Vancouver’s First Supervised Injection Site - Video

Via:  https://goo.gl/dFNMVW

Use of a Medically Supervised Injection Facility among Street Youth

Purpose

Supervised injecting facilities (SIFs) provide a sanctioned space for injection drug users and are associated with decreased overdose mortality and HIV risk behaviors among adults. Little is known about SIF use among youth. We identified factors associated with use of the Vancouver SIF, the only such facility in North America, among street youth.

Methods

From September 2005 to May 2012, we collected data from the At-Risk Youth Study (ARYS), a prospective cohort of street youth in Vancouver, Canada. Eligible youth were aged 14–26 years. Participants reporting injection completed questionnaires at baseline and semiannually. We used generalized estimating equation logistic regression to identify factors associated with SIF use.

Results

During the study period, 42.3% of 414 injecting youth reported use of the SIF at least once. Of all SIF-using youth, 51.4% went to the facility at least weekly, and 44.5% used it for at least one-quarter of all injections. SIF-using youth were more likely to live or spend time in the neighborhood surrounding the SIF, to inject in public, or to engage in daily injection of heroin, cocaine, or crystal methamphetamine.

Conclusions

This study, the first examining SIF use among street youth in North America, demonstrated that the facility attracted high-frequency young drug users most at risk of blood-borne infection and overdose, and those that otherwise inject in public spaces.

TABLE 1

Characteristicsa of 414 actively injecting youth, according to use of a supervised injection facility (SIF) in the preceding 6 months: At-Risk Youth Study (ARYS), Vancouver, British Columbia, 2005–2012.

	Recent SIF Use
Characteristic	Yes (%) (n = 175)	No (%) (n = 239)	OR (95% CI)	p Value
Sociodemographic factors
Median age, years (IQR)	23.4 (21.5, 25.1)	22.7 (20.4, 24.5)	1.14 (1.05 – 1.22)	0.003
Male	112 (64.0)	162 (67.8)	0.85 (0.56 – 1.27)	0.422
Aboriginal ancestry	45 (25.7)	50 (20.9)	1.31 (0.83 – 2.07)	0.252
High school education	67 (40.4)	94 (39.8)	1.02 (0.68 – 1.53)	0.915
Spent time in DTESc,d	143 (81.7)	114 (47.7)	4.90 (3.09 – 7.76)	<0.001
Homelessd	127 (73.0)	179 (75.2)	0.89 (0.57 – 1.39)	0.610
Incarceratedd	45 (25.9)	51 (21.4)	1.28 (0.81 – 2.03)	0.293
Sex workd	24 (13.7)	33 (13.8)	0.99 (0.56 – 1.75)	0.978
Drug use-related behaviors
Daily heroin injectiond	76 (43.4)	49 (20.5)	2.98 (1.93 – 4.59)	<0.001
Daily cocaine injectiond	11 (6.3)	5 (2.1)	3.14 (1.07 – 9.20)	0.029
Daily crystal meth injectiond	36 (20.6)	34 (14.2)	1.56 (0.93 – 2.62)	0.089
Overdosed	29 (16.6)	40 (16.7)	0.99 (0.59 – 1.67)	0.965
Dealt drugsd	94 (53.7)	115 (48.1)	1.25 (0.85 – 1.85)	0.261
Any public injectiond,e	129 (73.7)	147 (65.0)	1.51 (0.98 – 2.33)	0.063
Needed help injectingd	56 (32.0)	90 (40.0)	0.71 (0.47 – 1.07()	0.099
Visited crack house or shooting galleryd	65 (39.9)	67 (29.8)	1.56 (1.02 – 2.39)	0.038
Borrowed syringed	29 (16.6)	42 (18.7)	0.87 (0.51 – 1.46)	0.586
‘Jacked up’ by policed	68 (39.3)	90 (38.0)	1.06 (0.71 – 1.58)	0.784
Received drug treatmentd	68 (39.3)	80 (33.8)	1.27 (0.85 – 1.91)	0.248

aFor the 175 youth who reported SIF use, characteristics are shown for the first visit (baseline or follow-up) at which SIF use was reported; for 239 who never reported SIF use, characteristics are shown for the first visit at which injection drug use was reported

bPrior completion of or current enrollment in high school

cLived or spent time in the Downtown Eastside neighborhood, the area immediately surrounding Vancouver's SIF

dDuring the preceding six months

eOn the street, in a public bathroom, or in a park

Full article at:  http://goo.gl/SQIrpR

By:   Scott E. Hadland, MD, MPH,1,2 Kora DeBeck, PhD,3,4 Thomas Kerr, PhD,3,5 Paul Nguyen, PhD,3 Annick Simo, MSc,3Julio S. Montaner, MD,3,5 and Evan Wood, MD, PhD3,5

¹Boston Children’s Hospital, Division of Adolescent and Young Adult Medicine, Department of Medicine, 300 Longwood Avenue, Boston, MA, USA, 02115

²Harvard Medical School, Department of Pediatrics, 25 Shattuck St., Boston, MA, USA, 02115

³British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6

⁴Simon Fraser University, School of Public Policy, SFU Harbour Centre, 515 West Hastings Street, Suite 3271, Vancouver, BC, Canada, V6B 5K3

⁵University of British Columbia, Faculty of Medicine, 317 - 2194 Health Sciences Mall, Vancouver, BC, Canada, V6T 1Z3

Send correspondence to: Evan Wood, MD, PhD, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 – 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6, Phone: (604) 806-9116, Fax: (604) 806-9044, Email: ac.cbu.tenefc@we-irhu

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Potential Cost-Effectiveness of Supervised Injection Facilities in Toronto and Ottawa, Canada

BACKGROUND AND AIMS:

Supervised injection facilities (legally sanctioned spaces for supervised consumption of illicitly obtained drugs) are controversial public health interventions. We determined the optimal number of facilities in two Canadian cities using health economic methods.

DESIGN:

Dynamic compartmental model of HIV and hepatitis C transmission through sexual contact and sharing of drug use equipment.

MEASUREMENTS:

Direct health-care costs and quality-adjusted life-years (QALYs) over 20 years, discounted at 5% per year; incremental cost-effectiveness ratios.

FINDINGS:

In Toronto, one facility cost $4.1 million and resulted in a gain of 385 QALYs over 20 years, for an incremental cost-effectiveness ratio (ICER) of $10 763 per QALY [95% credible interval (95CrI): cost-saving to $278 311]. Establishing one facility in Ottawa had an ICER of $6127 per QALY (95CrI: cost-saving to $179 272). At a $50 000 per QALY threshold, three facilities would be cost-effective in Toronto and two in Ottawa. The probability that establishing three, four, or five facilities in Toronto was cost-effective was 17, 21, and 41%, respectively. Establishing one, two, or three facilities in Ottawa was cost-effective with 13, 35, and 41% probability, respectively. Establishing no facility was unlikely to be the most cost-effective option (14% in Toronto and 10% in Ottawa). In both cities, results were robust if the reduction in needle-sharing among clients of the facilities was at least 50% and fixed operating costs were less than $2.0 million.

CONCLUSIONS:

Using a $50 000 per quality-adjusted life-years threshold for cost-effectiveness, it is likely to be cost-effective to establish at least three legally sanctioned spaces for supervised injection of illicitly obtained drugs in Toronto, Canada and two in Ottawa, Canada.

Purchase full article at:  http://goo.gl/tPClxA

By:  Enns EA1, Zaric GS2, Strike CJ3,4, Jairam JA3, Kolla G3, Bayoumi AM5,6,7,8.

• 1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
• 2Ivey Business School, Western University, London, ON, Canada.
• 3Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
• 4Center for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
• 5Centre for Research on Inner City Health, Li KaShing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
• 6Department of Medicine, University of Toronto, Toronto, ON, Canada.
• 7Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
• 8Division of General Internal Medicine, St Michael's Hospital, Toronto, ON, Canada.

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health

Risk Environments Facing Potential Users of a Supervised Injection Site in Ottawa, Canada

Supervised injection sites (SISs) have been effective in reducing health risks among people who inject drugs (PWID), including those who face issues of homelessness, mental health illness, interactions with local policing practices, and HIV infection. We investigate the risk behaviours and risk environments currently faced by potential users of an SIS in Ottawa to establish the need for such a service and to contribute to the design of an SIS that can address current health risks and reduce harm.

The PROUD cohort is a community-based participatory research (CBPR) project that examines the HIV risk environment among people who use drugs in Ottawa. From March to October 2013, 593 people who reported using injection drugs or smoking crack cocaine were enrolled through street-based recruitment in the ByWard Market neighbourhood, an area of the city with a high concentration of public drug use and homelessness. Participants completed a demographic, behavioural, and risk environment questionnaire and were offered HIV point-of-care testing. We undertook descriptive and univariate analyses to estimate potential use of an SIS by PWID in Ottawa and to explore risk behaviours and features of the risk environment faced by potential users of the service.

Of those participants who reported injecting drugs in the previous 12 months (n = 270), 75.2 % (203) reported a willingness to use an SIS in Ottawa. Among potential SIS users, 24.6 % had recently injected with a used needle, 19.0 % had trouble accessing new needles, 60.6 % were unstably housed, 49.8 % had been redzoned by the police, and 12.8 % were HIV positive. Participants willing to use an SIS more frequently injected in public (OR = 1.98, 95 % CI = 1.06–3.70), required assistance to inject (OR = 1.84, 95 % CI = 1.00–3.38), were hepatitis C positive (OR = 2.13, 95 % CI = 1.16–3.91), had overdosed in the previous year (OR = 2.00, 95 % CI = 1.02–3.92), and identified as LGBTQ (OR = 5.61, 95 % CI = 1.30–24.19).

An SIS in Ottawa would be well-positioned to reach its target group of highly marginalized PWID and reduce drug-related harms. The application of CBPR methods to a large-scale quantitative survey supported the mobilization of communities of PWID to identify and advocate for their own service needs, creating an enabling environment for harm reduction action.

Table 2
Risk environment comparison by willingness to use a supervised injection service in Ottawa a
	Intention to use an SIS in Ottawa; no. (and %) of participant b
Characteristic c	Yes	No	OR (and 95 %CI) d
	n = 205	n = 67
Age	42.0	44.0	p value = 0.04
Sexual identity
LGBTQ	29 (93.5)	2 (6.5)	5.61 (1.30–24.19)
Straight	168 (72.1)	65 (27.9)
Injects with other people
Yes	176 (80.0)	44 (20.0)	3.23 (1.66–6.27)
No	26 (55.3)	21 (44.7)
Injects in public
Yes	81 (82.7)	17 (17.3)	1.98 (1.06–3.70)
No	113 (70.6)	47 (29.4)
Assistance to inject
Yes	81 (81.8)	18 (18.2)	1.84 (1.00–3.38)
No	120 (71.0)	49 (29.0)
Last hep C test
Positive	129 (80.1)	32 (19.9)	2.13 (1.16–3.91)
Negative	51 (65.4)	27 (34.6)
Overdosed
Yes	66 (83.5)	13 (16.5)	2.00 (1.02–3.92)
No	137 (71.7)	54 (28.3)

OR odds ratio, CI confidence interval

a Percentages are calculated on the basis of the sum across each row

b Except where indicated otherwise. Because of missing responses, the data for some characteristics do not sum to 272

c Variables are reported for the previous 12 months unless otherwise specified

d For each categorical variable, the reference category is the second category

Shaw et al.

Shaw et al. Harm Reduction Journal 2015 12:49   doi:10.1186/s12954-015-0083-9

Full article at: http://goo.gl/bKMFXL

By: Ashley Shaw^1*, Lisa Lazarus¹, Tyler Pantalone², Sean LeBlanc³, Dolly Lin⁴, Daina Stanley¹, Caleb Chepesiuk¹, Sheetal Patel¹, Mark Tyndall¹⁵ and The PROUD Community Advisory Committee

¹Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa K1Y 4E9, Ontario, Canada

²PROUD Committee, 85 Primrose Ave., Ottawa K1R 6M1, Ontario, Canada

³Drug Users Advocacy League, 216 Murray St., Ottawa K1N 5N1, ON, Canada

⁴Department of Medicine, University of Ottawa, 451 Smyth Rd., Ottawa K1H 8M5, Ontario, Canada

⁵University of Ottawa at The Ottawa Hospital, Division of Infectious Disease, 501 Smyth Rd., Ottawa K1H 8L6, ON, Canada

  

More at:  https://twitter.com/hiv_insight