Reduced Emergency Department Visits and Hospitalisation with Use of an Unsanctioned Safe Consumption Site for Injection Drug Use in the United States

Background: Safe consumption sites (SCS) are an evidence-based intervention to prevent drug use-related harm. In late 2014, an organisation in an undisclosed location in the USA opened an unsanctioned SCS.

Objective: To evaluate whether use of the unsanctioned SCS affected medical outcomes.

Design: A prospective cohort study.

Setting: Neighbourhoods surrounding the SCS.

Participants: People who injected drugs were recruited and interviewed at baseline and 6 and 12 months from 2018 to 2020.

Intervention: People using the SCS could bring pre-obtained drugs to consume via injection, which were monitored by trained staff with naloxone.

Main measures: Any overdose, number of non-fatal overdoses, skin and soft tissue infections, emergency department utilisation, number of emergency department visits, hospitalisation and number of nights spent in hospital.

Key results: A total of 494 participants enrolled in the study; 59 (12%) used the SCS at least once. We used propensity score weighting to analyse the association between SCS utilisation and measures. People using the SCS were 27% (95% CI: 12-46%) less likely to visit the emergency department, had 54% (95% CI: 33-71%) fewer emergency department visits, were 32% (95% CI: 4-57%) less likely to be hospitalised, and spent 50% (95% CI: 1-85%) fewer nights in hospital. Though not significant, people using the SCS had a lower likelihood of overdosing and slightly higher likelihood of skin and soft tissue infections.

Conclusions: Our findings support the use of SCS in the USA to reduce the growing burden of acute care service utilisation related to injection drug use.