Substance Use
Frequency of supervised consumption service use and acute care utilization in people who inject drugs Ayden Scheim* Ayden Scheim Zachary Bouck Zoë R. Greenwald Vicki Ling Shaun Hopkins Matt Johnson Ahmed Bayoumi Tara Gomes Dan Werb
Background: Supervised consumption service (SCS) use among people who inject drugs may reduce acute care utilization; however, prior studies have been limited by self-reported data and dichotomous exposures.
Methods: We conducted a prospective cohort study using linked questionnaire and health administrative data among people who inject drugs in Toronto, Canada (2018–2020). Baseline SCS use frequency was defined by a participant’s self-reported proportion of injections performed at an SCS over the past six months: “all/most” (≥75%), “some” (26–74%), “few” (1–25%), or “none” (0%). Outcomes measured over the following six months included: emergency department (ED) visits; hospitalizations; ED visits or hospitalizations for opioid-related overdose; and hospitalizations for injection-related infections. The relative effects of varying SCS use levels on study outcomes were estimated using inverse-probability-weighted negative binomial regression models.
Results: Of 467 participants, 25.5%, 30.4%, 28.7%, and 15.4% respectively reported “all/most”, “some”, “few”, and “none” levels of SCS use at baseline. SCS use frequency was not associated with ED visits, hospitalizations, or hospitalizations for injection-related infections. Participants reporting “some” SCS use had a higher rate of ED visits or hospitalizations for opioid-related overdose (versus “few”; rate ratio=2.30, 95% confidence interval=1.15–4.61).
Conclusions: In this first SCS evaluation linking client surveys to comprehensive health administrative data, SCS use had little impact on objectively measured acute care utilization, which was high overall. Results highlight the importance of disaggregating heterogeneous SCS use patterns and considering (non)comparability of SCS user and non-user groups.