Drug consumption rooms: A systematic review of evaluation methodologies

Abstract

Issues. Drug consumptions rooms (DCR) and supervised injecting facilities (SIF) are expanding internationally. Previous reviews have not systematically addressed evaluation methodologies. Approach. Results from systematic searches of scientific databases in English until June 2017 were coded for paper type, country and year of publication. For evaluation papers, study outcome, methodology/study design and main indicators of DCR/SIF 'exposure' were recorded. Key Findings. Two hundred and nineteen eligible peer-reviewed papers were published since 1999: the majority from Canada (n = 117 papers), Europe (n = 36) and Australia (n = 32). Fifty-six papers reported evaluation outcomes. Ecological study designs (n = 10) were used to assess the impact on overdose, public nuisance and crime; modelling techniques (n = 6) estimated impact on bloodborne diseases, overdose deaths and costs. Papers using individual-level data included four prospective cohorts (n = 28), cross-sectional surveys (n = 7) and service records (n = 5). Individual-level data were used to assess safer injecting practice, uptake into health and social services and all the other above outcomes except for impact on crime and costs. Four different indicators of DCR/SIF attendance were used to measure service 'exposure'. Implications. Research around DCRs/SIFs has used ecological, modelling, cross-sectional and cohort study designs. Further research could involve systematic inclusion of a control group of people who are eligible but do not access SIFs, validation of self-reported proportion of injections at SIFs or a stepped-wedge or a cluster trial comparing localities. Conclusions. Methodologies appropriate for DCR/SIF evaluation have been established and can be readily replicated from the existing literature. Research on operational aspects, implementation and transferability is also warranted. [

“Beyond Safer Injecting”—Health and Social Needs and Acceptance of Support among Clients of a Supervised Injecting Facility

“…Harm reduction programs are evidence-based interventions which reduce both individual and societal harms of drug use and change risk environments [1,2,3]. Supervised injecting facilities (SIFs) and Drug Consumption Rooms (DCRs) are harm reduction programs which provide space for safer drug administration in hygienic settings under the supervision of qualified staff [4], and are increasing in number worldwide [5]. In 2016, 92 SIFs/DCRs operated across 11 countries, with the majority in Germany, the Netherlands and Switzerland, several in Spain, Denmark, Norway and France, and, until recently, one each in Australia, Canada and Luxembourg [5].…”

“…Supervised injecting facilities (SIFs) and Drug Consumption Rooms (DCRs) are harm reduction programs which provide space for safer drug administration in hygienic settings under the supervision of qualified staff [4], and are increasing in number worldwide [5]. In 2016, 92 SIFs/DCRs operated across 11 countries, with the majority in Germany, the Netherlands and Switzerland, several in Spain, Denmark, Norway and France, and, until recently, one each in Australia, Canada and Luxembourg [5]. A ‘trial’ SIF/DCR opened in Melbourne, Australia in July 2018 [5], and the Canadian Ministry of Health has thus far approved 33 new Supervised Consumption Services between 2016 and 2018 with further applications being assessed [5].…”

“…In 2016, 92 SIFs/DCRs operated across 11 countries, with the majority in Germany, the Netherlands and Switzerland, several in Spain, Denmark, Norway and France, and, until recently, one each in Australia, Canada and Luxembourg [5]. A ‘trial’ SIF/DCR opened in Melbourne, Australia in July 2018 [5], and the Canadian Ministry of Health has thus far approved 33 new Supervised Consumption Services between 2016 and 2018 with further applications being assessed [5]. The opening of SIFs in Portugal is scheduled for 2018/19 and is under discussion in Ireland, Scotland and the US [5].…”

To what extent do supervised drug consumption services incorporate non-injection routes of administration? A systematic scoping review documenting existing facilities

“…While systematic reviews of SCS have been conducted in the past [3,4,57], our study is the first to focus explicitly on what is known regarding the service models of SCS that accommodate drug consumption by oral, intranasal, or inhalation routes. Despite capturing 193 potentially relevant articles that discussed supervising non-injection forms of drug consumption, only 39 identified specific examples of SCS allowing alternate routes of consumption and/or provided program participant characteristics for people who use drugs orally, intranasally, or by inhalation.…”

“…This scoping review is subject to limitations, the first of which was the exclusion of articles that were not published in English. Many SCS that permit non-injection routes of consumption exist in Europe, and only including articles in English may have resulted in the exclusion of some relevant literature [ 57 ]. However, of the 807 full-text articles we screened from the peer-reviewed databases, only 29 (3.6%) were excluded because they were not available in English.…”