Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Department of Surgery, McMaster University, Hamilton, Canada.
Drug Alcohol Rev. 2024 Nov;43(7):1880-1891. doi: 10.1111/dar.13921. Epub 2024 Aug 5.
This study aimed to assess the impact of the implementation of legally sanctioned supervised consumption sites (SCS) in the Canadian province of Ontario on opioid-related deaths, emergency department (ED) visits and hospitalisations at the public health unit (PHU) level.
Monthly rates per 100,000 population of opioid-related deaths, ED visits and hospitalisations for PHUs in Ontario between December 2013 and March 2022 were collected. Aggregated and individual analyses of PHUs with one or more SCS were conducted, with PHUs that instituted an SCS being matched to control units that did not. Autoregressive integrated moving average models were used to estimate the impact of SCS implementation on opioid-related deaths, ED visits and hospitalisations.
Twenty-one legally sanctioned SCS were implemented across nine PHUs in Ontario during the study period. Interrupted time series analyses showed no statistically significant changes in opioid-related death rates in aggregated analyses of intervention PHUs (increase of 0.02 deaths/100,000 population/month; p = 0.27). Control PHUs saw a significant increase of 0.38 deaths/100,000 population/month; p < 0.001. No statistically significant changes were observed in the rates of opioid-related ED visits in intervention PHUs (decrease of 0.61 visits/100,000 population/month; p = 0.39) or controls (increase of 0.403 visits; p = 0.76). No statistically significant changes to the rates of opioid-related hospitalisations were observed in intervention PHUs (0 hospitalisations/100,000 population/month; p = 0.98) or controls (decrease of 0.05 hospitalisations; p = 0.95).
This study did not find significant mortality or morbidity effects associated with SCS availability at the population level in Ontario. In the context of a highly toxic drug supply, additional interventions will be required to reduce opioid-related harms.
本研究旨在评估在加拿大安大略省实施合法监管的吸食场所（SCS）对阿片类药物相关死亡、急诊部门（ED）就诊和公共卫生单位（PHU）住院率的影响。
收集了 2013 年 12 月至 2022 年 3 月期间安大略省 PHU 每月每 10 万人中与阿片类药物相关的死亡、ED 就诊和住院率。对有一个或多个 SCS 的 PHU 进行了汇总和个体分析，并将实施 SCS 的 PHU 与未实施 SCS 的对照单位相匹配。使用自回归综合移动平均模型来估计 SCS 实施对阿片类药物相关死亡、ED 就诊和住院的影响。
在研究期间，安大略省的九个 PHU 共实施了 21 个合法监管的 SCS。中断时间序列分析显示，在干预 PHU 的汇总分析中，阿片类药物相关死亡率没有统计学上的显著变化（每 10 万人每月增加 0.02 例死亡；p=0.27）。对照 PHU 则显著增加了 0.38 例死亡/100,000 人/月；p<0.001。干预 PHU 中阿片类药物相关 ED 就诊率没有观察到统计学上的显著变化（每 100,000 人每月减少 0.61 次就诊；p=0.39）或对照 PHU（增加 0.403 次就诊；p=0.76）。干预 PHU 中阿片类药物相关住院率也没有观察到统计学上的显著变化（每 100,000 人每月 0 例住院；p=0.98）或对照 PHU（减少 0.05 例住院；p=0.95）。
本研究在安大略省人群水平上未发现 SCS 可用性与死亡率或发病率之间存在显著关联。在毒瘾极高的药物供应背景下，需要采取额外的干预措施来减少阿片类药物相关的危害。
