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

Abstract

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.

Intravenous misuse of slow-release oral morphine capsules: how much morphine is injected?

“…Experimentation with such an intravenous substitution could be carried out within the framework of the opening of supervised injection rooms “Haltes Soins Addictions” (“Drop-in Addiction Care”), prolonging the French experimentation with lower risk consumption rooms [ 30 , 31 ], after a rigorous evaluation of its benefits and risks within a clinical trial. These allow supervised self-administration of substances, particularly morphine from illicit markets, the drug most injected daily (24%) in these consumption rooms [ 32 ], while conforming to the principles of asepsis and promoting the entry of PWIM into multidisciplinary care which can be beneficial to them [ 30 , 31 ]. This care setting would be suitable for the eventual provision of an injectable substitution, alone or in addition to a validated OST, whose effectiveness has been scientifically documented [ 33 – 35 ].…”

People who inject oral morphine favor experimentation with injectable opioid substitution

“…The multidiciplinarity of the care framework proposed in these structures would favor entry into a comprehensive care pathway, including screening and the management of somatic and psychic comorbidities, social precariousness, etc., in parallel to the treatment of substance use disorder using with adapted galenic formulations. These structures have also been shown to reduce systemic viral infections (HIV and HCV), skin complications due to injections, non-fatal overdoses, and emergency room visits [ 38 ]. However, care must be taken to ensure that the care framework is sufficiently non-stigmatizing, flexible and respectful of confidentiality to avoid a coercive and restrictive dimension that would undermine its attractiveness and effectiveness, especially in young adults [ 18 , 20 , 23 , 24 , 39 ].…”

Willingness to use a drug consumption room among people who use drugs in Lyon, France, a city with no open scene of drug use (the TRABOUL survey)

“…However, France has been running behind some other European countries in terms of DCR implementation [ 8 ], and it was only in 2016 that an experimentation process was launched by the French Ministry of Health [ 9 , 10 ]. Since then, two DCRs have opened, one in Strasbourg and another in Paris in 2016, leading to substantial reductions in the occurrence of overdoses, the number of visits to emergency wards, and at-risk practices toward HIV and HCV [ 11 , 12 ].…”