Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Centre on Drug Policy Evaluation, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Drug Alcohol Depend. 2024 Dec 1;265:112490. doi: 10.1016/j.drugalcdep.2024.112490. Epub 2024 Nov 8.
Supervised consumption service (SCS) use among people who inject drugs may reduce acute care utilization; however, prior studies have been limited by self-reported outcomes and dichotomous exposures.
We conducted a prospective cohort study using linked questionnaire and health administrative data among people who inject drugs in Toronto, Canada (2018-2020). Baseline SCS use frequency was defined by a participant's self-reported proportion of injections performed at an SCS over the past six months: "all/most" (≥75 %), "some" (26-74 %), "few" (1-25 %), or "none" (0 %). Outcomes measured over the following six months included: emergency department (ED) visits; hospitalizations; ED visits or hospitalizations for opioid-related overdose; and hospitalizations for injection-related infections. The relative effects of varying SCS use levels on study outcomes were estimated using inverse-probability-weighted negative binomial regression models.
Of 467 participants, 25.5 %, 30.4 %, 28.7 %, and 15.4 % respectively reported "all/most", "some", "few", and "none" levels of SCS use at baseline. SCS use frequency was not significantly associated with ED visits, hospitalizations, or hospitalizations for injection-related infections. Participants reporting "some" SCS use had a higher rate of ED visits or hospitalizations for opioid-related overdose (versus "few"; rate ratio=2.30, 95 % confidence interval=1.15-4.61).
SCS use had little impact on objectively measured acute care utilization, which was high overall. Although preventing overdose mortality is the primary goal of SCS in Canada, resourcing sites to support their clients' acute healthcare needs may help build a continuum of care for people experiencing marginalization who inject drugs.
在注射毒品者中使用监督消费服务（SCS）可能会减少急症护理的利用；然而，先前的研究受到自我报告结果和二分暴露的限制。
我们在加拿大多伦多对注射毒品者进行了一项前瞻性队列研究，使用了关联的问卷调查和健康行政数据（2018-2020 年）。基线 SCS 使用频率通过参与者在过去六个月内在 SCS 上进行的注射比例来定义：“全部/大多数”（≥75%）、“一些”（26-74%）、“少数”（1-25%）或“无”（0%）。在接下来的六个月中测量的结果包括：急诊部（ED）就诊；住院；ED 就诊或与阿片类药物相关的过量住院；以及与注射相关的感染住院。使用逆概率加权负二项回归模型估计不同 SCS 使用水平对研究结果的相对影响。
在 467 名参与者中，分别有 25.5%、30.4%、28.7%和 15.4%报告了基线时的“SCS 使用全部/大多数”、“SCS 使用一些”、“SCS 使用少数”和“SCS 使用无”。SCS 使用频率与 ED 就诊、住院或与注射相关的感染住院无关。报告“SCS 使用一些”的参与者因与阿片类药物相关的过量就诊或住院的比率更高（与“SCS 使用少数”相比；比率比=2.30，95%置信区间=1.15-4.61）。
SCS 使用对客观测量的急症护理利用率影响不大，总体利用率较高。虽然在加拿大，SCS 的主要目标是预防过量死亡，但为支持其客户的急性医疗保健需求而配置资源的场所可能有助于为经历边缘化的注射毒品者建立一个连续的护理体系。
