Estimated Drug Overdose Deaths Averted by North Americas First Medically-Supervised Safer Injection Facility 英文参考文献.docVIP

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Estimated Drug Overdose Deaths Averted by North Americas First Medically-Supervised Safer Injection Facility 英文参考文献.doc

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Estimated Drug Overdose Deaths Averted by North Americas First Medically-Supervised Safer Injection Facility 英文参考文献

EstimatedDrugOverdoseDeathsAvertedbyNorth America’sFirstMedically-SupervisedSaferInjection Facility M-J.S.Milloy1,2,ThomasKerr1,3,MarkTyndall1,3,JulioMontaner1,3,EvanWood1,3 * 1British ColumbiaCentre forExcellenceinHIV/AIDS,St.Paul’sHospital, Vancouver,Canada, 2School ofPopulationandPublic Health,University ofBritishColumbia, Vancouver,Canada,3DepartmentofMedicine,UniversityofBritishColumbia,Vancouver,Canada Abstract Background:Illicitdrugoverdoseremainsaleadingcauseofprematuremortalityinurbansettingsworldwide.Wesought toestimatethenumberofdeathspotentiallyavertedbytheimplementationofamedicallysupervisedsaferinjectionfacility (SIF)inVancouver,Canada. Methodology/PrincipalFindings:Thenumberofpotentiallyaverteddeathswascalculatedusinganestimateofthelocal ratio of non-fatal to fatal overdoses. Inputs were derived from counts of overdose deaths by the British Columbia Vital StatisticsAgencyandnon-fataloverdoseratesfrompublishedestimates.Potentially-fataloverdosesweredefinedasevents withintheSIFthatrequiredtheprovisionofnaloxone,a911calloranambulance.Pointestimatesand95%Confidence Intervals(95%CI)werecalculatedusingaMonteCarlosimulation.BetweenMarch1,2004andJuly1,2008therewere1004 overdoseeventsintheSIFofwhich453eventsmatchedourdefinitionofpotentiallyfatal.In2004,2005and2006there were32,37and38drug-induceddeathsintheSIF’sneighbourhood.Owingtothewiderangeofnon-fataloverdoserates reportedintheliterature(between5%and30%peryear)weperformedsensitivityanalysesusingnon-fataloverdoserates of50,200and300per1,000personyears.Usingthesemodelinputs,thenumberofaverteddeathswere,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 deathsperannum. Conclusions/Significance:Basedonaconservativeestimateofthelocalratioofnon-fataltofataloverdoses,thepotentially fatal overdoses in the SIF during the study period could have resulted in between 8 and 51 deaths had they occurred outsidethefacility,orfr