Reduced emergency department visits and hospitalisation with use of an unsanctioned safe consumption site for injection drug use in the United States

Abstract

Background
Safe consumption sites (SCS) are an evidence-based intervention to prevent drug use–related harm. In late 2014, an organisation in an undisclosed location in the USA opened an unsanctioned SCS.

Objective
To evaluate whether use of the unsanctioned SCS affected medical outcomes.

Design
A prospective cohort study.

Setting
Neighbourhoods surrounding the SCS.

Participants
People who injected drugs were recruited and interviewed at baseline and 6 and 12 months from 2018 to 2020.

Intervention
People using the SCS could bring pre-obtained drugs to consume via injection, which were monitored by trained staff with naloxone.

Main Measures
Any overdose, number of non-fatal overdoses, skin and soft tissue infections, emergency department utilisation, number of emergency department visits, hospitalisation and number of nights spent in hospital.

Key Results
A total of 494 participants enrolled in the study; 59 (12%) used the SCS at least once. We used propensity score weighting to analyse the association between SCS utilisation and measures. People using the SCS were 27% (95% CI: 12–46%) less likely to visit the emergency department, had 54% (95% CI: 33–71%) fewer emergency department visits, were 32% (95% CI: 4–57%) less likely to be hospitalised, and spent 50% (95% CI: 1–85%) fewer nights in hospital. Though not significant, people using the SCS had a lower likelihood of overdosing and slightly higher likelihood of skin and soft tissue infections.

Conclusions
Our findings support the use of SCS in the USA to reduce the growing burden of acute care service utilisation related to injection drug use.