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Home > Supervised injection facilities and other supervised consumption sites: effectiveness and value. Evidence report.

Armbrecht, Eric and Guzauskas, Greg and Hansen, Ryan N and Pandey, Rajshree and Fazioli, Katherine and Chapman, Rick and Pearson, Steven D and Rind, David M (2020) Supervised injection facilities and other supervised consumption sites: effectiveness and value. Evidence report. Boston, MA: Institute for Clinical and Economic Review.

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A SIF is a permanent or mobile place where people can inject drugs they have obtained elsewhere. If it permits use of drugs by routes other than injection (such as smoking or snorting), “supervised consumption site” (SCS) is a more appropriate term. SIFs typically provide equipment to allow users to perform safe and sterile injections while being monitored by trained medical staff who can treat overdoses with oxygen, naloxone, and/or other first-responder care. While SIF model implementation seems to vary based on community needs, resources, and funding, interviews with stakeholders suggest that there are three core features: sterile equipment, trained personnel for supervision, and naloxone administration (along with other first-responder medical care). Additional services may be added to the core features, such as health screening, treatment for substance use disorders (SUDs), referral coordination for social support (e.g., housing), health care and mental health services.

The purpose of this assessment is to evaluate the health and economic outcomes of a SIF. This review seeks to answer the question: What is the net health benefit of implementing a SIF (which includes an SSP, Syringe Service Program) versus an SSP alone? The CDC recommends SSPs as an evidence-based program noting they are “safe, effective, and cost saving, do not increase illegal drug use or crime, and play an important role in reducing the transmission of viral hepatitis, HIV, and other infections.” The ICER value framework includes both quantitative and qualitative comparisons to ensure that the full range of benefits and harms are considered in the judgments about the clinical and economic value. The assessment of effectiveness and value is made in comparison to an SSP as we believe it unlikely that communities without SSPs would be willing to consider a SIF. A SIF implemented in a community without good SSP coverage may experience more than the incremental benefit.

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