Wednesday, 16 Jan 2019

Do Supervised Drugs Sites Save Lives? A new study will disappoint extremists on both sides of the debate.

The increase in the number of deaths due to the opioid epidemic has prompted search for new solutions. One of the most controversial is to establish sites where people can use illicit drugs such as heroin under the supervision of qualified personnel who can offer clean injection equipment and intervene in case of overdose. Henry Dorkin, a prominent physician from Massachusetts, spoke on behalf of many supporters when he argued that supervised drug consumption centers (CBDCs) were generating "substantial and documented reductions in the number of deaths, illnesses and deaths. Spending ", while US Deputy Attorney General Rod J. Rosenstein said that CFDS" are very dangerous and would only worsen the opioid crisis. " A comprehensive and recently published review of evidence by RAND Corporation scientists will disappoint both extremes of this debate, but it is very informative for any city that is considering establishing a CBDC.

The RAND team, led by Beau Kilmer, concluded that an important aspect of the experience of the SDCF staff was reflected in the scientific results: an episode of drug use under medical supervision was almost certainly less likely to provoke death or transmission of infectious diseases than an episode. elsewhere, as alone in an alley. With naloxone, rescue medication, and other medical measures, for example, almost any overdose of opioids can be canceled before it becomes fatal.

However, existing research does not show that drug users with access to DCF are less likely to die from an overdose over time, or that the opening of a CCDF decreases the rate of overdose deaths in a given population. community. These two findings may initially seem to contradict the conclusions about risk reduction associated with supervised drug use sessions, but they are not.

The report found that many people use SDCF intermittently, but do not adopt the safer use practices of CFDCs when they are used externally. A person who injects heroin into the CRPS one day can thus avoid a fatal overdose that day, but have one the next day outside the SDCF. More importantly, no one knows whether becoming a DMCC user leads to a longer career in drug use than other interventions (such as methadone maintenance). If, by making injection drug use safer and more positive (for example, by being surrounded by supportive people), DFQFs even modestly reduce the likelihood that an individual will stop injecting during the week, the next month or year, the benefits of a lower risk drug. use now can be reversed by an increased number of episodes of drug use later.

Why do not the low-risk drug use experiences of CBDS clearly translate into lower rates of overdose deaths in the community? RAND researchers point to scalability issues: even the most active SDCFs can supervise up to 150,000 injections per year, while US drug users inject heroin 1.1 billion times a year (and amazing number does not even count injections of other drugs). Approximately 7,000 FCAD should be opened to allow for the supervision of so many injections. If you want to understand how difficult it would be, consider that three decades after the opening of the first CBDC, there are only about 100 around the world.

Perhaps the most important finding of the RAND team was that most of the evaluation studies of the CFDS are of poor methodological quality. When scientists even imposed a minimal methodological bar for studies to be included in the analysis, only a handful of them were successful. This should make it difficult for anyone to argue convincingly about what evidence the FDCS "demonstrates". However, the debate on drug policy is uncertain, so there is no guarantee that many people will take this warning to heart.

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