Attendance at Supervised Injecting Facilities and Use of Detoxification Services
http://www.100md.com
《新英格兰医药杂志》
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 and 1.98 , respectively) (Table 1).
Table 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 1) are unlikely to result in reduced use of addiction-treatment services.
Figure 1. Supervised Injecting Facility.
Courtesy of Will Small.
(The views expressed in this letter are those of the authors and do not necessarily represent the official policies of Health Canada.)
Evan 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, Canada
Julio S.G. Montaner, M.D.
Thomas Kerr, Ph.D.
University of British Columbia
Vancouver, BC V6Z 1Y6, Canada
References
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.
Gandey A. US slams Canada over Vancouver's new drug injection site. CMAJ 2003;169:1063-1063.
Yamey G. UN condemns Australian plans for "safe injecting rooms." BMJ 2000;320:667-667.
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.
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.
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 and 1.98 , respectively) (Table 1).
Table 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 1) are unlikely to result in reduced use of addiction-treatment services.
Figure 1. Supervised Injecting Facility.
Courtesy of Will Small.
(The views expressed in this letter are those of the authors and do not necessarily represent the official policies of Health Canada.)
Evan 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, Canada
Julio S.G. Montaner, M.D.
Thomas Kerr, Ph.D.
University of British Columbia
Vancouver, BC V6Z 1Y6, Canada
References
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.
Gandey A. US slams Canada over Vancouver's new drug injection site. CMAJ 2003;169:1063-1063.
Yamey G. UN condemns Australian plans for "safe injecting rooms." BMJ 2000;320:667-667.
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.
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.