Supervised Injecting Facilities Associated with a Reduction in Overdose Mortality

Supervised injecting facilities (SIFs) have the potential to improve access to health care and drug treatment and reduce needle sharing and overdose deaths. This study used coroner death reports and census data to examine the impact of a newly established SIF in Vancouver, Canada, on illicit-drug overdose mortality in the surrounding area, where 70% of the clients resided. The SIF provided clean needles, referral to primary health services, and emergency care but did not provide any drugs. Mortality data for the period before establishment of the SIF (January 2001–September 2003) and after (September 2003–December 2005) were compared.

• In the city blocks within 500 meters (0.31 miles) of the SIF, overdose mortality declined from 254 to 165 deaths per 100,000 person-years (a decline of 35%).

• In the remainder of Vancouver, overdose mortality declined from 7.6 to 6.9 deaths per 100,000 person-years (not significant).

• There was no change in enrollment in methadone maintenance programs in any Vancouver area before or after establishment of the SIF.

Comments:

Despite its pre/post design, this study provides evidence that SIFs are associated with reduced overdose deaths, which is only 1 of a number of potential benefits. The authors did not address the main argument against these facilities, which is that they may encourage injection drug use, but the fact that overdose deaths did not increase in other areas is reassuring.

Darius A. Rastegar, MD

Reference:

Marshall BD, Milloy MJ, Wood E, et al. Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. Lancet. 2011;377(9775):1429–1437.