Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facility

Amos Irwin,Susan G Sherman,Brian W Weir,Andrew Lindsay,Ehsan Jozaghi,Sean T Allen

doi:10.1186/s12954-017-0153-2

Abstract

BackgroundIn Baltimore, MD, as in many cities throughout the USA, overdose rates are on the rise due to both the increase of prescription opioid abuse and that of fentanyl and other synthetic opioids in the drug market. Supervised injection facilities (SIFs) are a widely implemented public health intervention throughout the world, with 97 existing in 11 countries worldwide. Research has documented the public health, social, and economic benefits of SIFs, yet none exist in the USA. The purpose of this study is to model the health and financial costs and benefits of a hypothetical SIF in Baltimore.MethodsWe estimate the benefits by utilizing local health data and data on the impact of existing SIFs in models for six outcomes: prevented human immunodeficiency virus transmission, Hepatitis C virus transmission, skin and soft-tissue infection, overdose mortality, and overdose-related medical care and increased medication-assisted treatment for opioid dependence.ResultsWe predict that for an annual cost of $1.8 million, a single SIF would generate $7.8 million in savings, preventing 3.7 HIV infections, 21 Hepatitis C infections, 374 days in the hospital for skin and soft-tissue infection, 5.9 overdose deaths, 108 overdose-related ambulance calls, 78 emergency room visits, and 27 hospitalizations, while bringing 121 additional people into treatment.ConclusionsWe conclude that a SIF would be both extremely cost-effective and a significant public health and economic benefit to Baltimore City.

Highlights

In Baltimore, MD, as in many cities throughout the USA, overdose rates are on the rise due to both the increase of prescription opioid abuse and that of fentanyl and other synthetic opioids in the drug market
Despite the present study’s limitations, it demonstrates that a Supervised injection facility (SIF) in Baltimore would bring significant cost savings and public health benefits to the city
A single 13booth SIF facility in Baltimore City modeled on Insite in Vancouver would generate medical and economic savings of roughly $7.77 million per year

Summary

Introduction

In Baltimore, MD, as in many cities throughout the USA, overdose rates are on the rise due to both the increase of prescription opioid abuse and that of fentanyl and other synthetic opioids in the drug market. Baltimore City has one of the highest overdose death rates in the country, and overdoses have been increasing in recent years. From 2014 to 2015, heroin-related overdose deaths in Baltimore increased from 192 to 260 [1]. There are numerous additional medical costs associated with injection drug use, largely related to infectious diseases and soft-tissue infections. 18% of the people who inject drugs (PWID) in Baltimore are HIV positive, twice the 9% national average for PWID and 50 times the prevalence in the general population [6,7,8]. One in five Baltimore PWID suffers chronic skin and soft-tissue infection, the leading cause of PWID hospitalization [9,10,11]

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