Impact of drug consumption rooms on non-fatal overdoses, abscesses and emergency department visits in people who inject drugs in France: results from the COSINUS cohort.
Safer injecting facility
abscess
emergency department
injection drug users
overdose
risk environment
skin and soft tissue infections
Journal
International journal of epidemiology
ISSN: 1464-3685
Titre abrégé: Int J Epidemiol
Pays: England
ID NLM: 7802871
Informations de publication
Date de publication:
19 04 2023
19 04 2023
Historique:
received:
30
06
2021
accepted:
17
05
2022
medline:
20
4
2023
pubmed:
13
6
2022
entrez:
12
6
2022
Statut:
ppublish
Résumé
The effectiveness of drug consumption rooms (DCRs) for people who inject drugs (PWID) has been demonstrated for HIV and hepatitis C virus risk practices, and access to care for substance use disorders. However, data on other health-related complications are scarce. Using data from the French COSINUS cohort, we investigated the impact of DCR exposure on non-fatal overdoses, abscesses and emergency department (ED) visits, all in the previous 6 months. COSINUS is a 12-month prospective cohort study of 665 PWID in France studying DCR effectiveness on health. We collected data from face-to-face interviews at enrolment, and at 6 and 12 months of follow-up. After adjusting for other correlates (P-value < 0.05), the impact of DCR exposure on each outcome was assessed using a two-step Heckman mixed-effects probit model, allowing us to adjust for potential non-randomization bias due to differences between DCR-exposed and DCR-unexposed participants, while taking into account the correlation between repeated measures. At enrolment, 21%, 6% and 38% of the 665 participants reported overdoses, abscesses and ED visits, respectively. Multivariable models found that DCR-exposed participants were less likely to report overdoses [adjusted coefficient (95% CI): -0.47 (-0.88; -0.07), P = 0.023], abscesses [-0.74 (-1.11; -0.37), P < 0.001] and ED visits [-0.74 (-1.27; -0.20), P = 0.007]. This is the first study to show the positive impact of DCR exposure on abscesses and ED visits, and confirms DCR effectiveness in reducing overdoses, when adjusting for potential non-randomization bias. Our findings strengthen the argument to expand DCR implementation to improve PWID injection environment and health.
Sections du résumé
BACKGROUND
The effectiveness of drug consumption rooms (DCRs) for people who inject drugs (PWID) has been demonstrated for HIV and hepatitis C virus risk practices, and access to care for substance use disorders. However, data on other health-related complications are scarce. Using data from the French COSINUS cohort, we investigated the impact of DCR exposure on non-fatal overdoses, abscesses and emergency department (ED) visits, all in the previous 6 months.
METHODS
COSINUS is a 12-month prospective cohort study of 665 PWID in France studying DCR effectiveness on health. We collected data from face-to-face interviews at enrolment, and at 6 and 12 months of follow-up. After adjusting for other correlates (P-value < 0.05), the impact of DCR exposure on each outcome was assessed using a two-step Heckman mixed-effects probit model, allowing us to adjust for potential non-randomization bias due to differences between DCR-exposed and DCR-unexposed participants, while taking into account the correlation between repeated measures.
RESULTS
At enrolment, 21%, 6% and 38% of the 665 participants reported overdoses, abscesses and ED visits, respectively. Multivariable models found that DCR-exposed participants were less likely to report overdoses [adjusted coefficient (95% CI): -0.47 (-0.88; -0.07), P = 0.023], abscesses [-0.74 (-1.11; -0.37), P < 0.001] and ED visits [-0.74 (-1.27; -0.20), P = 0.007].
CONCLUSION
This is the first study to show the positive impact of DCR exposure on abscesses and ED visits, and confirms DCR effectiveness in reducing overdoses, when adjusting for potential non-randomization bias. Our findings strengthen the argument to expand DCR implementation to improve PWID injection environment and health.
Identifiants
pubmed: 35690956
pii: 6606118
doi: 10.1093/ije/dyac120
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
562-576Investigateurs
Marc Auriacombe
(M)
Cyril Berenger
(C)
Gilles Bertoia
(G)
Laélia Briand Madrid
(LB)
Maria Patrizia Carrieri
(MP)
Isabelle Célérier
(I)
Carole Chauvin
(C)
Manon Chevalier
(M)
Jean-Marie Danion
(JM)
Sébastien de Dinechin
(S)
Cécile Denis
(C)
Natascia Grelli
(N)
Marie Gutowski
(M)
Naomi Hamelin
(N)
Marie Jauffret-Roustide
(M)
Charlotte Kervran
(C)
Sébastien Kirchherr
(S)
Laurence Lalanne
(L)
Mireille Le Breton
(ML)
Gwenaëlle Maradan
(G)
Sarah Moriceau
(S)
Perrine Roux
(P)
Antoine Vilotitch
(A)
Informations de copyright
© The Author(s) 2022; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.