Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
Cermes3, Inserm U988/CNRS UMR 8211/EHESS/Université de Paris, Paris, France.
Int J Epidemiol. 2023 Apr 19;52(2):562-576. doi: 10.1093/ije/dyac120.
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.
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.
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].
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.
药物滥用监测室（DCR）对注射毒品者（PWID）在 HIV 和丙型肝炎病毒风险行为以及获得药物使用障碍治疗方面的有效性已得到证实。然而，关于其他健康相关并发症的数据却很少。利用法国 COSINUS 队列的数据，我们研究了 DCR 暴露对非致命性过量、脓肿和急诊室（ED）就诊的影响，这些都发生在过去 6 个月内。
COSIMUS 是一项针对法国 665 名 PWID 的为期 12 个月的前瞻性队列研究，旨在研究 DCR 对健康的影响。我们在登记时以及随访 6 个月和 12 个月时通过面对面访谈收集数据。在调整了其他相关因素（P 值 < 0.05）后，使用两步 Heckman 混合效应概率模型评估了 DCR 暴露对每种结果的影响，这使我们能够调整由于 DCR 暴露和未暴露参与者之间的差异而导致的潜在非随机化偏差，同时考虑到重复测量之间的相关性。
在登记时，665 名参与者中分别有 21%、6%和 38%报告了过量、脓肿和 ED 就诊。多变量模型发现，DCR 暴露者报告过量的可能性较小[调整系数（95%CI）：-0.47（-0.88；-0.07），P=0.023]、脓肿[-0.74（-1.11；-0.37），P<0.001]和 ED 就诊[-0.74（-1.27；-0.20），P=0.007]。
这是第一项表明 DCR 暴露对脓肿和 ED 就诊有积极影响的研究，并在调整潜在非随机化偏差后证实了 DCR 减少过量的有效性。我们的研究结果加强了扩大 DCR 实施以改善 PWID 注射环境和健康的论点。
