Use of on-site detoxification services co-located with a supervised injection facility

Abstract

Objectives Supervised injection facilities (SIFs) are increasingly being implemented worldwide in response to the harms associated with injection drug use. Although SIFs have been shown to promote engagement of people who use injection drugs (PWID) with external health services, little is known about the potential of co-locating on-site detoxification services with SIFs. The aim of this study was to characterize use of detoxification services co-located at Insite, North America’s first SIF, among PWID in Vancouver, Canada. Methods Data were derived from two prospective cohorts of PWID in Vancouver, Canada between November 2010 and December 2012. Using multivariable generalized estimating equation logistic regression, we identified factors independently associated with reporting use of detoxification services at the SIF. Results Among 1316 PWID, 147 (11.2%) reported enrolling in detoxification services co-located with the SIF at least once during the two year study period. In multivariable analyses, after adjustment for other potential cofounders, factors independently and positively associated with use of this service included residence <5 blocks from the SIF (Adjusted Odds Ratio [AOR] = 1.70), enrollment in methadone maintenance therapy (AOR = 1.90), public injection (AOR = 1.53), binge injection (AOR = 1.93), recent overdose (AOR = 1.90) and frequent SIF use (AOR = 8.15) (all p < 0.05). Discussion Use of on-site detoxification services offered at the SIF was common among PWID and associated with frequent SIF use and various markers of vulnerability and drug-related risk. These findings highlight the potential role of SIFs as a point of access to detoxification services for high-risk PWID. Future studies should examine if co-location leads to higher uptake of addiction services in comparison to services that create geographic or other obstacles.

Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: A cohort study

“…Indeed, no overdose deaths have ever occurred within any SIF in operation in Canada or internationally to date [11,19]. Further, regular SIF use and contact with addiction counsellors within SIFs have been associated with increased engagement with addiction treatment, including residential treatment and opioid agonist therapy [33–36,39], which may help to prevent deaths related to ongoing high-risk drug use [6,35,64–66]. SIFs may also mitigate mortality related to diverse causes by enhancing connections to other internal and external health and social services [37,38,40–42,67–72].…”

“Beyond Safer Injecting”—Health and Social Needs and Acceptance of Support among Clients of a Supervised Injecting Facility

“…Globally, SIFs also exist as stand-alone facilities within the immediate vicinity of supportive services, for example, the Sydney SIF is located near a low-threshold primary healthcare service. Other examples include co-locating SIFs at detoxification services (i.e., Vancouver Insite [34]) and healthcare facilities [35]. The Melbourne SIF is now based within a community health service on a public housing estate.…”

Leveraging the role of community pharmacists in the prevention, surveillance, and treatment of opioid use disorders

“…When applied to substance use disorders, it encompasses a number of evidence-based approaches that have been shown to reduce negative health and social outcomes, including decreased transmission of bloodborne infections and prevention of overdose deaths [44]. The strategic employment of harm reduction approaches also has the potential to offer opportunities for some of our most vulnerable patients to engage further with the healthcare system [45]. A number of studies have examined the implementation of harm reduction strategies into the community pharmacy environment, both within the US and abroad.…”