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Study Shows Supervised Injection Facility Would Be Cost-Effective in San Francisco

Establishing a supervised consumption facility for people who inject drugs in San Francisco could reduce new HIV and hepatitis C virus (HCV) infections, decrease overdose deaths, and save millions of dollars, according to a mathematical modeling study recently published online in the Journal of Drug Issues.

Safe injection facilities allow people to inject drugs under the supervision of medical staff, reducing the risk of death due to overdose. Nationally, overdose deaths exceeded 47,000 in 2014. Sterile syringes are provided, preventing transmission of HIV and viral hepatitis through shared equipment. Although people who inject drugs make up less than 1% of the U.S. population, they account for 11% of new HIV infections and more than half of new HCV infections. Injection facilities -- like syringe services -- also offer clients an entry point for seeking medical care and addiction treatment.

There are currently safe injection facilities in 11 countries including Switzerland, the Netherlands, Australia, and Canada. Vancouver's Insite served more than 6500 clients who made over 263,000 visits in 2015, according to Vancouver Coastal Health. Since it opened in 2003, the facility has intervened in nearly 5000 overdose incidents, resulting in zero deaths.

Several cities -- including San Francisco, Seattle, New York City, Ithaca NY, Baltimore, Boston, and Portland OR -- are vying to establish the first supervised injection site in the U.S.

Amos Irwin of the Criminal Justice Policy Foundation, Alex Kral of RTI International, and colleagues estimated the economic costs and benefits of establishing a supervised injection facility in San Francisco using mathematical models that combine local public health data with previous research on the effects of existing injection sites.

The researchers found that a single supervised injection facility in San Francisco with 13 injection booths (the same as Insite) would cost an estimated $2.6 million per year to operate, but would avert about $6.1 million in health costs, thereby saving the city $3.5 million annually. They estimated that every $1.00 spent would generate $2.33 in savings.

The mathematical models predicted that the facility could:

• Prevent 3.3 cases of HIV per year (estimated savings $1.3 million);
• Prevent 19 cases of hepatitis C per year (estimated savings $1.3 million);
• Reduce hospital stays for skin and soft tissue infections by 415 days per year (estimated savings $1.7 million);
• Save 1 life every 4 years (0.24 per year, estimated savings $284,000 million);
• Encourage 110 people to start medication-assisted addiction treatment using methadone or buprenorphine (estimated savings $1.5 million).

The study authors noted that preventing 3 HIV infections would reduce the city's total annual injection-related HIV cases by roughly 6%, while 19 fewer HCV infections would account for approximately 3% to 5% of the annual total among injection drug users.

San Francisco has already done a lot to reduce new HIV and HCV infections and to prevent overdose deaths by widely distributing naloxone. In cities with higher HIV and HCV incidence rates and more overdose deaths, supervised injection facilities should be even more cost-effective. In addition, due to San Francisco's high real estate prices, the cost to initially establish injection sites could be lower in less expensive cities.

The researchers noted that in addition to the 5 estimated outcomes, safe injection facilities also offer "significant public health benefits that could not be quantified for this study," such as reducing risky injecting behavior, 911 overdose calls, public drug use, and syringe littering.

"While the main reasons these sites should be implemented are for human rights and community health, it is also nice that they save cities money," said Kral. "This is a win-win proposition. We would improve the health of people who use drugs and make communities safer while saving money."

1/17/17

Sources

A Irwin, E Jozaghi, RN Bluthenthal, and AH Kral. A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA. Journal of Drug Issues. December 13, 2016 (online ahead of print).

RTI International. New study determines opening a supervised injection facility for people who inject drugs could save millions. Press release. December 14, 2016.