ID: HR19-1027

Presenting author: Barrot Lambdin

Presenting author biography:

Barrot H. Lambdin is a Senior Epidemiologist and Implementation Scientist within the Community Health and Implementation Research Program at RTI International. Over the last 15 years, he has led initiatives throughout the world that have identified determinants and tested strategies to advance the implementation of evidence-based interventions in healthcare settings.

An Unsanctioned Supervised Consumption Service in the United States: Findings from the first four years of operation

Barrot Lambdin, Peter Davidson, Alex Kral

Background
Supervised Consumption Services (SCS) for people who inject drugs (PWID) are designed to reduce overdose deaths and infectious disease transmission, link them to other clinical, social, and drug treatment services, and reduce social nuisance caused by public drug use. Over 100 legally authorized SCSs exist in 10 countries. One SCS has operated in the United States since September 2014 without formal legal authorization. We describe quantitative and qualitative data on use of this facility by PWID.

Methodology
We utilized quantitative survey data collected from every individual using the SCS to inject drugs from September 2014 to September 2018, and qualitative interviews conducted with 23 individuals using or working at the site between June and August 2016.

Results
The SCS was used for 6,801 injecting events during the study period. Fifteen overdoses involving respiratory depression occurred, with all being reversed successfully by staff using naloxone. Over 90% of PWID reported that if not at the site they would be injecting in a public restroom, street, park or parking lot. Over 80% reported needing to rush injections when not at the site. Qualitatively, PWID reported that access to the site had increased their safety and reduced their need to use drugs in public spaces. Staff reported the ‘underground’ nature of the site limited the number of people they could serve and their ability to serve the mentally ill out of fear of disclosure and possible legal sanction.

Conclusion
This preliminary work supports the suggestion that SCS facilities can improve safety for PWID and reduce nuisance to surrounding communities, even when operated on a limited scale restricted by concerns about legal consequence. These data support the argument that a rigorous trial of an SCS should be conducted in the United States.