Supervised injection facilities reduce risk of premature death in Canada
Decade-long Canadian study of people who inject drugs reports high number of premature deaths – but finds those who regularly use supervised injection facilities are significantly less likely to die.
Supervised injection facilities (SIFs) are places where people can inject illicit drugs under the supervision of health professionals trained in overdose management. They also provide sterile equipment, education on safer drug consumption practices, and referrals to other health services.
Around 140 SIFs currently exist in the world, mainly in Canada, Australia and Europe. They have already been proven to reduce overdoses among people who inject drugs, reduce the harms associated with injection drug use such as syringe sharing, and increase the uptake of health and social services. But until this study, whether SIFs reduce the overall risk of premature death, regardless of cause, had not been examined.
This issue is particularly pressing due to the disproportionately high number of deaths among people who inject drugs in many countries. Accidental overdose and AIDS-related illness are the leading causes of death among this group, although suicide, liver-related conditions, and circulatory and respiratory infections are also common causes.
In the USA and Canada, in particular, overdose deaths have increased dramatically in recent years to the point that overdose is now a leading cause of accidental death among the general population. As a result, average life expectancy has declined in the USA and stalled in Canada for the first time in four decades. In response, many local authorities are now considering introducing SIFs as a way to address drug-related harms, particularly in the USA where none currently exist.
The study took place in Vancouver between 2006 and 2017 and involved 811 people who inject drugs, around two-thirds of whom were men. Participants remained in the study for around six years. They completed questionnaires every six months, and were also tested for HIV and hepatitis C and other health conditions. This data was then cross-referenced with medical records to ascertain death rates and causes of death.
On enrolment, just over half (53%) used SIFs frequently; defined as once a week or more. Frequent SIF users tended to be younger than non-frequent users and be unstably housed. They were also more likely to be HIV-negative and less likely to be enrolled in addiction treatment programmes than non-frequent users.
A total of 112 participants (13.8%) died during the study, equivalent to a mortality rate of just under 23 deaths per 1,000 person-years. The median years of potential life lost per death was 34.
Regular SIF users were found to have a reduced risk of death compared to those who reported less than weekly or no use of the service. This remained true when adjusted for age, sex, being HIV-positive, being unstably housed, injecting cocaine, injecting drugs in public, having been in prison, and being enrolled in an addiction programme.
The current study did not examine the underlying reasons for the association between frequent SIF use and reduced risk of death, something that warrants further investigation. However, it provides compelling evidence of the effectiveness of SIFs in reducing deaths among people who inject drugs – something that is urgently needed, not only in Canada and the USA, but in many countries across the world.