Correspondence
Attendance at Supervised Injecting Facilities and Use of Detoxification Services
N Engl J Med 2006; 354:2512-2514June 8, 2006
- Article
To the Editor:
In September 2003, the first safer injecting facility in North America opened in Vancouver, Canada. Here, injection-drug users can inject preobtained illicit drugs under medical supervision.1 A concern regarding such facilities is that they may lessen the likelihood that injection-drug users will seek addiction-treatment services.2,3 Randomized trials are lacking to address this concern. We assessed factors associated with time to entry into a detoxification program at one of the city's three detoxification centers. We used data collected by means of a questionnaire as part of a cohort study (supported by Health Canada) of persons who use supervised injecting facilities, called the Scientific Evaluation of Supervised Injecting (SEOSI) cohort.4
Between December 1, 2003, and March 1, 2005, 4764 persons used the facility and 1194 randomly selected repeat attendees were invited to enroll in SEOSI.4 The randomization was such that the facility's intake computer alerted the staff to explain the invitation to attendees at their next visit to the program (repeated use was required for enrollment). Of these 1194 persons, 158 (13 percent) either did not return to the supervised injecting facility or declined the invitation, and 5 were considered by study staff to be unable (i.e., mentally ill or too intoxicated) to provide informed consent. Among the 1031 persons (86 percent) enrolled, the median age was 39 years, 29 percent were female, 58 percent used the facility an average of at least weekly, and the median number of visits was 47 during a median of 344 days of follow-up. One hundred eighty-five persons (18 percent) began a detoxification program during follow-up.
In multivariate analyses with the use of Cox regression, an average of at least weekly use of the supervised injecting facility and any contact with the facility's addictions counselor were both independently associated with more rapid entry into a detoxification program (relative hazards, 1.72 [95 percent confidence interval, 1.25 to 2.38] and 1.98 [95 percent confidence interval, 1.26 to 3.10], respectively) (Table 1Table 1
Univariate and Multivariate Cox Proportional-Hazards Analysis of the Time to Entry into a Detoxification Program among 1031 Users of Injection Drugs after the Opening of a Supervised Injecting Facility (SIF).).Because our study design was observational, it is possible that other factors may explain the observed associations; for example, greater concern for one's health or a tendency to “comply” might lead to greater use of the supervised injecting facility, as well as more ready acceptance of detoxification. In this regard, we have previously shown that greater use of the supervised injecting facility is associated with markers traditionally associated with reduced access to care, including a higher intensity of drug use and homelessness.5 In addition, contact with the addictions counselor was among the strongest independent predictors of more rapid entry into a detoxification program. Our findings provide reassurance that supervised injection facilities (Figure 1Figure 1
Supervised Injecting Facility.) are unlikely to result in reduced use of addiction-treatment services.(The views expressed in this letter are those of the authors and do not necessarily represent the official policies of Health Canada.)
5 ReferencesEvan Wood, Ph.D.
Mark W. Tyndall, M.D.
University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
ewood@cfenet.ubc. ca Ruth Zhang, M.Sc.
Jo-Anne Stoltz, Ph.D.
Calvin Lai, M.Math.
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, CanadaJulio S.G. Montaner, M.D.
Thomas Kerr, Ph.D.
University of British Columbia, Vancouver, BC V6Z 1Y6, Canada1
Kerr T ,Tyndall M ,Li K ,Montaner JS ,Wood E . Safer injection facility use and syringe sharing in injection drug users. Lancet 2005;366:316-318
CrossRef | Web of Science | Medline2
Gandey A . US slams Canada over Vancouver's new drug injection site. CMAJ 2003;169:1063-1063
Web of Science | Medline3
Yamey G . UN condemns Australian plans for “safe injecting rooms.” BMJ 2000;320:667-667
CrossRef | Web of Science | Medline4
Wood E ,Kerr T ,Lloyd-Smith E , et al. Methodology for evaluating Insite: Canada's first medically supervised safer injection facility for injection drug users. Harm Reduct J 2004;1:9-9
CrossRef | Medline5
Wood E ,Tyndall MW ,Li K , et al. Do supervised injecting facilities attract higher-risk injection drug users? Am J Prev Med 2005;29:126-130
CrossRef | Web of Science | Medline
- Citing Articles (24)
Citing Articles
1
John Strang, Thomas Babor, Jonathan Caulkins, Benedikt Fischer, David Foxcroft, Keith Humphreys. (2012) Drug policy and the public good: evidence for effective interventions. The Lancet 379:9810, 71-83
CrossRef2
Salaam Semaan, Paul Fleming, Caitlin Worrell, Haley Stolp, Brittney Baack, Meghan Miller. (2011) Potential role of safer injection facilities in reducing HIV and Hepatitis C infections and overdose mortality in the United States. Drug and Alcohol Dependence 118:2-3, 100-110
CrossRef3
Brandon DL Marshall, M-J Milloy, Evan Wood, Julio SG Montaner, Thomas Kerr. (2011) Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study. The Lancet 377:9775, 1429-1437
CrossRef4
Will Small, Liz Ainsworth, Evan Wood, Thomas Kerr. (2011) IDU Perspectives on the Design and Operation of North America's First Medically Supervised Injection Facility. Substance Use & Misuse 46:5, 561-568
CrossRef5
Kora DeBeck, Thomas Kerr, Lorna Bird, Ruth Zhang, David Marsh, Mark Tyndall, Julio Montaner, Evan Wood. (2011) Injection drug use cessation and use of North America's first medically supervised safer injecting facility. Drug and Alcohol Dependence 113:2-3, 172-176
CrossRef6
Kathleen N. Deering, Thomas Kerr, Mark W. Tyndall, Julio S.G. Montaner, Kate Gibson, Laurel Irons, Kate Shannon. (2011) A peer-led mobile outreach program and increased utilization of detoxification and residential drug treatment among female sex workers who use drugs in a Canadian setting. Drug and Alcohol Dependence 113:1, 46-54
CrossRef7
Brandon D L Marshall, Evan Wood. (2010) Toward a Comprehensive Approach to HIV Prevention for People Who Use Drugs. JAIDS Journal of Acquired Immune Deficiency Syndromes 55, S23-S26
CrossRef8
M.- J. S. Milloy, T. Kerr, R. Zhang, M. Tyndall, J. Montaner, E. Wood. (2010) Inability to access addiction treatment and risk of HIV infection among injection drug users recruited from a supervised injection facility. Journal of Public Health 32:3, 342-349
CrossRef9
Vivian Levy, Jennifer L. Evans, Ellen S. Stein, Peter J. Davidson, Paula J. Lum, Judith A. Hahn, Kimberly Page. (2010) Are young injection drug users ready and willing to participate in preventive HCV vaccine trials?. Vaccine 28:37, 5947-5951
CrossRef10
(2010) Drug Policy and the Public Good: a summary of the book. Addiction 105:7, 1137-1145
CrossRef11
STEFFANIE A. STRATHDEE, JAVIER RIO NAVARRO. (2010) Commentary on Salmon et al. (2010): The case for safer inhalation facilities-waiting to inhale. Addiction 105:4, 684-685
CrossRef12
Allison M. Salmon, Ingrid Van Beek, Janaki Amin, John Kaldor, Lisa Maher. (2010) The impact of a supervised injecting facility on ambulance call-outs in Sydney, Australia. Addiction 105:4, 676-683
CrossRef13
Martin A. Andresen, Neil Boyd. (2010) A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facility. International Journal of Drug Policy 21:1, 70-76
CrossRef14
Elisa Lloyd-Smith, Evan Wood, Ruth Zhang, Mark W. Tyndall, Julio S. Montaner, Thomas Kerr. (2009) Determinants of Cutaneous Injection-Related Infection Care at a Supervised Injecting Facility. Annals of Epidemiology 19:6, 404-409
CrossRef15
Evan Wood, Thomas Kerr, Mark W. Tyndall, Julio S.G. Montaner. (2008) The Canadian government's treatment of scientific process and evidence: Inside the evaluation of North America's first supervised injecting facility. International Journal of Drug Policy 19:3, 220-225
CrossRef16
Evan Wood, Julio S Montaner, Thomas Kerr. (2008) Illicit drug addiction, infectious disease spread, and the need for an evidence-based response. The Lancet Infectious Diseases 8:3, 142-143
CrossRef17
Andrew D. Hathaway, Kirk I. Tousaw. (2008) Harm reduction headway and continuing resistance: Insights from safe injection in the city of Vancouver. International Journal of Drug Policy 19:1, 11-16
CrossRef18
E. Wood, J. S.G. Montaner, K. Li, R. Zhang, L. Barney, S. A. Strathdee, M. W. Tyndall, T. Kerr. (2008) Burden of HIV Infection Among Aboriginal Injection Drug Users in Vancouver, British Columbia. American Journal of Public Health 98:3, 515-519
CrossRef19
L. Beletsky, C. S. Davis, E. Anderson, S. Burris. (2008) The Law (and Politics) of Safe Injection Facilities in the United States. American Journal of Public Health 98:2, 231-237
CrossRef20
Thomas Kerr, Jo Kimber, Kora DeBeck, Evan Wood. (2007) The role of safer injection facilities in the response to HIV/AIDS among injection drug users. Current HIV/AIDS Reports 4:4, 158-164
CrossRef21
Stefan Baral, Susan G Sherman, Peggy Millson, Chris Beyrer. (2007) Vaccine immunogenicity in injecting drug users: a systematic review. The Lancet Infectious Diseases 7:10, 667-674
CrossRef22
(2007) A 21st-century Lazarus: the role of safer injection sites in harm reduction and recovery. Addiction 102:6, 848-849
CrossRef23
Evan Wood, Mark W. Tyndall, Ruth Zhang, Julio S. G. Montaner, Thomas Kerr. (2007) Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction 102:6, 916-919
CrossRef24
Dan Small. (2007) Fools rush in where angels fear to tread. International Journal of Drug Policy 18:1, 18-26
CrossRef
