Historique
Article de Périodique
Supervised consumption sites: a nuanced assessment of the causal evidence [Addiction opinion and debate] (2019)
Auteur(s) :
J. P. CAULKINS ;
B. PARDO ;
B. KILMER
Article en page(s) :
2109-2115
Sous-type de document :
Revue de la littérature / Literature review
Refs biblio. :
47
Domaine :
Drogues illicites / Illicit drugs
Langue(s) :
Anglais
Discipline :
SAN (Santé publique / Public health)
Thésaurus mots-clés
SALLE DE CONSOMMATION A MOINDRE RISQUE
;
EVALUATION
;
REDUCTION DES RISQUES ET DES DOMMAGES
;
COUT
;
EFFICACITE
;
SURDOSE
Note générale :
Commentaries:
- How much do we need to know about supervised consumption sites? It depends who's asking. Satel S., p. 2116-2117.
- The need to broaden and strengthen the evidence base for supervised consumption sites. May T., Holloway K., Bennett T., p. 2117-2118.
- The unmaking of 'evil': claiming space for rational discourse on US drug policy. Frydl K.J., p. 2119-2120.
- The benefits of evaluating literatures with essays. Caulkins J.P., Pardo B., Kilmer B., p. 2120-2121.
Letter to the Editor:
Belackova V., Salmon A.M., Jauncey M., Day C.A. Safer injecting facilities-is the research there? A comment on Caulkins et al. (2019). Addiction, 2020, Vol. 115, n° 4, p. 784-785. https://doi.org/10.1111/add.14885
Authors' reply:
Caulkins J.P., Kilmer B., Pardo B. Disagreeing on whether we agree. Addiction, 2020, Vol. 115, n° 4, p. 785-786. https://doi.org/10.1111/add.14915
- How much do we need to know about supervised consumption sites? It depends who's asking. Satel S., p. 2116-2117.
- The need to broaden and strengthen the evidence base for supervised consumption sites. May T., Holloway K., Bennett T., p. 2117-2118.
- The unmaking of 'evil': claiming space for rational discourse on US drug policy. Frydl K.J., p. 2119-2120.
- The benefits of evaluating literatures with essays. Caulkins J.P., Pardo B., Kilmer B., p. 2120-2121.
Letter to the Editor:
Belackova V., Salmon A.M., Jauncey M., Day C.A. Safer injecting facilities-is the research there? A comment on Caulkins et al. (2019). Addiction, 2020, Vol. 115, n° 4, p. 784-785. https://doi.org/10.1111/add.14885
Authors' reply:
Caulkins J.P., Kilmer B., Pardo B. Disagreeing on whether we agree. Addiction, 2020, Vol. 115, n° 4, p. 785-786. https://doi.org/10.1111/add.14915
Résumé :
BACKGROUND AND AIMS: Supervised consumption sites (SCS) operate in more than 10 countries. SCS have mostly emerged as a bottom-up response to crises, first to HIV/AIDS and now overdose deaths, in ways that make rigorous evaluation difficult. Opinions vary about how much favorable evidence must accumulate before implementation. Our aim was to assess the nature and quality of evidence on the consequences of implementing SCS.
METHODS: We reviewed the higher-quality SCS literature, focusing on articles evaluating natural experiments and mathematical modeling studies that estimate costs and benefits. We discuss the evidence through the lens of three types of decision-makers and from three intellectual perspectives.
RESULTS: Millions of drug use episodes have been supervised at SCS with no reported overdose deaths; however, uncertainties remain concerning the magnitude of the population-level effects. The published literature on SCS is large and almost unanimous in its support, but limited in nature and the number of sites evaluated. It can also overlook four key distinctions: (1) between outcomes that occur within the facility and possible spillover effects on behavior outside the SCS; (2) between effects of supervising consumption and the effects of other services offered, such as syringe or naloxone distribution; (3) between association and causation; and (4) between effectiveness and the cost-effectiveness of SCS compared to other interventions.
CONCLUSIONS: The causal evidence for favorable outcomes of supervised consumption sites is minimal, but there appears to be little basis for concern about adverse effects. This raises the question of how context and priors can affect how high the bar is set when deciding whether to endorse supervised consumption sites. The literature also understates distinctions and nuances that need to be appreciated to gain a rich understanding of how a range of stakeholders should interpret and apply that evidence to a variety of decisions.
METHODS: We reviewed the higher-quality SCS literature, focusing on articles evaluating natural experiments and mathematical modeling studies that estimate costs and benefits. We discuss the evidence through the lens of three types of decision-makers and from three intellectual perspectives.
RESULTS: Millions of drug use episodes have been supervised at SCS with no reported overdose deaths; however, uncertainties remain concerning the magnitude of the population-level effects. The published literature on SCS is large and almost unanimous in its support, but limited in nature and the number of sites evaluated. It can also overlook four key distinctions: (1) between outcomes that occur within the facility and possible spillover effects on behavior outside the SCS; (2) between effects of supervising consumption and the effects of other services offered, such as syringe or naloxone distribution; (3) between association and causation; and (4) between effectiveness and the cost-effectiveness of SCS compared to other interventions.
CONCLUSIONS: The causal evidence for favorable outcomes of supervised consumption sites is minimal, but there appears to be little basis for concern about adverse effects. This raises the question of how context and priors can affect how high the bar is set when deciding whether to endorse supervised consumption sites. The literature also understates distinctions and nuances that need to be appreciated to gain a rich understanding of how a range of stakeholders should interpret and apply that evidence to a variety of decisions.
Affiliation :
RAND Drug Policy Research Center, RAND, Santa Monica, CA, USA