title: Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study.
abstract: BACKGROUND
  Overdose from illicit drugs is a leading cause of premature mortality in North America. Internationally, more than 65 supervised injecting facilities (SIFs), where drug users can inject pre-obtained illicit drugs, have been opened as part of various strategies to reduce the harms associated with drug use. We sought to determine whether the opening of an SIF in Vancouver, BC, Canada, was associated with a reduction in overdose mortality.
  
  
  METHODS
  We examined population-based overdose mortality rates for the period before (Jan 1, 2001, to Sept 20, 2003) and after (Sept 21, 2003, to Dec 31, 2005) the opening of the Vancouver SIF. The location of death was determined from provincial coroner records. We compared overdose fatality rates within an a priori specified 500 m radius of the SIF and for the rest of the city.
  
  
  RESULTS
  Of 290 decedents, 229 (79·0%) were male, and the median age at death was 40 years (IQR 32-48 years). A third (89, 30·7%) of deaths occurred in city blocks within 500 m of the SIF. The fatal overdose rate in this area decreased by 35·0% after the opening of the SIF, from 253·8 to 165·1 deaths per 100,000 person-years (p=0·048). By contrast, during the same period, the fatal overdose rate in the rest of the city decreased by only 9·3%, from 7·6 to 6·9 deaths per 100,000 person-years (p=0·490). There was a significant interaction of rate differences across strata (p=0·049).
  
  
  CONCLUSIONS
  SIFs should be considered where injection drug use is prevalent, particularly in areas with high densities of overdose.
  
  
  BACKGROUND
  Vancouver Coastal Health, Canadian Institutes of Health Research, and the Michael Smith Foundation for Health Research.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D062787:Drug Overdose / Q000401:mortality; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000506:poisoning*; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs; D015819:Substance Abuse, Intravenous / Q000401:mortality*
chemical_list: D013287:Illicit Drugs