key: cord-0893726-8fba36yu authors: Marshall, Tyler; Abba-Aji, Adam; Tanguay, Robert; Greenshaw, Andrew J. title: The Impact of Supervised Consumption Services on Fentanyl-related Deaths: Lessons Learned from Alberta’s Provincial Data date: 2021-03-19 journal: Can J Psychiatry DOI: 10.1177/0706743721999571 sha: 51bde3dcf83b1b65c0ea68a9fe6907b4e8bb8fae doc_id: 893726 cord_uid: 8fba36yu nan In many cases, "adverse events" (even if non-life threating or minor) are reported as overdoses, and the term "reversal" is used even when the response was a simple administration of oxygen. This leaves the public with an inference that without these sites thousands of people would fatally overdose or no longer be alive. Comparatively rare cases resulted in the use of naloxone. As a result, the committee became concerned with issues of transparency and accountability with the regards to the way overdose reversals are tracked and reported. The committee finds this misleading and the ambiguity and faulty reporting cannot responsibly make such a determination. 3 After reviewing the literature, we developed an a priori hypothesis that an increase of SCS visits in Alberta would be associated with a decrease in fentanyl-related overdose deaths. We then reviewed the publicly available opioid response reports from the Province of Alberta website (https://open.alberta.ca/publications/albertaopioid-response-surveillance-report). In this quarterly reported data set, confirmed fentanyl-related deaths were determined by medical examiner's reports, and SCS visits were recorded as number of total visits at each of the provincial SCS locations. In 2020, according to these data, opioids were involved in over 80% of all drug-related deaths, and fentanyl was involved in 94% of all opioidrelated deaths. 4 Using a Pearson correlation, we found a statistically significant association between the number of total quarterly SCS visits and fentanyl-related overdose deaths (r ¼ À0.643, df ¼ 1, P ¼ 0.028, two-tailed; Figure 1 ). Based on the basic data available, we were unable to control for effects of other public health initiatives that took place simultaneously such as: (i) take-home naloxone programs, (ii) changes in black market carfentanil availability, and (iii) increased access to addiction treatment and medications such as opioid agonist therapy. Nevertheless, data from the provincial report suggest that SCS have facilitated over 10,000 referrals to addiction treatment programs and account for 12.2% of all provincial naloxone kit dispensing. Further, SCS visits decreased by 64.3% during Q2 2020 in comparison with Q1 2020, while fentanyl-related overdoses increased by 118.4%. 4, 5 This outlier may reflect a plethora of other complications associated with the COVID-19 pandemic such as poorer mental health, increased unemployment, and so on. Despite these limitations, the association is consistent with the findings from the systematic review although the review was based on data from other jurisdictions. Based on our preliminary finding of a negative association of SCS visits in Alberta with decreased fentanyl-related overdose deaths, we call for more independent, peerreviewed research to clarify the impact of SCS on overdose deaths in newly implemented SCS. Moreover, we suggest additional research to investigate novel ways in which SCS may further contribute to increased access and continuity of care for people who use drugs. We believe that future research in this area is urgent as the impact of two concurrent public health crises-the drug overdose crisis and the COVID-19 pandemic-continue to contribute to an overwhelming burden on the health care system. The author(s) received no financial support for the research, authorship, and/or publication of this article. Tyler Marshall, MPH https://orcid.org/0000-0002-7644-3639 The supplemental material for this article is available online. Supervised consumption sites and services: explained Supervised injection services: what has been demonstrated? a systematic literature review Impact: a socio-economic review of supervised consumption sites in Alberta COVID-19 opioid response surveillance report: Q2 2020. Analytics and performance reporting. 2020 Alberta opioid response surveillance report Q1 2020 analytics and performance reporting We would like to thank Dr. Sunita Vohra, Dr. Elaine Hyshka, and Jayelle Warken for their helpful comments on earlier versions of this manuscript. The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.