{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T03:44:11Z","timestamp":1781063051445,"version":"3.54.1"},"reference-count":49,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T00:00:00Z","timestamp":1722816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Drug and Alcohol Review"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>This study aimed to assess the impact of the implementation of legally sanctioned supervised consumption sites (SCS) in the Canadian province of Ontario on opioid\u2010related deaths, emergency department (ED) visits and hospitalisations at the public health unit (PHU) level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Monthly rates per 100,000 population of opioid\u2010related deaths, ED visits and hospitalisations for PHUs in Ontario between December 2013 and March 2022 were collected. Aggregated and individual analyses of PHUs with one or more SCS were conducted, with PHUs that instituted an SCS being matched to control units that did not. Autoregressive integrated moving average models were used to estimate the impact of SCS implementation on opioid\u2010related deaths, ED visits and hospitalisations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010one legally sanctioned SCS were implemented across nine PHUs in Ontario during the study period. Interrupted time series analyses showed no statistically significant changes in opioid\u2010related death rates in aggregated analyses of intervention PHUs (increase of 0.02 deaths\/100,000 population\/month; <jats:italic>p<\/jats:italic>\u2009=\u20090.27). Control PHUs saw a significant increase of 0.38 deaths\/100,000 population\/month; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001. No statistically significant changes were observed in the rates of opioid\u2010related ED visits in intervention PHUs (decrease of 0.61 visits\/100,000 population\/month; <jats:italic>p<\/jats:italic>\u2009=\u20090.39) or controls (increase of 0.403 visits; <jats:italic>p<\/jats:italic>\u2009=\u20090.76). No statistically significant changes to the rates of opioid\u2010related hospitalisations were observed in intervention PHUs (0 hospitalisations\/100,000 population\/month; <jats:italic>p<\/jats:italic>\u2009=\u20090.98) or controls (decrease of 0.05 hospitalisations; <jats:italic>p<\/jats:italic>\u2009=\u20090.95).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>This study did not find significant mortality or morbidity effects associated with SCS availability at the population level in Ontario. In the context of a highly toxic drug supply, additional interventions will be required to reduce opioid\u2010related harms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dar.13921","type":"journal-article","created":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T04:55:29Z","timestamp":1722920129000},"page":"1880-1891","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The associations of supervised consumption services with the rates of opioid\u2010related mortality and morbidity outcomes at the public health unit level in Ontario (Canada): A controlled interrupted time\u2010series analysis"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1046-4066","authenticated-orcid":false,"given":"Tessa","family":"Robinson","sequence":"first","affiliation":[{"name":"Department of Health Research Methods, Evidence &amp; Impact, Faculty of Health Sciences McMaster University  Hamilton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9928-9016","authenticated-orcid":false,"given":"Forough","family":"Farrokhyar","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence &amp; Impact, Faculty of Health Sciences McMaster University  Hamilton Canada"},{"name":"Department of Surgery McMaster University  Hamilton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2186-4030","authenticated-orcid":false,"given":"Benedikt","family":"Fischer","sequence":"additional","affiliation":[{"name":"Research and Graduate Studies University of the Fraser Valley  Abbotsford Canada"},{"name":"Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences Simon Fraser University  Vancouver Canada"},{"name":"Department of Psychiatry University of Toronto  Toronto Canada"},{"name":"Department of Psychiatry Federal University of Sao Paulo  S\u00e3o Paulo Brazil"},{"name":"School of Population Health University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.15620\/cdc:122556"},{"key":"e_1_2_9_3_1","volume-title":"Opioid\u2010 and stimulant\u2010related harms in Canada","author":"Federal p, and territorial special advisory committee on the epidemic of opioid overdoses","year":"2023"},{"key":"e_1_2_9_4_1","unstructured":"Ontario Agency for Health Protection and Promotion (Public Health Ontario).Interactive opioid tool: Opioid\u2010related morbidity and mortality in Ontario Toronto ON. 2022 [updated 20 September 2022]. Available from:https:\/\/www.publichealthontario.ca\/en\/data-and-analysis\/substance-use\/interactive-opioid-tool"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201700235"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.24095\/hpcdp.38.6.02"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108321"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.disamonth.2018.12.002"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2021.04.017"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0265665"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-023523G"},{"key":"e_1_2_9_12_1","unstructured":"Government of Canada. Safer Supply 2023. Available from:https:\/\/www.canada.ca\/en\/health-canada\/services\/opioids\/responding-canada-opioid-crisis\/safer-supply.html"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.15717"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-017-0154-1"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2022.04.005"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.14747"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103881"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-021-01235-8"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.14643"},{"key":"e_1_2_9_20_1","unstructured":"Government of Canada.Supervised consumption sites: Status of applications Ottawa: Government of Canada; [updated 8 May 2023]. Available from:https:\/\/www.canada.ca\/en\/health-canada\/services\/substance-use\/supervised-consumption-sites\/status-application.html#wb-auto-4"},{"key":"e_1_2_9_21_1","volume-title":"Technical notes: interactive opioid tool","author":"Ontario Agency for Health Protection and Promotion (public health Ontario)","year":"2022"},{"key":"e_1_2_9_22_1","first-page":"348","article-title":"Interrupted time series regression for the evaluation of public health interventions: a tutorial","volume":"46","author":"Lopez Bernal J","year":"2017","journal-title":"Int J Epidemiol"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyy135"},{"key":"e_1_2_9_24_1","first-page":"23","article-title":"Social and economic characteristics of those experiencing hospitalizations due to opioid poisonings","volume":"29","author":"Carri\u00e8re G","year":"2018","journal-title":"Health Rep"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.24095\/hpcdp.42.6.01"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13011-022-00463-5"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0225548"},{"key":"e_1_2_9_28_1","volume-title":"IBM SPSS statistics for Macintosh, version 28.0","author":"Inc SPSS","year":"2021"},{"key":"e_1_2_9_29_1","volume-title":"Time series analysis forecasting and control","author":"Box GE","year":"1970"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/oso\/9780190943943.001.0001"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2021.103400"},{"key":"e_1_2_9_32_1","volume-title":"R: a language and environment for statistical computing. R foundation for statistical Computing","author":"R Core Team","year":"2023"},{"key":"e_1_2_9_33_1","volume-title":"Final report on the evaluation of the Sydney medically supervised injecting Centre","author":"MISC Evaluation Committee","year":"2003"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/1747-597X-1-11"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.14664"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2018.04.024"},{"key":"e_1_2_9_37_1","volume-title":"Opioid mortality surveillance report: analysis of opioid\u2010related deaths in Ontario July 2017\u2013June 2018","author":"Ontario Agency for Health Protection and Promotion (Public Health Ontario), Office of the Chief Coroner, Ontario Forensic Pathology Service, Ontario Drug Policy Research Network","year":"2019"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/dar.13796"},{"key":"e_1_2_9_39_1","article-title":"The continuous opioid death crisis in Canada: changing characteristics and implications for path options forward","volume":"19","author":"Fischer B","year":"2023","journal-title":"Lancet Reg Health Am"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.201618"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdz162"},{"key":"e_1_2_9_42_1","first-page":"801","article-title":"Safer drug supply\u201d measures in Canada to reduce the drug overdose fatality toll: clarifying concepts, practices and evidence within a public health intervention framework","volume":"84","author":"Fischer B","year":"2023","journal-title":"J Stud Alcohol Drugs"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-022-00614-8"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.220892"},{"key":"e_1_2_9_45_1","volume-title":"Evaluation of overdose prevention sites: Campbell River, Courtenay, Cowichan Vallet, and Port Alberni","author":"The evaluation of overdose prevention sites working group","year":"2018"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2019.09.019"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1515\/em-2018-0010"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62353-7"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-9-77"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2013.08.002"}],"container-title":["Drug and Alcohol Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dar.13921","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T12:00:22Z","timestamp":1730894422000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dar.13921"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,5]]},"references-count":49,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1111\/dar.13921"],"URL":"https:\/\/doi.org\/10.1111\/dar.13921","archive":["Portico"],"relation":{},"ISSN":["0959-5236","1465-3362"],"issn-type":[{"value":"0959-5236","type":"print"},{"value":"1465-3362","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,5]]},"assertion":[{"value":"2023-11-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}