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. 2008 Oct 7;3(10):e3351.
doi: 10.1371/journal.pone.0003351.

Estimated drug overdose deaths averted by North America's first medically-supervised safer injection facility

M-J S Milloy  1 , Thomas Kerr, Mark Tyndall, Julio Montaner, Evan Wood
Affiliations

Estimated drug overdose deaths averted by North America's first medically-supervised safer injection facility

M-J S Milloy et al. PLoS One. .

Abstract

Background: Illicit drug overdose remains a leading cause of premature mortality in urban settings worldwide. We sought to estimate the number of deaths potentially averted by the implementation of a medically supervised safer injection facility (SIF) in Vancouver, Canada.

Methodology/principal findings: The number of potentially averted deaths was calculated using an estimate of the local ratio of non-fatal to fatal overdoses. Inputs were derived from counts of overdose deaths by the British Columbia Vital Statistics Agency and non-fatal overdose rates from published estimates. Potentially-fatal overdoses were defined as events within the SIF that required the provision of naloxone, a 911 call or an ambulance. Point estimates and 95% Confidence Intervals (95% CI) were calculated using a Monte Carlo simulation. Between March 1, 2004 and July 1, 2008 there were 1004 overdose events in the SIF of which 453 events matched our definition of potentially fatal. In 2004, 2005 and 2006 there were 32, 37 and 38 drug-induced deaths in the SIF's neighbourhood. Owing to the wide range of non-fatal overdose rates reported in the literature (between 5% and 30% per year) we performed sensitivity analyses using non-fatal overdose rates of 50, 200 and 300 per 1,000 person years. Using these model inputs, the number of averted deaths were, respectively: 50.9 (95% CI: 23.6-78.1); 12.6 (95% CI: 9.6-15.7); 8.4 (95% CI: 6.5-10.4) during the study period, equal to 1.9 to 11.7 averted deaths per annum.

Conclusions/significance: Based on a conservative estimate of the local ratio of non-fatal to fatal overdoses, the potentially fatal overdoses in the SIF during the study period could have resulted in between 8 and 51 deaths had they occurred outside the facility, or from 6% to 37% of the total overdose mortality burden in the neighborhood during the study period. These data should inform the ongoing debates over the future of the pilot project.

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Conflict of interest statement

Competing Interests: Evan Wood, Thomas Kerr and M-J Milloy declare that there is no competing interest that they should disclose. Julio Montaner has received educational grants from, served as an ad hoc adviser to or spoken at various events sponsored by Abbott Laboratories, Agouron Pharmaceuticals Inc., Boehringer Ingelheim Pharmaceuticals Inc., Borean Pharma AS, Bristol-Myers Squibb, DuPont Pharma, Gilead Sciences, GlaxoSmithKline, Hoffmann-La Roche, Immune Response Corporation, Incyte, Janssen-Ortho Inc., Kucera Pharmaceutical Company, Merck Frosst Laboratories, Pfizer Canada Inc., Sanofi Pasteur, Shire Biochem Inc., Tibotec Pharmaceuticals Ltd. and Trimeris Inc. Mark Tyndall has received research grants from and served as an ad hoc adviser to Tibotec (J&J), BMS and Gilead Sciences.

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