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• W2014714366 abstract "Gary Christian and colleagues raise various concerns in reference to our paper that showed a 35% reduction in overdose mortality within the vicinity of Vancouver's supervised injecting facility. They refer to publicly available data from the British Columbia Vital Statistics Agency to argue that overdose deaths increased rather than decreased in the geographic area of interest between 2001 and 2005. This apparent discrepancy can be explained by several problematic assumptions that underlie Christian and colleagues' critique. First, our study focused on an a-priori-defined area in close proximity to the supervised injecting facility that included 41 city blocks, the centroid of each being within 500 m of the facility. The data considered by Christian and colleagues refer to a much larger region (ie, the entire local health area) that includes about 400 city blocks (figure). As shown clearly in figure 3 of our paper,1Marshall BDL Milloy M-J Wood E Montaner JSG Kerr T Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study.Lancet. 2011; 377: 1429-1437Summary Full Text Full Text PDF PubMed Scopus (296) Google Scholar the reduction in overdose mortality was only noted in close proximity to the supervised injecting facility, with the effect diminishing strikingly beyond this area. Second, although we restricted our analysis to deaths deemed by the coroner to be caused by an accidental illicit drug overdose, the data referred to by Christian and colleagues include all drug-induced deaths (eg, suicides and adverse effects of drugs in therapeutic use).2British Columbia Vital Statistics AgencySelected vital statistics and health status indicators.http://www.vs.gov.bc.ca/stats/annual/2005/pdf/ann05.pdfGoogle Scholar Finally, we examined mortality rates as opposed to absolute death counts to account for changes in the population at risk. Christian and colleagues further claim that the noted reduction in overdose mortality was due to increased heroin availability in 2001; however, we have previously published data to show that daily heroin use remained stable between 2001 and 2005.3Wood E Stoltz JA Li K Montaner J Kerr T The cause of the Australian heroin shortage: time to reconsider?.Addiction. 2006; 101: 623-625Crossref Scopus (7) Google Scholar, 4Urban Health Research Initiative of the British Columbia Centre for Excellence in HIV/AIDSDrug situation in Vancouver.http://uhri.cfenet.ubc.ca/images/documents/dsiv2009.pdfGoogle Scholar These data were referenced in our original report. Additionally, publicly available assessments of the police crackdown to which Christian and colleagues refer show that this operation ended within weeks of the opening of the supervised injecting facility and was not ongoing as they claim;5Dandurand Y Griffiths C Chin V Chan J Confident policing in a troubled community: evaluation of the Vancouver Police Department's city-wide enforcement team initiative.http://www.vancouveragreement.ca/wp-content/uploads/ConfidentPolicing2004sm.pdfGoogle Scholar therefore, any brief displacement of drug users would have probably resulted in a conservative bias by differentially reducing overdose mortality in the area of interest before the facility's opening. Finally, regarding mode of drug use, we note that coroners' records do not indicate whether deaths were injection-related or not. However, if we restrict our analysis to records in which injection drug use was indirectly suggested, including for example discarded injection paraphernalia surrounding the decedent (ie, 85% of the original 89 deaths occurring within 500 m of the supervised injecting facility), our estimate for the reduction in overdose mortality is slightly greater at 36%. The results of our study show that Vancouver's supervised injecting facility had a localised yet significant effect on overdose mortality. These facilities can and should be a central component of evidence-based responses to reducing drug-related harms in communities with a high burden of overdose related to injection drug use. JSGM as received educational grants from and served as an ad-hoc adviser to or speaker at various events sponsored by Abbott Laboratories, Agouron Pharmaceuticals, Boehringer Ingelheim, Borean Pharma, Bristol-Myers Squibb, DuPont Pharma, Gilead Sciences, GlaxoSmithKline, Hoffmann-La Roche, Immune Response Corporation, Incyte, Janssen-Ortho, Kucera, Merck Frosst Laboratories, Pfizer Canada, Sanofi Pasteur, Shire Biochem, Tibotec, and Trimeris. All other authors declare that they have no conflicts of interest. Overdose deaths and Vancouver's supervised injection facilityThe report by Brandon Marshall and colleagues (April 23, p 1429),1 in which it is claimed that the opening of a supervised injection facility on Sept 21, 2003, in Vancouver, BC, Canada, was associated with a 35% decrease in overdose deaths in its immediate surrounding, contains serious errors. Full-Text PDF" @default.
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• W2014714366 title "Overdose deaths and Vancouver's supervised injection facility – Authors' reply" @default.
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• W2014714366 doi "https://doi.org/10.1016/s0140-6736(12)60055-5" @default.
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