The purpose of this study is to analyze mortality due to overdose in areas that have implemented supervised injection sites and understand what factors these facilities affect that can lead to a change in outcomes

Bhambri, Shubh

English

Rowan University

Rowan University Rowan Digital Works Stratford Campus Research Day 26th Annual Research Day May 5th, 12:00 AM Understanding Changes in Mortality with Implementation of Safe Injection Sites Shubh Bhambri Rowan University Follow this and additional works at: https://rdw.rowan.edu/stratford_research_day  Part of the Community Health and Preventive Medicine Commons, Health and Medical Administration Commons, Health Services Research Commons, Investigative Techniques Commons, Medical Humanities Commons, and the Substance Abuse and Addiction Commons Let us know how access to this document benefits you - share your thoughts on our feedback form. Bhambri, Shubh, "Understanding Changes in Mortality with Implementation of Safe Injection Sites" (2022). Stratford Campus Research Day. 121. https://rdw.rowan.edu/stratford_research_day/2022/May5/121 This Poster is brought to you for free and open access by the Conferences, Events, and Symposia at Rowan Digital Works. It has been accepted for inclusion in Stratford Campus Research Day by an authorized administrator of Rowan Digital Works. RESEARCH POSTER PRESENTATION DESIGN © 2015www.PosterPresentations.comOpioid Epidemic• Three waves composing the Opioid Epidemic:1o Wave 1: Prescription opioidso Wave 2: Heroino Wave 3: Synthetic opioids• Introduction of fentanyl allowed more potent formulations at cheaper costso Increased fentanyl-based deaths by around 12-fold and opioid-based deaths by over six-fold when compared to the first wave2• Safe injection sites have led to reduced harm and decrease in overdose deaths in countries that have implemented them3• Can become a gold standard for decreasing mortality due to opioid-based overdose• Limitations due to federal law and political disagreementBACKGROUNDData Collection• Utilization of various clinical databases and government information pageso Studies used different methodologies o Prioritized studies after 2010 to focus on impact on current wave of epidemicType of Outcomes Measured• Mortality due to overdoseo Other outcomes including hospital and ambulance utilization, perceived fear, and viral infection rates investigated in order to identify factors that influence the primary outcomeData Analysis• Comparative analysis of studies in order to determine the consensus and viability of safe injection sites as an intervention while looking at various sources in order to explain the correlative relationship and recognize any patterns.METHODS DISCUSSION• Current methodology (i.e. “War on Drugs”) has not significantly changed outcomes when looking at drug use10• Multiple explanations for decrease in mortality due to injection siteso Safer environment devoid of intervention from policing forces and the publicv Avoidance of increased pressure and speed of injectiono Greater oversight due to presence of medical staffv Care before injection: needle exchange, testing for contaminants (i.e. fentanyl, stimulants, etc.), clean and well-lit environmentv Care during injection: monitoring, reversalv Care after injection: ambulance access, referrals• First study to examine impact of various factors that lead to improved mortality outcomes in supervised injection sites• Mediate discussion within the public and policy makers to decrease stigma and begin implementation of sites in the U.S.LIMITATIONS• Incomplete information due minimal implementation of sites worldwide and limited outcome measurements with all sites• Limited control over methodology with some sources relying on subjective data from interviews and surveys • Comparative analysisShubh Bhambri, OMS-III, Rowan University School of Osteopathic MedicineUnderstanding Changes in Mortality with Implementation of Safe Injection SitesThe purpose of this study is to analyze mortality due to overdose in areas that have implemented supervised injection sites and understand what factors these facilities affect that can lead to a change in outcomes.OBJECTIVESEfficacy and Outcomes of Safe Injection SitesVancouver, Canada • between eight and fifty-one deaths prevented in two years of operation4,5• no fatal implications in users at site6• fatal overdose rate within the 500m area of the injection site decreased by 35.0%, as compared to the citywide decrease of 9.3% (p=0.049)7Unsanctioned site in the United States (unspecified location)• over five years of operation, 33 overdoses over 10,514 injections with no fatalities8Predictive models for Philadelphian injection site• prevent six to seven fatalities per thirty stations per year9• speculated further decreases due to referrals expanded operationsACKNOWLEDGEMENTSSpecial thanks to Dr. Adarsh Gupta for guidance with this project.RESULTSREFERENCES1. Understanding the Epidemic. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/epidemic/index.html. Published March 19, 2020. Accessed November 1, 2020.2. O’Donnell JK, Gladden RM, Seth P. Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region —United States, 2006–2015. MMWR Morbidity and Mortality Weekly Report. 2017;66(34):897-903. doi:10.15585/mmwr.mm6634a23. Bowers L. Safe injection sites and drug injection overdose: A literature review. SSRN Electronic Journal. 2017. doi:10.2139/ssrn.3415130 Z. 4. Milloy M-JS, Kerr T, Mathias R, et al. Non-fatal overdose among a cohort of active injection drug users recruited from a supervised injection facility. The American Journal of Drug and Alcohol Abuse. 2008;34(4):499-509. doi:10.1080/00952990802122457 (B) 15.5. Semaan S, Fleming P, Worrell C, Stolp H, Baack B, Miller M. Potential role of safer injection facilities in reducing HIV and hepatitis C infections and overdose mortality in the United States. Drug and Alcohol Dependence. 2011;118(2-3):100-110. doi:10.1016/j.drugalcdep.2011.03.0066. Ng J, Sutherland C, Kolber MR. Does evidence support supervised injection sites?. Can Fam Physician. 2017;63(11):8667. Kennedy MC, Hayashi K, Milloy M-J, Wood E, Kerr T. Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: A cohort study. PLOS Medicine. 2019;16(11). doi:10.1371/journal.pmed.10029648. Kral AH, Lambdin BH, Wenger LD, Davidson PJ. Evaluation of an unsanctioned safe consumption site in the United States. New England Journal of Medicine. 2020;383(6):589-590. doi:10.1056/nejmc20154359. Wares JR, Dong J, Gevertz JL, et al. Predicting the impact of placing an overdose prevention site in Philadelphia: a mathematical modeling approach [published correction appears in Harm Reduct J. 2021 Dec 15;18(1):129]. Harm Reduct J. 2021;18(1):110. Published 2021 Oct 30. doi:10.1186/s12954-021-00559-410.Coyne CJ, Hall A. Four Decades and Counting: The Continued Failure of the War on Drugs. Social Science Research Network. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2979445. Published June 3, 2017. Accessed November 3, 2021

Understanding Changes in Mortality with Implementation of Safe Injection Sites

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Understanding Changes in Mortality with Implementation of Safe Injection Sites

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