95% confidence interval (CI): 2.08-8.29). Among those willing to use SIS, 87 (64%) said they would always/usually use SIS, while 48 (36%) said they would sometime/occasionally use SIS. In multivariable analyses, being female (AOR: 2.44; 95% CI: 1.06-5.65) and reporting injecting alone was positively associated with higher expected frequency of use (AOR: 2.59; 95% CI: 1.02-6.58). CONCLUSIONS Our findings suggest that SIS could play a role in addressing the harms of injection drug use in remote and mid-sized settings particularly for those who inject in public, as well as women and those who inject alone, who report higher expected frequency of SIS use. Design preferences of local PWID, in addition to differences according to gender should be taken into consideration to maximize the uptake of SIS, alongside existing health and social service provisions available to PWID.
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Affiliation(s)
- Sanjana Mitra
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, H.R. MacMillan Building, Vancouver, BC V6T 1Z4 Canada
| | - Beth Rachlis
- Institute for Clinical and Evaluative Sciences, 2075 Bayview Avenue, G172, Toronto, ON M4N 3M5 Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
| | - Bonnie Krysowaty
- Lakehead Social Planning Council, #38-125 Syndicate Avenue South, Thunder Bay, ON P7E 6H8 Canada
| | - Zack Marshall
- School of Social Work, McGill University, 3506 University Street, Room 300, Montreal, QC H3A 2A7 Canada
| | - Cynthia Olsen
- Thunder Bay Drug Strategy, City of Thunder Bay, 500 Donald Street East, P.O. Box 800, Thunder Bay, ON P7C 2K4 Canada
| | - Sean Rourke
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 209 Victoria Street, 3rd Floor, Toronto, ON M5B 1T8 Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8 Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
- Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
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Auriacombe M, Roux P, Briand Madrid L, Kirchherr S, Kervran C, Chauvin C, Gutowski M, Denis C, Carrieri MP, Lalanne L, Jauffret-Roustide M. Impact of drug consumption rooms on risk practices and access to care in people who inject drugs in France: the COSINUS prospective cohort study protocol. BMJ Open 2019; 9:e023683. [PMID: 30796121 PMCID: PMC6398695 DOI: 10.1136/bmjopen-2018-023683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 12/27/2018] [Accepted: 01/04/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The high prevalence of hepatitis C and the persistence of HIV and hepatitis C virus (HCV) risk practices in people who inject drugs (PWID) in France underlines the need for innovative prevention interventions. The main objective of this article is to describe the design of the COSINUS cohort study and outline the issues it will explore to evaluate the impact of drug consumption rooms (DCR) on PWID outcomes. Secondary objectives are to assess how DCR (a) influence other drug-related practices, such as the transition from intravenous to less risky modes of use, (b) reduce drug use frequency/quantity, (c) increase access to treatment for addiction and comorbidities (infectious, psychiatric and other), (d) improve social conditions and (e) reduce levels of violence experienced and drug-related offences. COSINUS will also give us the opportunity to investigate the impact of other harm reduction tools in France and their combined effect with DCR on reducing HIV-HCV risk practices. Furthermore, we will be better able to identify PWID needs. METHODS AND ANALYSIS Enrollment in this prospective multi-site cohort study started in June 2016. Overall, 680 PWID in four different cities (Bordeaux, Marseilles, Paris and Strasbourg) will be enrolled and followed up for 12 months through face-to-face structured interviews administered by trained staff to all eligible participants at baseline (M0), 3 month (M3), 6 month (M6) and 12 month (M12) follow-up visits. These interviews gather data on socio-demographic characteristics, past and current drug and alcohol consumption, drug-use related practices, access to care and social services, experience of violence (as victims), offences, other psychosocial issues and perception and needs about harm reduction interventions and services. Longitudinal data analysis will use a mixed logistic model to assess the impact of individual and structural factors, including DCR attendance and exposure to other harm reduction services, on the main outcome (HIV-HCV risk practices). ETHICS AND DISSEMINATION This study was reviewed and approved by the institutional review board of the French Institute of Medical Research and Health (opinion number: 14-166). The findings of this cohort study will help to assess the impact of DCR on HIV-HCV risk practices and other psycho-social outcomes and trajectories. Moreover, they will enable health authorities to shape health and harm reduction policies according to PWID needs. Finally, they will also help to improve current harm reduction and therapeutic interventions and to create novel ones.
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Affiliation(s)
- Marc Auriacombe
- University of Bordeaux, Bordeaux, Aquitaine, France
- Addiction Team, SANPSY, CNRS USR 3413, Bordeaux, France
- Department of Psychiatry, University of Pennsylvania Center for Studies of Addiction, Philadelphia, Pennsylvania, USA
- Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Laélia Briand Madrid
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Sébastien Kirchherr
- Department of Psychiatry and Addictology, INSERM 1114, University Hospital of Strasbourg, Strasbourg, France
| | - Charlotte Kervran
- University of Bordeaux, Bordeaux, Aquitaine, France
- Addiction Team, SANPSY, CNRS USR 3413, Bordeaux, France
| | - Carole Chauvin
- CERMES3 (INSERM U988/UMR CNRS 8211/EHESS/Paris Descartes University), Paris, France
| | - Marie Gutowski
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Cécile Denis
- Addiction Team, SANPSY, CNRS USR 3413, Bordeaux, France
- Department of Psychiatry, University of Pennsylvania Center for Studies of Addiction, Philadelphia, Pennsylvania, USA
| | - Maria Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Laurence Lalanne
- INSERM U1114, Strasbourg, Alsace, France
- Department of Psychiatry and Addictology, Hopitaux universitaires de Strasbourg, Strasbourg, France
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Jiao S. Harm reduction: Philosophical drivers of conceptual tensions and ways forward. Nurs Inq 2019; 26:e12286. [PMID: 30773745 DOI: 10.1111/nin.12286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 11/29/2022]
Abstract
Of the various debates surrounding harm reduction, a conceptual tension that perhaps has the most relevance for the provision of services is that of harm reduction as a technical solution versus a contextualized social practice. The aim of this paper was to examine this conceptual tension. First, the two perspectives will be presented through the use of examples. Second, philosophical drivers that serve to underpin and justify each perspective will be explicated at the level of the knowledge that we privilege; the ideologies that we subscribe to; and the interests that we stand to serve. In this paper, I argue that the existing tension between technical and social approaches to harm reduction is embedded within discord pertaining to ways of knowing, paradigms of inquiry, prevailing ideologies, and notions of harm and risk. Building on these sources of tension, I suggest a means of philosophical reconciliation between the two approaches and ways forward, namely through acknowledging multiple sources of knowledge, through embracing paradigmatic incommensurability, through considering alternative conceptions of people who use drugs as political subjects, through involving service providers and end-users in shared decision-making, and lastly through reaffirming people who use drugs as the intended beneficiaries of services.
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Affiliation(s)
- Sunny Jiao
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Sutter A, Curtis M, Frost T. Public drug use in eight U.S. cities: Health risks and other factors associated with place of drug use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 64:62-69. [DOI: 10.1016/j.drugpo.2018.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
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Abstract
The US is facing dual public health crises related to opioid overdose deaths and HIV. Injection drug use is fueling both of these epidemics. The War on Drugs has failed to stem injection drug use and has contributed to mass incarceration, poverty, and racial disparities. Harm reduction is an alternative approach that seeks to decrease direct and indirect harms associated with drug use without necessarily decreasing drug consumption. Although overwhelming evidence demonstrates that harm reduction is effective in mitigating harms associated with drug use and is cost-effective in providing these benefits, harm reduction remains controversial and the ethical implications of harm reduction modalities have not been well explored. This paper analyzes harm reduction for injection drug use using the core principles of autonomy, nonmaleficence, beneficence, and justice from both clinical ethics and public health ethics perspectives. This framework is applied to harm reduction modalities currently in use in the US, including opioid maintenance therapy, needle and syringe exchange programs, and opioid overdose education and naloxone distribution. Harm reduction interventions employed outside of the US, including safer injection facilities, heroin-assisted treatment, and decriminalization/legalization are then discussed. This analysis concludes that harm reduction is ethically sound and should be an integral aspect of our nation's healthcare system for combating the opioid crisis. From a clinical ethics perspective, harm reduction promotes the autonomy of, prevents harms to, advances the well-being of, and upholds justice for persons who use drugs. From a public health ethics perspective, harm reduction advances health equity, addresses racial disparities, and serves vulnerable, disadvantaged populations in a cost-effective manner.
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McPhee I, Sheridan B, O’Rawe S. Time to look beyond ageing as a factor? Alternative explanations for the continuing rise in drug related deaths in Scotland. DRUGS AND ALCOHOL TODAY 2018. [DOI: 10.1108/dat-06-2018-0030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to examine the reasons and risk factors that explain the threefold increase in drug-related deaths from 267 in 1996 to 934 in 2017 in Scotland. The authors explore the known links between deprivation and problem drug use (PDU) and discuss the impact of drug policy and service provision on PDU and drug-related deaths.
Design/methodology/approach
Using quantitative data sets from the National Records of Scotland (NRS) for drug-related deaths registered in 2017 and data sets from the Scottish Index of Multiple Deprivation (SIMD), we produce statistical data on mortality rates relating to areas of deprivation, gender and age.
Findings
The data highlight the disproportionate number of deaths in the most deprived areas in comparison to the least deprived areas and the national average. Findings indicate that one quarter of male and female DRD in 2017 were under 35. When examining the least deprived vingtile, drug-related deaths account for 2.84 per 100,000 population. Based on this mortality rate calculation, the amount of drug-related deaths are 23 times higher in the most deprived area than the least deprived area.
Research limitations/implications
The research design uses data obtained from the NRS and data from Scottish Multiple Index of Deprivation. Due to the limitations of available data, the research design focused on SIMD population vingtiles.
Practical implications
This research contributes to making unarguable links between entrenched structural inequality and increased drug-related death.
Social implications
This paper contributes to knowledge on the need for drug policy advisors to recognise the importance of deprivation that plays a major part in risks of problematic drug use and harms.
Originality/value
While several national data sets have published information by SIMD vingtile, no published research has sought to investigate the disproportionate number of deaths by population in the most deprived areas.
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Reddon H, Marshall BDL, Milloy MJ. Elimination of HIV transmission through novel and established prevention strategies among people who inject drugs. Lancet HIV 2018; 6:e128-e136. [PMID: 30558843 DOI: 10.1016/s2352-3018(18)30292-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/01/2018] [Accepted: 10/12/2018] [Indexed: 11/16/2022]
Abstract
Despite the effectiveness of existing HIV prevention strategies for people who inject drugs (PWID), uncontrolled outbreaks of HIV among this group are common and occur around the world. In this Review, we summarise recent evidence for novel and established HIV prevention approaches to eliminate HIV transmission among PWID. Effective HIV prevention strategies include mobile needle and syringe programmes, pre-exposure prophylaxis, supervised injection facilities, and, to a lesser extent, some behavioural interventions. Studies have also shown the cost-effectiveness of long-standing HIV prevention strategies including needle and syringe programmes, opioid agonist therapy, and antiretroviral therapy for prevention. Although each individual intervention can reduce the risk of HIV acquisition among PWID, there is a consensus that a combination of approaches is required to achieve substantial and durable reductions in HIV transmission. Unfortunately, in many settings, the implementation of these interventions is often limited by public and political opposition that manifests as structural barriers to HIV prevention, such as the criminalisation of drug use. Given that there is ample evidence showing the effectiveness of several HIV prevention methods, social and political advocacy will be needed to overcome these barriers and integrate innovative HIV prevention approaches with addiction science to create effective drug policies.
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Affiliation(s)
- Hudson Reddon
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - 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.
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Wolfson-Stofko B, Elliott L, Bennett AS, Curtis R, Gwadz M. Perspectives on supervised injection facilities among service industry employees in New York City: A qualitative exploration. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 62:67-73. [PMID: 30359875 PMCID: PMC6279482 DOI: 10.1016/j.drugpo.2018.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 08/08/2018] [Accepted: 08/21/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Approximately 100 supervised injection facilities (SIFs) operate in 66 cities around the world to reduce overdose deaths, the spread of disease and public disorder, though none legally exist in the United States. Public bathrooms are among the most common public places for injection reported by people who inject drugs in New York City (NYC) and service industry employees (SIEs) inadvertently become first-responders when overdoses occur in business bathrooms. The goal of this study was to assess SIE acceptability of SIFs and the perceived effects that SIFs would have on them, their colleagues, their businesses and communities. METHODS Semi-structured qualitative interviews were conducted with 15 SIEs recruited through convenience sampling throughout NYC. Participants were provided with peer-reviewed scientific evidence prior to discussing SIFs. Data were analysed using a hybrid deductive and inductive approach. RESULTS Most SIEs had encountered drug use (93%, n = 14/15) and syringes (73%, n = 11/15) in their business bathrooms and three had encountered unresponsive individuals. Nearly all workers (93%, n = 14/15) were supportive of SIFs and believed SIFs would reduce injection drug use in their business bathrooms. Participants also believed that 'not in my backyard' arguments from community boards may impede SIF operation. CONCLUSIONS Service industry employees are critical stakeholders due to their exposure to occupational health hazards related to public injection. Those interviewed were amenable to SIF operation as a form of occupational harm reduction and their experiences provide an important dimension to the political debate surrounding SIFs.
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Affiliation(s)
- Brett Wolfson-Stofko
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, United States; National Development & Research Institute, Center on Community and Health Disparities Research, 71 W. 23rd St, 4th Fl, New York, NY, 10010, United States.
| | - Luther Elliott
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, United States; National Development & Research Institute, Center on Community and Health Disparities Research, 71 W. 23rd St, 4th Fl, New York, NY, 10010, United States
| | - Alex S Bennett
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, United States; National Development & Research Institute, Center on Community and Health Disparities Research, 71 W. 23rd St, 4th Fl, New York, NY, 10010, United States
| | - Ric Curtis
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, United States; John Jay College of Criminal Justice, City University of New York, Department of Law, Police Science and Criminal Justice Administration, Department of Anthropology, 524 W. 59th St, New York, NY, 10019, United States
| | - Marya Gwadz
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, United States
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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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Drug consumption rooms in Catalonia: A comprehensive evaluation of social, health and harm reduction benefits. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 62:24-29. [PMID: 30352331 DOI: 10.1016/j.drugpo.2018.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/06/2018] [Accepted: 09/23/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Despite the availability of several drug consumption rooms (DCR) in different European countries few epidemiological studies have evaluated their benefits. A network of DCR for people who inject drugs (PWID) has existed in Catalonia since 2000. We aimed to study the impact of frequently attending DCR on injecting in public, infectious risk (disposal of used syringes in safe places, sharing needles and/or injecting equipment), accessing drug dependence services and non-fatal overdoses. METHODS In 2014-2015, we performed the cross-sectional study REDAN in Catalonia's network of harm reduction centres (needle exchange programs, outreach programs, and DCR). A sample of current PWID were recruited. Self-reported data about risky and other behaviours and about access to care were collected through anonymous face-to-face structured interviews. Oral fluid samples were also collected to test for HIV and HCV antibodies. Multiple logistic regressions were used to assess the impact of frequently attending DCR on the different outcomes. RESULTS Among the 730 PWID recruited, 510 reported attending DCR in the previous 6 months, of whom 21·2% were 'frequent' attenders. After multiple adjustment, frequent attenders had a 61% lower risk of injecting in public (AOR [95%CI]:0·39[0·18-0·85]) and sharing needles or other injecting equipment (0·39[0·18-0·85]) than 'medium' and 'low' attenders. They were six times more likely to place used syringes in a safe place (6·08[3·62-10·23]) and were twice as likely to access drug dependence services (2·56[1·44-4·55]). No significant effect was found for non-fatal overdoses, perhaps because of survival bias. CONCLUSION The multiple benefits found strongly advocate for the maintenance of current DCR and the promotion of new DCR, in conjunction with other harm reduction strategies, in European countries where they are not yet available.
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O'Keefe D, Aitken C, Scott N, Dietze P. Analysis of time of drug use according to needle and syringe program operating hours in Melbourne, Australia: Effects on individual-level needle and syringe coverage. Drug Alcohol Depend 2018; 191:259-265. [PMID: 30153607 DOI: 10.1016/j.drugalcdep.2018.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Restricted needle and syringe program (NSP) operating hours in Australia have been reported as a barrier to access for people who inject drugs (PWID). We explored the prevalence of drug use occurring outside NSP operating hours with a particular focus on its impacts on individual-level needle and syringe coverage. METHODS Using data from 584 participants in a cohort of PWID in Melbourne, Australia, we analyzed time and day of drug use for heroin, methamphetamine and pharmaceutical opioids. We related this drug use to the typical operating times of Melbourne's fixed-site NSPs, categorizing drug use as either "in-hours" or "out-of-hours". We explored associations with out-of-hours drug use using a generalized linear mixed model of pooled longitudinal data. RESULTS 23% of heroin use and 50% of methamphetamine use occurred out-of-hours. In regression analysis, males and those injecting in public locations had significantly reduced odds of out-of-hours drug use. Those currently employed and those using methamphetamine (compared to heroin) had significantly increased odds of out-of-hours drug use. There was no significant association between individual-level needle and syringe coverage and hours of drug use. CONCLUSIONS Deficiencies in individual-level needle and syringe coverage may not be due to restricted NSP operating hours. Instead, insufficient coverage may be the result of other factors in the lives of PWID or other NSP access difficulties. These preliminary results suggest improvements to coverage in Australia may not result from increased hours of NSP operation, but instead via improvements to client targeting.
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Affiliation(s)
- Daniel O'Keefe
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Campbell Aitken
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Nick Scott
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
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Belackova V, Salmon AM, Schatz E, Jauncey M. Drug consumption rooms (DCRs) as a setting to address hepatitis C - findings from an international online survey. HEPATOLOGY, MEDICINE AND POLICY 2018; 3:9. [PMID: 30288332 PMCID: PMC6103962 DOI: 10.1186/s41124-018-0035-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 07/27/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Prevalence of Hepatitis C Virus (HCV) among people who inject drugs (PWID) is high. Risky injecting behaviours have been found to decrease in drug consumption rooms (DCRs) and supervised injecting facilities (SIFs), yet HCV prevention and treatment in these settings have not been extensively explored. METHODS To determine the range and scope of HCV prevention and treatment options in these services, we assessed DCR/SIF operational features, their clients' characteristics and the HCV-related services they provide. A comprehensive online survey was sent to the managers of the 91 DCRs/SIFs that were operating globally as of September 2016. A descriptive cross-country analysis of the main DCR/SIF characteristics was conducted and bivariate logistic models were used to assess factors associated with enhanced HCV service provision. RESULTS Forty-nine valid responses were retrieved from DCRs/SIFs in all countries where they were established at the time of the survey (Australia, Canada, Denmark, France, Germany, Luxembourg, Netherlands, Norway, Spain and Switzerland). Internationally, the operational capacities of DCRs/SIFs varied in terms of funding, location, size and staffing, but their clients all shared common features of vulnerability and marginalisation. Estimated HCV prevalence rates were around 60%. Among a range of health and social services and referrals to other programs, most DCRs/SIFs provided HCV testing onsite (65%) and/or offered liver monitoring or disease management (54%). HCV treatment onsite was offered or was planned to be offered by 21% of DCRs/SIFs. HCV testing onsite was associated with provision of other services addressing blood-borne diseases and HCV treatment was linked to the provision of OST. HCV disease management was associated with employing a nurse at a DCR/SIF and HCV treatment was associated with employing a medical doctor. CONCLUSIONS DCRs/SIFs offer easy-to-access HCV-related services for PWID. The availability of onsite medical professionals and provision of support and education to non-medical staff are key to enhanced provision of HCV-related services in DCRs/SIFs. Funding and support for HCV treatment at the community level, via low-threshold services such as DCRs/SIFs, are worthy of action.
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Affiliation(s)
- Vendula Belackova
- Uniting Sydney Medically Supervised Injecting Centre (MSIC), Sydney, Australia
| | - Allison M. Salmon
- Uniting Sydney Medically Supervised Injecting Centre (MSIC), Sydney, Australia
| | - Eberhard Schatz
- Correlation network, Foundation De Regenboog Groep, Amsterdam, The Netherlands
| | - Marianne Jauncey
- Uniting Sydney Medically Supervised Injecting Centre (MSIC), Sydney, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW Australia
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Trayner KMA, Weir A, McAuley A, Godbole G, Amar C, Grant K, Penrice G, Roy K. A pragmatic harm reduction approach to manage a large outbreak of wound botulism in people who inject drugs, Scotland 2015. Harm Reduct J 2018; 15:36. [PMID: 29996865 PMCID: PMC6042261 DOI: 10.1186/s12954-018-0243-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/05/2018] [Indexed: 11/12/2022] Open
Abstract
Background People who inject drugs (PWID) are at an increased risk of wound botulism, a potentially fatal acute paralytic illness. During the first 6 months of 2015, a large outbreak of wound botulism was confirmed among PWID in Scotland, which resulted in the largest outbreak in Europe to date. Methods A multidisciplinary Incident Management Team (IMT) was convened to conduct an outbreak investigation, which consisted of enhanced surveillance of cases in order to characterise risk factors and identify potential sources of infection. Results Between the 24th of December 2014 and the 30th of May 2015, a total of 40 cases were reported across six regions in Scotland. The majority of the cases were male, over 30 and residents in Glasgow. All epidemiological evidence suggested a contaminated batch of heroin or cutting agent as the source of the outbreak. There are significant challenges associated with managing an outbreak among PWID, given their vulnerability and complex addiction needs. Thus, a pragmatic harm reduction approach was adopted which focused on reducing the risk of infection for those who continued to inject and limited consequences for those who got infected. Conclusions The management of this outbreak highlighted the importance and need for pragmatic harm reduction interventions which support the addiction needs of PWID during an outbreak of spore-forming bacteria. Given the scale of this outbreak, the experimental learning gained during this and similar outbreaks involving spore-forming bacteria in the UK was collated into national guidance to improve the management and investigation of future outbreaks among PWID.
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Affiliation(s)
- Kirsten M A Trayner
- Health Protection Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland. .,Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland.
| | - Amanda Weir
- Health Protection Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland
| | - Andrew McAuley
- Health Protection Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland.,Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland
| | - Gauri Godbole
- Gastrointestinal Bacteria Reference Unit (GBRU), National Infection Service, Public Health England, London, England
| | - Corinne Amar
- Gastrointestinal Bacteria Reference Unit (GBRU), National Infection Service, Public Health England, London, England
| | - Kathie Grant
- Gastrointestinal Bacteria Reference Unit (GBRU), National Infection Service, Public Health England, London, England
| | - Gillian Penrice
- Public Health Protection Unit, Gartnavel Royal Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | - Kirsty Roy
- Health Protection Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland
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