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.
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.
Int J Drug Policy. 2021 Jan;87:102993. doi: 10.1016/j.drugpo.2020.102993. Epub 2020 Nov 5.
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).
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.
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]).
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.
为了降低过量死亡人数，加拿大目前有超过 40 家监督药物使用服务（SCS）机构。反对 SCS 的观点认为，风险补偿可能会导致非致命性过量的增加。本研究估计了 SCS 使用与最近注射吸毒者（PWID）非致命性过量之间的关联。
我们分析了 2018 年 11 月至 2020 年 3 月期间，在加拿大多伦多的一个成年 PWID 队列中收集的横断面基线数据。最近的非致命性过量是在过去六个月内自我报告的。主要暴露是 SCS 使用频率，自我报告为过去六个月内在 SCS 进行的注射比例（全部或大部分[75-100%]、部分[26-74%]、很少[≤25%]或无）。根据 SCS 使用频率比较了所有独特组之间最近过量的流行率，并使用修正泊松回归估计了调整后的流行率比（PR）。
在 701 名 PWID 中（中位数[IQR]年龄，40[33 至 49]；64.3%的跨性别男性；56.8%每天注射），大多数报告了 SCS 使用（全部/大部分，26.2%；部分，30.9%；很少，29.4%）而不是不使用（13.5%），有 38.6%报告了最近的过量。从调整后的回归分析来看，与不使用 SCS 或使用频率较低相比，更频繁地使用 SCS 与过量之间没有统计学上的显著关联。与 SCS 使用者相比，SCS 使用频率与过量之间的关联在 SCS 使用者与非使用者之间要小得多（例如，全部/大部分与无：PR，1.43[95%CI，0.93 至 2.21]；全部/大部分与部分：PR，0.94[95%CI，0.75 至 1.17]；全部/大部分与很少：PR，1.15[95%CI，0.89 至 1.48]）。
研究结果表明，SCS 使用频率与最近非致命性过量之间没有统计学上的显著关联，尤其是在可能更相似的 SCS 使用者中。然而，过量现象很普遍，突显了预防非致命性过量和相关发病率的必要性。
