Predicting the impact of placing an overdose prevention site in Philadelphia: a mathematical modeling approach

Harm Reduction Journal

Jing Dong¹  Joanna R. Wares¹  Ami Radunskaya²  Jana L. Gevertz³  Kendra Viner⁴  Doug Wiebe⁵  Sara Solomon⁵ 

[1] Department of Mathematics and Computer Science, University of Richmond, 204 Jepson Hall, 221 Richmond Way, 23173, Richmond, VA, USA;Department of Mathematics and Statistics, Pomona College, 91711, Claremont, CA, USA;Department of Mathematics and Statistics, The College of New Jersey, 08628, Ewing, NJ, USA;Division of Substance Use Prevention and Harm Reduction, Department of Public Health, 19109, Philadelphia, PA, USA;Penn Injury Science Center, Department of Biostatistics, Informatics and Epidemiology, University of Pennsylvania, 19104, Philadelphia, PA, USA;

关键词: Fatal overdose;    Harm reduction;    Markov model;    People who use drugs;    Supervised injection facility;    Geospatial analysis;    Overdose prevention site;   

DOI  :  10.1186/s12954-021-00559-4

来源: Springer

【 摘 要 】

BackgroundFatal overdoses from opioid use and substance disorders are increasing at an alarming rate. One proposed harm reduction strategy for reducing overdose fatalities is to place overdose prevention sites—commonly known as safe injection facilities—in proximity of locations with the highest rates of overdose. As urban centers in the USA are tackling legal hurdles and community skepticism around the introduction and location of these sites, it becomes increasingly important to assess the magnitude of the effect that these services might have on public health.MethodsWe developed a mathematical model to describe the movement of people who used opioids to an overdose prevention site in order to understand the impact that the facility would have on overdoses, fatalities, and user education and treatment/recovery. The discrete-time, stochastic model is able to describe a range of user behaviors, including the effects from how far they need to travel to the site. We calibrated the model to overdose data from Philadelphia and ran simulations to describe the effect of placing a site in the Kensington neighborhood.ResultsIn Philadelphia, which has a non-uniform racial population distribution, choice of site placement can determine which demographic groups are most helped. In our simulations, placement of the site in the Kensington neighborhood resulted in White opioid users being more likely to benefit from the site’s services. Overdoses that occur onsite can be reversed. Our results predict that for every 30 stations in the overdose prevention site, 6 per year of these would have resulted in fatalities if they had occurred outside of the overdose prevention site. Additionally, we estimate that fatalities will decrease further when referrals from the OPS to treatment are considered.ConclusionsMathematical modeling was used to predict the impact of placing an overdose prevention site in the Kensington neighborhood of Philadelphia. To fully understand the impact of site placement, both direct and indirect effects must be included in the analysis. Introducing more than one site and distributing sites equally across neighborhoods with different racial and demographic characteristics would have the broadest public health impact. Cities and locales can use mathematical modeling to help quantify the predicted impact of placing an overdose prevention site in a particular location.

【 授权许可】

CC BY