TY - JOUR
T1 - Supervised consumption service use and recent non-fatal overdose among people who inject drugs in Toronto, Canada
AU - Scheim, Ayden I.
AU - Bouck, Zachary
AU - Tookey, Paula
AU - Hopkins, Shaun
AU - Sniderman, Ruby
AU - McLean, Elizabeth
AU - Garber, Gary
AU - Baral, Stefan
AU - Rourke, Sean B.
AU - Werb, Dan
N1 - Funding Information:
We wish to thank our research participants for their invaluable contributions to the study. This research was funded by the Canadian Institutes of Health Research (PJT-153152) and the St. Michael's Hospital Foundation. We thank the members of the Ontario Integrated Supervised Injection Services Research Program including Sean B. Rourke, Stefan Baral, Gary Garber, Lynne Leonard, Ayden Scheim, Thomas Kerr, Dan Werb, Elizabeth McLean, Ruby Sniderman, Jean Bacon, Geoff Bardwell, Tara Gomes, Mary-Clare Kennedy, Zack Marshall, Margaret Millson, Sanjana Mitra, Beth Rachlis, Carol Strike, and Kednapa Thavorn. Dan Werb is supported by a CIHR New Investigator Salary Award, an Ontario Ministry of Research Innovation and Science Early Research Award, and the St. Michael's Hospital Foundation.
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2021/1
Y1 - 2021/1
N2 - 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.
AB - 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.
KW - Cohort studies
KW - Injection drug use
KW - Overdose
KW - Supervised injection
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U2 - 10.1016/j.drugpo.2020.102993
DO - 10.1016/j.drugpo.2020.102993
M3 - Article
C2 - 33160158
AN - SCOPUS:85095419254
SN - 0955-3959
VL - 87
JO - International Journal of Drug Policy
JF - International Journal of Drug Policy
M1 - 102993
ER -