Most supervised drug
consumption facilities offer hepatitis C virus (HCV) testing and referrals, but
very few offer treatment, indicating that they could potentially play a greater
role in curbing transmission and negative health outcomes related to hepatitis
C, according to research presented this week at the 22nd
International AIDS Conference (AIDS 2018) in Amsterdam.
hepatitis B virus (HBV) and HIV are readily spread through shared drug
injection equipment, and people who use drugs have high rates of these
infections. Drug overdose is also a growing concern, worsened by the
introduction of fentanyl and other opioids that are much stronger than heroin.
The advent of highly effective and well-tolerated
direct-acting antivirals offers the opportunity to expand hepatitis C treatment
beyond liver disease specialists. Mathematical models – and early real-world
evidence – suggest that providing treatment for enough people could eliminate
hepatitis C as a public health threat. As one of the highest-risk groups,
people who inject drugs are key to this effort.
A non-invasive test, used instead of a biopsy, to measure the stiffness
or elasticity of the liver using an ultrasound probe.
consumption rooms, known in some countries as supervised injection facilities, allow
people to use drugs under the watch of trained staff, who can administer
naloxone (Narcan) if needed to
reverse opioid overdoses. They provide sterile syringes and other equipment,
preventing transmission of HIV, HBV and HCV. They reduce street-based drug use
and improper syringe disposal, as well as offering clients an entry point for
seeking addiction treatment and medical care.
Supervised consumption sites tend to serve the most vulnerable people
who inject drugs, including those facing mental health issues and homelessness.
has shown that they reduce risk behaviour and harms associated with drug use
including overdose and infectious disease transmission.
There are currently around 100 drug consumption rooms around the
world, most of them in Europe. Amsterdam was among the cities that
pioneered the concept in the 1980s. Australia has a supervised
injecting centre in Sydney and is trying to open another in Melbourne. Vancouver's Insite, the first North American
facility, served more than 7300 clients in 2017. Several
cities are currently vying to open the first supervised consumption site in
the United States, including San
Francisco, New York, Philadelphia and Seattle. Despite the large number
of people who inject drugs in London and elsewhere, the UK currently has no drug
Eberhard Schatz of De
Regenboog Groep in Amsterdam presented findings from a study looking at what
kinds of hepatitis C testing, treatment and other health and support services are
provided by drug consumption facilities. This information was gathered using an
The study, conducted in 2016, included 49 supervised
consumption sites. A majority were in the Netherlands (20 operating sites, of
which 8 participated in the study), Germany (26 operating and 17 participating
site), Switzerland (18 operating and 7 participating sites), Spain (15
operating and 9 participating sites). Two of the six sites in Denmark, both
sites in France, and the sole site at the time in Australia, Canada, Luxembourg
and Norway also participated. (Canada has since opened more sites.)
Among the participating sites, 67% were run by
non-profit organisations, 40% by governments, 7% by private parties and one by
a church. Funding mostly came from local or municipal sources (71%), followed
by state or regional sources (36%) and national governments (13%). A majority
of consumption rooms (57%) were co-located with other services used by people
who inject drugs, 30% were stand-alone facilities and 20% were mobile
The average number of visits per day was 80 and on
average the sites had 12 stations or booths for drug consumption. A majority of
clients used them to inject drugs, but some also smoked, inhaled or snorted
The consumption rooms had an average of seven paid and
one unpaid or volunteer staff on site during a typical day. Eighty per cent
employed nurses, 78% included social workers, 44% had onsite medical doctors,
28% had health educators and 22% included paid peer counsellors.
Almost all the consumption sites offered syringe
distribution, condoms and referrals for health services, drug addiction
treatment or other care. A quarter offered onsite opioid substitution therapy (OST,
usually methadone or buprenorphine), while 70% referred clients elsewhere for
OST. Most (89%) provided onsite overdose management, though 26% did outside
referrals for this; 37% provided naloxone to take away.
Two-thirds of the sites offered onsite HCV testing and
pre- and post-test counselling. Most provided brochures, counselling or other
hepatitis education resources. An estimated 80% of clients received testing and
60% were found to be HCV-positive (median across sites). Just over half (54%) offered
A quarter of the sites offered liver health monitoring
such as fibrosis blood tests or FibroScan,
and an additional 11% planned to do so. However, just two sites (4%) provided
hepatitis C treatment onsite and only one other planned to do so. Ten programmes
either currently offered or planned to offer treatment offsite. Sites that
employed nurse or doctors and those that offered OST were more likely to
provide onsite hepatitis C medical management.
Looking at other services, half of the sites offered
support for health self-management (around healthy diet, obesity, etc.) and 44%
offered mental health care. Most sites offered coffee or a tea and a place for
clients to charge their phones, while 78% provided personal care facilities
such as showers and laundry.
Asked how they would increase capacity given
additional funding for HCV-related services, just over half said they would
hire more staff, 46% would offer more staff training, 41% would fund
educational materials, 26% would employ peer support workers and 24% would
develop referral pathways. One programme indicated they would buy a FibroScan machine.
Drug consumption rooms or supervised injection
facilities "provide a broad range of
social and health services in safe environment for people who inject drugs,"
and some already offer HCV-related services, the researchers concluded.
financial resources for qualified staff and capacity building are essential to
enhance the capacity for HCV services," they added. These facilities
"should be considered as a low-threshold HCV treatment provider for people
who inject drugs on the community level; innovative arrangements should be