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Publications

Journal Article Ppublish

PubMed: 42636772 DOI: 10.1016/j.drugpo.2026.105473

Supervised consumption service use and high-frequency public injecting among people who inject drugs in Toronto: A cross-sectional analysis (2018-2020).

Int J Drug Policy 156:105473

Authors: Frishta Nafeh, Zoƫ R Greenwald, Matthew Bonn, Jolene Eeuwes, Kate Atkinson, Steffanie A Strathdee, Mohammad Karamouzian, Dan Werb

Affiliations

  • Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
  • Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
  • ChangeMark Research & Evaluation, Canada.
  • Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.
  • Parkdale Queen West Community Health Centre, Toronto, ON, Canada.
  • Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, United States.
  • Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, United States.

Abstract

BACKGROUND

Public injecting increases the risk of adverse drug-related outcomes. Supervised consumption services (SCS) have been associated with improvements in individual and public health outcomes. However, evidence of their impact on public injecting within current risk environments remains limited.

METHODS

We analyzed cross-sectional survey data from people who inject drugs in Toronto, Canada, between 2018 and 2020. We used modified Poisson regression with robust standard errors to estimate the associations between recent (past 6-month) SCS use and high-frequency public injecting, defined as usually/always versus sometimes/occasionally/never injecting in public, overall and stratified by housing instability.

RESULTS

Among 700 participants, 15% (n = 108) reported high-frequency public injecting. In descriptive analyses, compared with infrequent or no public injecting, high-frequency public injecting was associated with younger age (median 36 vs. 40 years), lower educational attainment, housing instability, and needle/syringe sharing; all with 95% CIs excluding the null. Recent SCS use was reported by 87% (n = 608) of participants and was associated with a 51% lower prevalence of high-frequency public injecting (adjusted prevalence ratio (aPR) = 0.49; 95% CI: 0.32-0.77). In analyses stratified by housing instability, this association was observed among participants experiencing mostly unstable housing (aPR = 0.47; 95% CI: 0.29-0.75); among those with some or no unstable housing, precision was limited due to sparse events.

CONCLUSION

Recent SCS use was associated with lower prevalence of high-frequency public injecting overall and among individuals experiencing housing instability, underscoring the need for integrated interventions that address housing needs and harm reduction service access.

MeSH

Cross-Sectional Studies, Housing, Pharmaceutical Preparations, Prevalence