Impact of 24-hour schedule of a drug consumption room on service use and number of non-fatal overdoses. A quasiexperimental study in Barcelona

Abstract

Background: The opening hours of drug consumption rooms could constitute a barrier to access among people who use drugs (PWUD). CAS Baluard is an outpatient substance use care center in Barcelona, which provides a drug consumption room in Barcelona among other services. The objectives of our study were to compare the client profile, the facility use, the drugs used, and the number of non-fatal overdose episodes between (1) a 15-hour opening period of a drug consumption room versus a 24-hour opening period; and (2) between daytime and nighttime during the 24-hour period.

Methods: Data from CAS Baluard was obtained from March-June (15-hour opening period) and July-October (24-hour opening period), 2018. The sociodemographic characteristics of clients were gathered in both periods and in the daytime and nighttime client groups in the 24-hour period. Finally, associations were estimated between facility use and period and between facility use and opening hours.

Results: There were 1,089 clients in the 15-hour period and 1,262 in the 24-hour period. There were no sociodemographic differences in the clients between periods. During nighttime, there was a higher proportion of women (17%) and homeless people (47%) than during daytime (12% and 30%, respectively). Injected cocaine use was more frequent during nighttime (34%) than during daytime (25%) and injected heroin use was less frequent during nighttime (17%) than during daytime (24%). There was a non-significant increase in non-fatal overdose risk during nighttime (PR 3.9 95%CI 0.98-15.64). However, when we analyzed heroin use alone, the increase in non-fatal overdose risk was significant (PR 4.69 95%CI 1.17-18.75).

Conclusion: During nighttime, attendance at the facility was higher among women, homeless people, and people who used stimulants. Our results point to a possible increase in overdose risk during nighttime, when most drug consumption rooms are closed.

Keywords: Harm reduction; Health Services Accessibility; Needle exchange programs; Substance abuse treatment centers; Substance-related disorders.