Transcript Potential Users of a Supervised Injection Site in Ottawa, Powerpoint

Reaching Those Most at Risk for
Drug-Related Harm:
Potential Users of a Supervised Injection
Service in Ottawa, Canada
Ashley Shaw; Lisa Lazarus; Sean LeBlanc ; June Cummings; Dolly Lin;
Caleb Chepesiuk; Sheetal Patel; Mark Tyndall,
For the PROUD Community Advisory Committee
Epidemiology and Public Health
May 2, 2014 - 15:00.
Conflict of Interest Disclosure
We have no conflicts of interest to declare.
BACKGROUND:
Supervised Injection Services (SIS)
A controlled health care setting where PWUID can access clean
injection equipment and inject pre-obtained drugs under the
supervision of a healthcare professional (Health Canada, 2008)
Often includes:
 Harm reduction education
 Overdose management
 Referral to health and social services,
including drug and addictions counselling
and treatment
Currently, there are over 90 SISs in operation around the
world, with the majority located in European countries
THE EVIDENCE: SISs…
Reach the most marginalised PWUID
 Who face issues of homelessness, mental health illness, interactions
with the law, HIV infection
Decrease high-risk injection practices
 Sharing injection equipment
 Rushed injecting
 Injecting in public
 Unsafe syringe disposal
 No alcohol swabbing of injection sites
Reduce harm
 Decreased incidence of overdose deaths
 Reduced infection rates (Injection-site and blood-borne)
 Improved timely access to services (wound care, addictions treatment)
No negative impacts on public order and safety
Potential Users of a Supervised
Injection Service in Ottawa
 No new sites established in Canada since
Insite opened its doors in 2003
 TOSCA recommended 2 SIS be
opened in Ottawa
To determine the potential impact of an SIS in
Ottawa, we set out to determine whether the
people who face the highest risk of negative
health outcomes are likely to use an SIS
The Ottawa Context
 HCV prevalence is at 60% and HIV is at 11-20% among
PWUID in Ottawa
 At least 35 people died of overdose
in 2011 (Skinner,
Regional Supervising Coroner)
 2012 TOSCA Study: in the previous 6 months, 20% of
PWUID surveyed had experienced non-fatal overdose and
14% had injected with used needles
 Limited peer inclusion at all levels
PROUD was the community’s response
Participatory Research in Ottawa; Understanding Drugs
The PROUD Study: GOALS
1. To build community capacity and ownership in all
aspects of the PROUD study

Empower the drug using population to develop
research that affects their own community
2. To better understand the HIV risk environment
among people who use drugs in the Ottawa area
3. To support the development of improved health
and harm reduction services

Peer-based HIV testing, supervised injection services
The PROUD Study: METHODS
Study Design:
 Prospective cohort study grounded in a Community-based
participatory research (CBPR) framework
 Community Advisory Committee
Sampling and Recruitment:
 From March - December 2013,
862 participants were enrolled into the study using a targeted,
street-based recruitment strategy
• Wave 1: 597 from Ottawa’s downtown core
• Wave 2: 265 from other areas within Ottawa
Eligibility criteria:
• Aged 16+ years old; used injection drugs or smoked crack cocaine in
the past year; lived in Ottawa for at least three months
The PROUD Study: METHODS
Data collection:
 The PROUD CAC developed a cross-sectional survey covering 8
themes of importance to their community
 A trained peer or medical student volunteer administered
a onetime iPad-based questionnaire, followed by an HIV POC test
(570 HIV tests were administered)
 Prospective follow-up will occur through data linkages to health
care records available from the Institute for Clinical and Evaluative
Sciences (ICES)
Statistical analysis:
 A descriptive analysis was conducted comparing HIV risk factors
among PROUD participants who indicated a willingness to use an SIS
and those who did not
 Sub-sample analysis of the first 597 participants recruited
RESULTS
Among the 272 participants who reported injecting
drugs in the past 12 months
75.4% reported a willingness to use an SIS in
Ottawa
Among Potential SIS users:
 24.9% had injected with a used needle in the past year
 61.3% were unstably housed
 74.6% reported a mental health diagnosis
 14.2% were HIV positive
18.5% had engaged in sex work in the past year
 Among women who reported willingness, 43.1% had engaged in
sex work in the past year
RESULTS
REACHING THOSE MOST AT RISK FOR DRUG RELAT
INJECTION SERVICE IN
Table 1: Characteristics associated with willingness to
use a supervised injection service in Ottawa a
Characteristic
c
Intention to use an SIS
in Ottawa;
No. (and %) of
b
participants
Yes
No
n = 205
n = 67
OR (and 95%
CI)
Age
Gender
Female
Male
Sexual Identity
LGBTQ
Straight
Injects in public
Yes
No
Injects with
other people
Yes
No
40.0
43.1
1.05 (1.0-1.1)
54 (84.4)
150 (72.8)
10 (15.6)
56 (27.2)
2.02 (1.0-4.2)
35 (94.6)
2 (5.4)
6.69 (1.628.6)
170 (72.3)
65 (27.7)
86 (81.9)
115 (71.0)
19 (18.1)
47 (29.0)
1.85 (1.0-3.4)
178 (80.2)
26 (55.3)
44 (19.8)
21 (44.7)
3.27 (1.7-6.3)
Assistance to
inject
Yes
No
Overdosed
Yes
No
Last Hep C
d
test
Positive
Negative
Ever redzoned
Yes
No
82 (82.0)
121 (71.2)
18 (18.0)
49 (28.8)
1.85 (1.0-3.4)
55 (85.9)
145 (72.1)
9 (14.1)
56 (27.9)
2.36 (1.1-5.1)
131 (80.4)
51 (65.4)
32 (19.6)
27 (34.6)
103 (83.7)
100 (68.5)
20 (16.3)
46 (31.5)
2.17 (1.2-4.0)
2.37 (1.3-4.3)
Note: OR = odds ratio, CI = confidence interval.
a. Percentages are calculated on the basis of the sum across each row.
b. Except where indicated otherwise. Because of missing responses, the data for some
characteristics do not sum to 272.
c. For each categorical variable, the reference category is the second category. For age, the OR
reflects per year older, and for number of overdoses, the OR reflects per additional overdose.
All drug use behaviour variables are reported for the previous 12 months unless otherwise specified
POLICY IMPLICATIONS
CURRENT CONTEXT
 Providers should be granted an exemption under section 56 of the
Controlled Drugs and Substances Act
 The Supreme Court of Canada granted a constitutional exemption to
Insite in 2011 –> an opportunity for new sites to open
 Bill C2 Respect for Communities Act; An Act to amend the Controlled
Drugs and Substances Act was reintroduced in October, 2013
FUTURE ACTION
 A call for evidence-based
policy that facilitates rather than
impedes the implementation of proven healthcare services
 Support the rights of PWUID to health, safety and access to care
CONCLUSIONS AND NEXT STEPS
 PWUID continue to face significant drug-
related harms and barriers to accessing health
and harm reduction services
 An SIS in Ottawa would likely reach its target
group of high-risk injection drug users
 Evidence indicates that an SIS could make a
significant contribution toward engaging hardto-reach populations and reducing harm
NEXT STEPS
SPECIAL THANKS TO OUR:
Community Advisory Committee: Kelly F., Chris D., Dan M.,
Rick S., Tyler P., Hana D., Alana M., Tarah H., Caleb C., Fred C., Sean
L., June C., Christine L., Gilles D., Sharp D
Community Partners: Thank you to Ottawa Public Health for
their support of the HIV POC testing-component of the project, our
medical student volunteers, and our community partners DUAL,
OASIS, Ottawa Inner City Health, AIDS Committee of Ottawa, and
the Shepherds of Good Hope
Funding received from: The Canadian Institutes of Health
Research (CIHR), the Ontario HIV Treatment Network (OHTN) and
The Ottawa Hospital, Department of Medicine and
Division of Infectious Diseases, University of Ottawa
Contact Information
For more information:
www.supervisedinjectionottawa.com
 Supporters
Ashley Shaw
E-mail: [email protected]
Sean LeBlanc
E-mail: [email protected]
Mark Tyndall
E-mail: [email protected]