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Utilization patterns and health impacts of supervised drug consumption facilities in Vancouver, Canada Kennedy, Mary Clare

Abstract

Background: A growing body of research has demonstrated the role of supervised drug consumption facilities (SCFs) in mitigating harms associated with illicit drug use. However, scientific evidence concerning long-term SCF utilization patterns and health impacts among people who use drugs (PWUD) is still lacking. Further, little is known about novel approaches to SCF programming, including peer involvement as staff, and how this may influence service dynamics. This dissertation sought to: systematically review the literature on the health and community impacts of SCFs; longitudinally examine discontinued use of a SCF; assess the impact of SCF use on all-cause mortality and exposure to violence; and characterize peer involvement in low-threshold SCFs, including how this may shape service engagement and associated health outcomes among PWUD. Methods: Quantitative data were derived from two community-recruited prospective cohort studies of PWUD in Vancouver, Canada. These data were confidentially linked to an external vital statistics database. In addition, observational fieldwork and interview data were drawn from a rapid ethnographic study examining the implementation, operations and impacts of low-threshold SCFs in Vancouver. Multivariable regression analyses of cohort data were used to examine the association between various factors and discontinued SCF use, as well as to longitudinally assess the impact of SCF use on all-cause mortality and exposure to violence. Ethnographic data were analyzed thematically to characterize peer involvement in SCFs. Results: Most SCF clients discontinued using this service during follow up, and injection cessation co-occurred with the majority of SCF use cessation events. Higher-risk subpopulations of PWUD were less likely to cease using the SCF while actively injecting. Frequent SCF use was protective against all-cause mortality, as well as exposure to violence among men but not women. Peer involvement in SCFs was found to promote service engagement and the reduction of harms among PWUD. Conclusions: These findings support the inclusion of SCFs within the continuum of services for PWUD, particularly given that use of such services may reduce the risk of serious harms, including mortality and exposure to violence. The expansion of peer-run and women-only SCFs may afford opportunities to extend the reach and impact of this intervention.

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Attribution-NonCommercial-NoDerivatives 4.0 International

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