One of the most pressing public health issues in recent Canadian history has undoubtedly been the opioid and overdose crisis. Since 2016, when the Public Health Agency of Canada began monitoring opioid-related deaths, there have been over 40,000 opioid toxicity deaths in Canada: a staggering figure that has led some provinces to label the crisis a public health emergency.
A number of public health measures and studies have attempted to attenuate the crisis, including research into who is most vulnerable to overdose, the distribution of fentanyl test strips, and the proliferation of methadone and safer supply programs.
A related measure has been the creation of supervised consumption sites, which offer testing and health services, as well as a safe place for people to use their drugs while being monitored in the case of an overdose. However, are these programs actually effective in reducing overdose deaths? A new study by researchers, including from St. Michael’s Hospital in Toronto, suggests that they are.
Neighbourhood Benefits
While supervised consumption sites (SCS) are effective at preventing overdose deaths for those who visit them, the authors highlight that not much is known about how these sites affect overdose mortality rates at a population level. The study focused on Toronto — a city with high overdose mortality rates and a number of SCS. Overdose-related data from the Chief Coroner of Ontario were collected between May 2017 and December 2019, a period which saw the opening of nine SCS in Toronto (all following the start of the data collection date).
Using this data, the researched aimed to better understand overdose deaths at a neighbourhood level, examine the effects on overdose rates of SCS being opened, and analyze the relationship between overdose rates and proximity to a SCS.
During the data collection period between May 2017 and December 2019, Toronto experienced a total of 787 overdose deaths, with the vast majority of them being opioid-related (83%), involving fentanyl (66%), and occurring outside of the person’s home (65%).
However, the benefits of SCS were quite prominent. The city saw a 42% decrease in overdose mortality rates between the pre-SCS and post-SCS period. Specifically, a 67% decrease was found in neighbourhoods that were within 500 metres of an SCS compared to those that were not.
This effect was most prominent for downtown neighbourhoods that were close to an SCS. The decrease in overdose deaths was approximately equivalent to “the prevention of two overdose deaths per 100,000 residents in each square mile immediately surrounding SCS sites”. The decrease in mortality was even found up to a distance of 5 kilometres from an SCS!
The researchers hypothesize that this effect could be due in part to the dissemination of naloxone kits across neighbourhoods. They conclude that SCS “might also contribute to population-level overdose prevention efforts”.
