Drug-related overdoses within a medically supervised safer injection facility

Background: In September 2003, North America's first supervised injection facility (SIF) opened in Vancouver, Canada. We sought to examine the incidence and characteristics of overdose events at the SIF. Methods: The Vancouver SIF evaluation involves a comprehensive database within the SIF and the Scientific Evaluation of Supervised Injection (SEOSI) cohort consisting of 1046 SIF users. We examined the incidence and features of overdoses at the SIF and the responses made by SIF staff. Cox regression was used to examine factors associated with time to overdose among SEOSI participants. Results: Between 1 March 2004 and 30 August 2005, there were 336 overdose events at the SIF, yielding a rate of 1.33 (95% CI: 0.0-3.6) overdoses per 1000 injections. The most common indicator of overdose was depressed respiration (60%), and the most common intervention involved the administration of oxygen (87%). In total, 90 SEOSI participants had an overdose at the SIF during the study period. Factors independently associated with time to overdose included fewer years injecting (RH=0.98, 95% CI: 0.96-1.00 per year), daily heroin use (RH=1.82, 95% CI: 1.16-2.85), and having a history of overdose (RH = 1.92, 95% CI: 1.21-3.06). Conclusions: There have been a large number of overdoses within the SIF, and it is noteworthy that none of these overdoses resulted in a fatality. These findings suggest that SIF can play a role in managing overdoses among IDU and indicate the need for further evaluation of the impact of SIF on morbidity and mortality associated with overdose. (c) 2006 Elsevier B.V. All rights reserved.