Frequency of supervised consumption service use and acute care utilization in people who inject drugs

Supervised consumption service (SCS) use among people who inject drugs may reduce acute care utilization; however, prior studies have been limited by self-reported outcomes and dichotomous exposures.

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.

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 significantly 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).

SCS use had little impact on objectively measured acute care utilization, which was high overall. Although preventing overdose mortality is the primary goal of SCS in Canada, resourcing sites to support their clients' acute healthcare needs may help build a continuum of care for people experiencing marginalization who inject drugs.