The Science

Safehouse Data Narrative

Overdose Prevention Sites (OPS) were first implemented in the 1990s in the Netherlands, Switzerland, and Germany.  Also known as Supervised Injection Sites/Services (SIS), Supervised Injection Facilities (SIF), and Safer Consumption Sites (SCS), OPS have been implemented in over 120 locations worldwide and have a solid research base demonstrating positive impact on reducing overdose fatalities, reducing public drug consumption, and not increasing drug use and crime.[1]

Starting in 2014, the notoriously potent heroin in Philadelphia progressively became regularly contaminated with the synthetic opioid fentanyl. Fentanyl is even more powerful than heroin and has a shorter half-life—meaning people who use it will need to use it more frequently in order to avoid withdrawal symptoms. Within a few years, overdose deaths in Philadelphia skyrocketed from under 500 per year to over 1000 per year.[2] Many neighborhoods in Philadelphia felt the strain of living among the dual opiate and overdose epidemics, and they struggled with the resulting challenges to their quality of life.

To address the epidemic, the city expanded the distribution of naloxone (a medication to reverse overdoses) and increased access to treatment, including medication-assisted treatment. While there has been some progress in reducing the number of overdose deaths, there has also been an increased burden on hospitals, emergency medical services and other first responders.

In 2017, the Mayor’s Task Force to Combat the Opioid Epidemic released a report recommending that Philadelphia implement an OPS pilot.[3] We believe the evidence base in support of OPS is sound and we hope to contribute to it with additional research and evaluation. Based on the existing research, we are confident that we will see the same positive outcomes found in other OPS. 

In short, the evidence has shown that OPS can:

  • Decrease fatal overdose. Studies from existing OPS locations consistently found lowered overall rates of fatal overdose following the implementation of OPS.[4],[5]
  • Increase quality of life for neighbors. Researchers found that OPS reduces public injection and improper syringe disposal.[6] OPS is not associated with increases in crime.[7]
  • Prevent other health consequences of injection drug use. OPS has been shown to prevent HIV and hepatitis C transmission as well as abscesses and bacterial infections. Preventing these outcomes in Philadelphia is expected to have major costs savings for our health systems.[8]
  • Increase access to drug treatment. In its first three years, 46% of Insite, the first SIS in North America, clients entered drug treatment.[9] Safehouse’s model will have treatment referral and MAT onsite.
  • Reduced taxpayer burden. Safehouse is not being funded with taxpayer dollars and will likely result in significant cost savings to Philadelphia taxpayers by reduced health care costs and overdose response costs.[10] 
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HARM REDUCTION

OPIOID EPIDEMIC

SIS/OPS/CONSUMPTION ROOMS

  • Andresen MA, Boyd N. A cost-benefit and cost-effectiveness analysis of of Vancouver’s supervised injection facility. Int J Drug Policy 21(1):70-6 (Jan. 2010)

  • Abernathy B, Gladstein E, Farley T, Jones D. Report on Exploratory Visits for Comprehensive User Engagement Site. (Jan. 22, 2018)

  • CBC News, Supervised drug sites working, Etches tells province (Sept. 18, 2018)
  • Beau Kilmer et al., Rand Corp., Considering Heroin-Assisted Treatment and Supervised Drug Consumption Sites in the United States (2018)
    • “The existing reviews of scientific evaluation of [supervised consumption sites] report positive findings across a broad range of outcomes.”
  • Chloe Potier et al., Supervised injection services: What has been demonstrated? A systematic literature review, 145 Drug & Alcohol Dependence, Results (2014)
    • Concluding, after review of seventy-five relevant articles, that supervised consumption sites “were efficacious in promoting safer injection conditions, enhancing access to primary health care, and reducing overdose frequency,” that they are “associated with reduced levels of public drugs injections or dropped syringes,” and that such sites “were not found to increase drug injecting, drug trafficking or crime in the surrounding environments”
  • City of Toronto, Supervised Injection Services (Aug. 20, 2018)
  • DeBeck K., Kerr T., Bird L., et al., Drug Alcohol Depend, “Injection Drug Use Cessation and Use of North America’s First Medically Supervised Safer Injecting Facility” (Jan. 15, 2011)
  • Degkwitz, P., Haasen, C., Verthein, U., and Zurhold, H., Journal of Drug Issues, "Drug Consumption Rooms in Hamburg, Germany: Evaluation of the Effects on Harm Reduction and the Reduction of Public Nuisance" (2003)
  • Harm Reduction Coalition, Alternatives To Public Injection (2016)
  • Health Canada, Final Report of the Expert Advisory Committee on Supervised Injection Site Research, "Vancouver’s INSITE Service and Other Supervised Injection Sites: What Has Been Learned from Research?" (Apr. 3, 2008)
  • Johns Hopkins Bloomberg School of Public Health, Safe Consumption Spaces Would be Welcomed By High-Risk Opioid Users (Jun 5, 2019).
    • A large majority of people who use heroin and fentanyl would be willing to use safe consumption spaces where they could obtain sterile syringes and have medical support in case of overdose, suggests a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.
  • Kerr, T., Tyndall, M. W., Lai, C., Montaner, J. S., & Wood, E., International Journal of Drug Policy, "Drug-related overdoses within a medically supervised safer injection facility" (2006)
  • Kerr, T., PhD, Tyndall, M. W., MD, Zhang, R., MSc, Lai, C., MMath, Montaner, J. S., MD, & Wood, E., PhD., American Journal of Public Health, "Circumstances of First Injection Among Illicit Drug Users Accessing a Medically Supervised Safer Injecting Facility" (2007)
  • Marshall, B. D., Milloy, M., Wood, E., Montaner, J. S., & Kerr, T., The Lancet, "Reduction in overdose mortality after the opening of North Americas first medically supervised safer injecting facility: A retrospective population-based study" (2011)
  • Park, J.N., Sherman, S.G., Rouhani, S. et al. Willingness to Use Safe Consumption Spaces among Opioid Users at High Risk of Fentanyl Overdose in Baltimore, Providence, and Boston. J Urban Health 96: 353. https://doi.org/10.1007/s11524-019-00365-1 (2019)
  • Wood, E., Canadian Medical Association Journal, "Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users" (2004)
  • Wood, E., Tyndall, M. W., Lai, C., Montaner, J. S., & Kerr, T. Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime (2006)
  • Wood, E., Tyndall, M. W., Zhang, R., Montaner, J. S., & Kerr, T., Rate of detoxification service use and its impact among a cohort of supervised injecting facility users (2007)
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SYRINGE EXCHANGE PROGRAMS

 

SAFEHOUSE DATA NARRATIVE REFERENCES:

  1. Potier, C., et al., Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend, 2014. 145: p. 48-68
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  2. The Mayor’s Task Force to Combat the Opioid Epidemic in Philadelphia, Final Report and Recommendations (2017)
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  3. Ibid
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  4. Milloy, M.J., et al., Non-fatal overdose among a cohort of active injection drug users recruited from a supervised injection facility. Am J Drug Alcohol Abuse, 2008. 34(4): p. 499-509
    back to footnote 4 source
  5. International Network of Drug Consumption Rooms. 2015; Available from: http://www.drugconsumptionroom-international.org/
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  6. Wood E, Kerr T, Small W, Li K, Marsh D, et al. 2004. Changes In Public Order After The Opening of a Medically Supervised Safer Injection Facility for Injection Drug Users. Canadian Medical Association Journal 171:731-4
    back to footnote 6 source
  7. Potier, C., et al.
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  8. Larson, S., Padron, N., Mason, J. & Bogaczyk, Supervised Consumption Facilities – Review of the Evidence (2017)
    back to footnote 8 source
  9. DeBeck, K., et al., Injection drug use cessation and use of North America's first medically supervised safer injecting facility. Drug Alcohol Depend, 2011. 113(2-3): p. 172-6
    back to footnote 9 source
  10. Larson et al.
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