Changes in public order after the opening of an overdose monitoring facility for people who inject drugs

Casey León; Lena J P Cardoso; Salem Johnston; Sarah Mackin; Barry Bock; Jessie M Gaeta

doi:10.1016/j.drugpo.2017.12.009

Changes in public order after the opening of an overdose monitoring facility for people who inject drugs

Int J Drug Policy. 2018 Mar:53:90-95. doi: 10.1016/j.drugpo.2017.12.009. Epub 2018 Jan 2.

Authors

Casey León¹, Lena J P Cardoso², Salem Johnston², Sarah Mackin³, Barry Bock², Jessie M Gaeta⁴

Affiliations

¹ Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA. Electronic address: cleon@bhchp.org.
² Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA.
³ Boston Public Health Commission, 774 Albany Street, Boston, MA, 02118, USA.
⁴ Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA; Boston Medical Center, Section of General Internal Medicine, Boston, MA 02118, USA.

PMID: 29294417
DOI: 10.1016/j.drugpo.2017.12.009

Abstract

Background: In the face of an increasingly fatal opioid crisis, Boston Health Care for the Homeless Program (BHCHP) opened the Supportive Place for Observation and Treatment (SPOT), a unique low-threshold harm reduction program for monitoring people who have injected drugs and are at imminent risk of overdose. This study examines the impact of the opening of the SPOT program on measures of injection drug-related public order in the neighborhood surrounding the facility.

Methods: Data was collected at 10 weeks prior and 12 weeks post SPOT implementation on: number of over-sedated individuals in public, publicly discarded syringes, publicly discarded injection-related litter, and instances of active injection drug use or exchange of drugs. Changes were evaluated using Poisson log-linear regression models. Potential confounders such as weather and police presence were measured and controlled for.

Results: The average number of over-sedated individuals observed in public significantly decreased by 28% (4.3 [95% Confidence Interval (CI) 2.7-6.9] v 3.1 [CI 1.4-6.8]) after SPOT opened. The opening of SPOT did not have a significant effect on the other measures of public order. The daily average number of publicly discarded syringes (28.5 [CI 24.5-33.1] v 28.4 [CI 22.0-36.5]), pieces of publicly discarded injection-related litter (376.3 [CI 358.6-394.8] v 375.0 [CI 345.8-406.6]), and observed instances of active use or exchange of drugs (0.2 [CI 0.1-0.9] v 0.1 [CI 0.0-0.1]) were not statistically significantly different after the opening of SPOT.

Conclusions: The opening of SPOT was associated with a significant decrease in observed over-sedated individuals. Other measures of injection-drug related public order did not improve or worsen with the opening of SPOT, however, they have been shown to improve with the implementation of a supervised injection facility.

Keywords: Community health; Harm reduction; Public order; Substance use disorder; Substance use treatment; Supervised injection facility.

MeSH terms

Adult
Boston / epidemiology
Drug Overdose / diagnosis
Drug Overdose / epidemiology
Drug Overdose / therapy*
Drug Users*
Female
Harm Reduction
Humans
Male
Needle-Exchange Programs / organization & administration*
Needle-Exchange Programs / statistics & numerical data
Police
Skilled Nursing Facilities / organization & administration*
Skilled Nursing Facilities / statistics & numerical data
Substance Abuse, Intravenous / therapy*
Syringes
Weather