Addiction 2007 102;6:916-9
Wood E, Tyndall MW, Zhang R, Montaner JSG, Kerr T. Rate of detoxification service use and its impact among a cohort of supervised injecting facility users.
Dear Colleagues,
Finally we have some direct evidence of the benefits of injecting facilities in reducing drug use and encouraging treatment. This is in addition to their primary goal of protecting their clients while still using injected drugs. This paper counters the claim that such harm reduction measures �entrench drug use�. In fact, those who attended the Canadian injecting room were MORE likely to have attended detoxification and other forms of treatment in the year after the facility opened. The increased uptake of detox services was statistically significant. While the clients were mostly still active street drug users, their use of the injecting services diminished while treatment entry increased.
This paper should silence the few remaining honest critics of injecting services. They not only save lives, they also encourage a referral pathway into treatment services and they do not encourage more drug use. While many of us had a gut feeling this was the case, it is reassuring to find it supported in this high quality peer reviewed article from Canada.
Comments by Andrew Byrne ..
Abstract herewith for those interested in more details.
Background
Vancouver, Canada recently opened a medically supervised injecting facility (SIF) where injection drug users (IDU) can inject pre-obtained illicit drugs. Critics suggest that the facility does not help IDU to reduce their drug use.
Methods
We conducted retrospective and prospective database linkages with residential detoxification facilities and used generalized estimating equation (GEE) methods to examine the rate of detoxification service use among SIF participants in the year before versus the year after the SIF opened. In secondary analyses, we used Cox regression to examine if having been enrolled in detoxification was associated with enrolling in methadone or other forms of addiction treatment. We also evaluated the impact of detoxification use on the frequency of SIF use.
Results
Among 1031 IDU, there was a statistically significant increase in the uptake of detoxification services the year after the SIF opened. [odds ratio: 1.32 (95% CI, 1.11-1.58); P = 0.002]. In turn, detoxification was associated independently with elevated rates of methadone initiation [relative hazard = 1.56 (95% CI, 1.04-2.34); P = 0.031] and elevated initiation of other addiction treatment [relative hazard = 3.73 (95% CI, 2.57-5.39); P < 0.001]. Use of the SIF declined when the rate of SIF use in the month before enrolment into detoxification was compared to the rate of SIF use in the month after discharge (24 visits versus 19 visits; P = 0.002).
Conclusions
The SIF's opening was associated independently with a 30% increase in detoxification service use, and this behaviour was associated with increased rates of long-term addiction treatment initiation and reduced injecting at the SIF.
