New Strategies Are Needed to Stop Overdose Fatalities: The Case for Supervised Injection Facilities
Authors: Jessie M. Gaeta, Melanie Racine
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions1 May 2018New Strategies Are Needed to Stop Overdose Fatalities: The Case for Supervised Injection FacilitiesJessie M. Gaeta, MD and Melanie Racine, MPHJessie M. Gaeta, MDInstitute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, and Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts (J.M.G.)Search for more papers by this author and Melanie Racine, MPHInstitute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts (M.R.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-0258 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Last summer, the lifeless body of a 26-year-old heroin-using man, Tim (not his real name), was discovered in the shadows of a side street in Boston. Ninety minutes before, he had come to our clinic at Boston Health Care for the Homeless Program, mere blocks away, pleading for help. He told us with certainty that he was going to relapse that day, ending 6 weeks of hard-earned sobriety. Our nurse offered to connect Tim to treatment at the nearby methadone clinic or our office-based addiction treatment program, but he refused. He said he wasn't ready to enter another treatment program: ...References1. Gaeta J, Bock B, Takach M. Providing a safe space and medical monitoring to prevent overdose deaths. Health Affairs Blog. 31 August 2016. Accessed at www.healthaffairs.org/do/10.1377/hblog20160831.056280/full/ on 29 January 2018. Google Scholar2. Marshall BD, Milloy MJ, Wood E, Montaner JS, Kerr T. Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study. Lancet. 2011;377:1429-37. [PMID: 21497898] doi:10.1016/S0140-6736(10)62353-7 CrossrefMedlineGoogle Scholar3. Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend. 2014;145:48-68. [PMID: 25456324] doi:10.1016/j.drugalcdep.2014.10.012 CrossrefMedlineGoogle Scholar4. Wood E, Tyndall MW, Zhang R, Stoltz JA, Lai C, Montaner JS, et al. Attendance at supervised injecting facilities and use of detoxification services [Letter]. N Engl J Med. 2006;354:2512-4. [PMID: 16760459] CrossrefMedlineGoogle Scholar5. DeBeck K, Kerr T, Bird L, Zhang R, Marsh D, Tyndall M, et al. Injection drug use cessation and use of North America's first medically supervised safer injecting facility. Drug Alcohol Depend. 2011;113:172-6. [PMID: 20800976] doi:10.1016/j.drugalcdep.2010.07.023 CrossrefMedlineGoogle Scholar6. Kerr T, Stoltz JA, Tyndall M, Li K, Zhang R, Montaner J, et al. Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study. BMJ. 2006;332:220-2. [PMID: 16439401] CrossrefMedlineGoogle Scholar7. Massachusetts Medical Society, Task Force on Opioid Therapy and Physician Communication. Establishment of a pilot medically supervised injection facility in Massachusetts. 2017. Accessed at www.massmed.org/advocacy/state-advocacy/sif-report-2017 on 30 January 2018. Google Scholar8. American Medical Association. AMA wants new approaches to combat synthetic and injectable drugs. 2017. Accessed at www.ama-assn.org/ama-wants-new-approaches-combat-synthetic-and-injectable-drugs on 30 January 2018. Google Scholar9. León C, Cardoso L, Mackin S, Bock B, Gaeta JM. The willingness of people who inject drugs in Boston to use a supervised injection facility. Subst Abus. 2017:1-7. [PMID: 28799847] doi:10.1080/08897077.2017.1365804 CrossrefMedlineGoogle Scholar10. Kral AH, Davidson PJ. Addressing the nation's opioid epidemic: lessons from an unsanctioned supervised injection site in the U.S. Am J Prev Med. 2017;53:919-922. [PMID: 28801014] doi:10.1016/j.amepre.2017.06.010 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, and Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts (J.M.G.)Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts (M.R.)Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0258.Corresponding Author: Jessie M. Gaeta, MD, Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA 02118; e-mail, [email protected]org.Current Author Addresses: Dr. Gaeta and Ms. Racine: Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, 780 Albany St., Boston, MA 02118.Author Contributions: Conception and design: J.M. Gaeta.Analysis and interpretation of the data: J.M. Gaeta.Drafting of the article: M. Racine.Critical revision for important intellectual content: J.M. Gaeta.Final approval of the article: J.M. Gaeta.Provision of study materials and patients: J.M. Gaeta.This article was published at Annals.org on 6 February 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byImpact of a Homeless Encampment Closure on Crime Complaints in the Bronx, New York City, 2017: Implications for Municipal PolicyNotes on harm reduction and the opioid epidemic in the United StatesHIV and Substance Use DisorderRisk Factors for Opioid Overdose 1 May 2018Volume 168, Issue 9Page: 664-665KeywordsAddictionDetoxificationDrugsHealth careHealth care facilitiesHealth care policyNursesOpioid addictionResearch quality assessmentSafety studies ePublished: 6 February 2018 Issue Published: 1 May 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...