What studies show about how many overdose deaths supervised drug consumption sites prevent each year. (Answer: Hardly any.)

The principal argument offered for creating supervised drug consumption sites is that they “are proven to save lives”--but seldom or never do supporters mention any specific numbers. Likely this is because the studies advocates claim prove their point actually show results most people would find deeply discouraging:

• The sites have no positive impact on overall overdose mortality: research shows that a state that legalizes SCSs should not expect to see any reduction in its overdose death rate.

• Even within localities where an SCS does exist, around one hundred overdose deaths will still occur for every one death the sites might avert, according to the research, including a study specifically cited by SCS advocates which projected that opening a very large SCS in Boston might have prevented 3 overdose deaths, out of the 352 overdose deaths occurring in 2022 in our city.

Research has consistently found that drug consumption sites aren’t effective in reducing what scientists term population-level overdose deaths (e.g., death rates at the state or national levels). This is primarily because the amount of drug use happening in society is multiple orders of magnitude larger than can be accommodated and rendered relatively “safer” within the sites, nor can the size or numbers of SCSs ever be scaled up enough to ever come close to bridging this difference.

• Consider this: All of the 40 or so SCSs that exist nationwide in Canada put together host—i.e., divert from the street and make relatively “safer”—a combined total of 2,700 drug uses a day, with the average Canadian SCS hosting 45 uses daily, all according to official Canadian government data. A person addicted to fentanyl typically uses around eight times a day. So this means the average SCS makes “safer” the equivalent of just six users’ worth of drug use (45/8 = 5.6). Similarly, all the sites everywhere Canada combined divert about only three or four hundred fentanyl users’ worth of drug use (2,700/eight drug uses per day per person = 338). Given Canada has hundreds of thousands of drug users, and the United States has millions, it’s a mathematical impossibility for drug consumption sites to make a meaningful impact.

Nor are drug consumption sites effective in saving lives even when judging their effect at the most local level and their immediate community.

Research seeking to quantify the local impact on overdose deaths when a community opens an SCS has most commonly examined the “Insite” SCS in Vancouver that is the biggest SCS in the world by volume of use, hosting 2.9 million drug use visits since opening in 2003 (an average of 401/day). One well-known such study—cited again and again by Massachusetts SCS supporters as proof of concept—found that Insite likely averted between two and 12 overdose deaths a year. Another study, done for the Canadian government, found Insite likely averts one death a year. A study of a large SCS in Australia called Sydney United concluded that site probably averts about four deaths a year. Another study found a hypothetical SCS in Philadelphia having a capacity twice as big as Insite could save five lives a year. (See below for details and citations for all studies and figures mentioned here.)

In sum: studies suggest an SCS that operates at or above the scale of the biggest existing site in the world, Insite, may perhaps avert a handful of fatal overdose deaths a year. While every life matters, this result needs to be judged in proportion to the numbers of lives being lost: Boston has about 350 overdose deaths annually, Vancouver has over 600 and Philadelphia has around 1,400. Additionally, Insite is enormous, hosting nine times more volume of drug use than the average SCS in Canada (401/45 = 8.9). Extrapolating out Insite-like results to the performance of normal sites that are smaller suggests the typical SCS may not avert even one single overdose death in a given year.

Study: “Estimated Drug Overdose Deaths Averted by North America’s First Medically-Supervised Safer Injection Facility.”

Key finding: The Insite SCS (Vancouver, Canada) likely averted between 2 and 12 deaths a year, based upon comparison to the prevalence of overdose deaths occurring for use happening outside Insite in the same Downtown Eastside neighborhood during the 2004 to 2008 period covered by the study. Per the study: “Using these model inputs, the number of averted deaths were, respectively: 50.9 (95% CI: 23.6–78.1); 12.6 (95% CI: 9.6–15.7); 8.4 (95% CI: 6.5–10.4) during the study period, equal to 1.9 to 11.7 averted deaths per annum.”

What this would mean for Boston: A Supervised Drug Consumption Site that had the same impact as Insite did according to this study would reduce drug overdose deaths by between 0.5% and 3.5%. (Boston had 352 overdose fatalities in 2022)

Comment: This study and a related one by the same researcher group (described immediately below) have been repeatedly highlighted by SCS advocates in Massachusetts and nationally as their primary evidence for the contention that SCSs save lives, including specifically by: the “Massachusetts for Overdose Prevention Centers” coalition’s website (in its “Resources” section); SIFMA Now! website (in its “Explore the Research” page); MA Department of Public Health OPC Feasibility Report; a pro-SCS Boston Globe editorial; the Massachusetts Medical Society’s Report of the Task Force on Opioid Therapy and Physician Communication; and the

Citation: Milloy MJS, Kerr T, Tyndall M, Montaner J, Wood E (2008) Estimated Drug Overdose Deaths Averted by North America’s First Medically-Supervised Safer Injection Facility. PLoS ONE 3(10): e3351. doi:10.1371/journal.pone.0003351