Thread by @MyHarmReduction

A Letter to the Editor was published in the NEJM this week by @alexhkral and colleagues summarizing their recent evaluation of an unsanctioned Safer Consumption Space in an undisclosed US City. This is huge: nejm.org/doi/full/10.10… THREAD -

First of all, this is huge because the Safer Consumption Space exists and has existed for 6 yrs. A group of harm reduction activists and heroes (whose names we may never know) took action and started an underground SCS to save lives. They refused to wait. They acted.

Second of all, this is huge because the NEJM (a 'prestigious and exclusive journal') published a letter about this unsanctioned (read: illegal/controversial) SCS operating somewhere in the US. They provided a platform for the researchers to articulate and document the results.

Third of all, this is huge because it is a testament to the commitment that the harm reduction community has to providing results & evidence to support what we do (EVEN WHEN WE SHOULDN'T HAVE TO). I mean, these folks ran an underground site & still wanted to document results. 🤯

Now let's take a look at what they did, what they measured, and what we learned from this evaluation.

According to supplementary materials, the SCS was 2 rooms: 1 with 5/6 stations for injecting, 1 with a couch/chairs to chill out. Capped at 60 participants enrolled at any time

First 3 yrs was open 4-6hrs/day 5 days/week. Past 2 yrs, open 6-8hrs/day 5 days/week.

Though staff didn't help with injections, participants were allowed to help each other (THIS IS ALSO HUGE, bc no proposed legal sites would allow assisted injection).

Staff were available to monitor and respond to OD, used pulse oximeters to measure oxygen levels, administered naloxone, and monitored 60 minutes post-administration.

Here's a table summarizing # of injections per year (this increased over time) up to a total of 10,514 over 5 years. While a total of 33 overdoses occurred, all were reversed and managed on site with no calls for further medical emergency services.

SIDE BAR: Sometimes people talk about Safer Consumption Sites/Supervised Injection Facilities and say that they 'prevent overdoses.' This is not true. Overdoses still happen at these sites (toxic drug supply, vulnerability, etc) but overdose DEATHS are what we mean. Specify.

Here is a graph from the supplemental materials that shows how many injections occurred on site per month during the 5 years in the time frame. Show how extended hours increased utilization. (Read: if you open one, they will come. The longer they're open, the more they'll come)

Another extremely informative graph about drug types used, illustrating changing drug use trends and patterns over 5 years to more speedballs/goofballs. (Read: stop calling it an 'opioid' crisis already and let's talk abt drug mixing!)

Hope that's helpful! Please download the letter and the supplementary materials! They're open access!