Abstract
BackgroundFatal overdoses from opioid use and substance disorders are increasing at an alarming rate. One proposed harm reduction strategy for reducing overdose fatalities is to place overdose prevention sites—commonly known as safe injection facilities—in proximity of locations with the highest rates of overdose. As urban centers in the USA are tackling legal hurdles and community skepticism around the introduction and location of these sites, it becomes increasingly important to assess the magnitude of the effect that these services might have on public health.MethodsWe developed a mathematical model to describe the movement of people who used opioids to an overdose prevention site in order to understand the impact that the facility would have on overdoses, fatalities, and user education and treatment/recovery. The discrete-time, stochastic model is able to describe a range of user behaviors, including the effects from how far they need to travel to the site. We calibrated the model to overdose data from Philadelphia and ran simulations to describe the effect of placing a site in the Kensington neighborhood.ResultsIn Philadelphia, which has a non-uniform racial population distribution, choice of site placement can determine which demographic groups are most helped. In our simulations, placement of the site in the Kensington neighborhood resulted in White opioid users being more likely to benefit from the site’s services. Overdoses that occur onsite can be reversed. Our results predict that for every 30 stations in the overdose prevention site, 6 per year of these would have resulted in fatalities if they had occurred outside of the overdose prevention site. Additionally, we estimate that fatalities will decrease further when referrals from the OPS to treatment are considered.ConclusionsMathematical modeling was used to predict the impact of placing an overdose prevention site in the Kensington neighborhood of Philadelphia. To fully understand the impact of site placement, both direct and indirect effects must be included in the analysis. Introducing more than one site and distributing sites equally across neighborhoods with different racial and demographic characteristics would have the broadest public health impact. Cities and locales can use mathematical modeling to help quantify the predicted impact of placing an overdose prevention site in a particular location.
Highlights
Fatal overdoses from opioid use and substance disorders are increasing at an alarming rate
Given that the use of an overdose prevention sites (OPSs) is greatly influenced by proximity, we looked at the identity and location of individuals who overdosed relative to the proposed OPS site
Under the assumption that there are 55,000 active opioid users, we found from the overdose data that approximately 6.9% of opioid users nonfatally overdose and 1.88% fatally overdose in a oneyear period in the absence of an OPS in Philadelphia
Summary
Fatal overdoses from opioid use and substance disorders are increasing at an alarming rate. To address the opioid crisis, the city of Philadelphia created a task force and multi-pronged approach to address this public health problem. This included the Resilience Project [3], a collaboration of 35 city departments that worked together across seven key mission areas to address the opioid epidemic: (1) closing encampments and providing alternate housing and recovery services to its residents; (2) reducing criminal activity in areas with high drug activity; (3) reducing the number of unsheltered individuals; (4) reducing trash and litter including drug paraphernalia; (5) reducing overdoses and the spread of infectious diseases; (6) increasing treatment options; and (7) mobilizing community resources [3]. The crisis remains prominent with the COVID-19 pandemic introducing heightened challenges for people who use drugs [3, 4]
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