Location
Philadelphia, PA
Start Date
9-5-2018 1:00 PM
Description
INTRODUCTION: Opioid drug abuse has become an increasing concern throughout the United States, especially within the Philadelphia region. In 2017, the number of deaths by drug overdose were four times that of deaths by homicide. In addition, a total of 935 cases of secondary conditions due to needle sharing such as HIV and HCV occurred during the past year. The opioid epidemic has caused a public health emergency and any measures that could decrease the morbidity and mortality associated with opioid abuse are vital. A current proposal to combat this issue in Philadelphia is the implementation of a Comprehensive User Engagement Site (CUES); a site intended to offer medical resources and assistance for opioid users. This study analyzed the clinical, ethical, and economic considerations associated with a potential CUES site in Philadelphia.
METHODS: A review of the literature was conducted using PubMed, EMBASE, and various public data sources. Search keywords included the history and efficacy of safe injection facilities (SIFs), their implementation to Philadelphia, and other related terms. Semi-structured discussion sessions were also conducted among members of the Institute of Clinical Bioethics at Saint Joseph’s University, resident physicians at Mercy Health System, and PCOM medical students. Topics of discussion included the risks, benefits, and ethics involved in initiating a CUES in Philadelphia, with research regarding past SIFs being uses as a comparative model.
RESULTS: The impact of a CUES in Philadelphia has been estimated to avert 3-48 cases of HIV infections annually, 15-213 cases of HCV infections annually, and between 24-76 deaths. In addition, the site is estimated to reduce costs due to skin infection by $1.5-1.9 Million annually, costs due to overdose deaths by upwards of $75 Million annually, as well as costs related to ambulance and hospital visits by $123,000 and $300,000 per averted case respectively. Ethical analysis revealed that safe injection is ethically permissible given the primary intent is to limit the user’s exposure to harm.
DISCUSSION: The implementation of a CUES in Philadelphia may be an effective tool to address opioid crisis. It would reduce healthcare costs through prevention of drug-related sequelae, offer treatment and resources for people seeking to overcome their opioid dependence, and act as an educational opportunity for future healthcare professionals by promoting student engagement with marginalized populations.
Embargo Period
5-31-2018
Comprehensive User Engagement Sites (CUES): Is This a Viable Option for the Opioid Epidemic in Philadelphia?
Philadelphia, PA
INTRODUCTION: Opioid drug abuse has become an increasing concern throughout the United States, especially within the Philadelphia region. In 2017, the number of deaths by drug overdose were four times that of deaths by homicide. In addition, a total of 935 cases of secondary conditions due to needle sharing such as HIV and HCV occurred during the past year. The opioid epidemic has caused a public health emergency and any measures that could decrease the morbidity and mortality associated with opioid abuse are vital. A current proposal to combat this issue in Philadelphia is the implementation of a Comprehensive User Engagement Site (CUES); a site intended to offer medical resources and assistance for opioid users. This study analyzed the clinical, ethical, and economic considerations associated with a potential CUES site in Philadelphia.
METHODS: A review of the literature was conducted using PubMed, EMBASE, and various public data sources. Search keywords included the history and efficacy of safe injection facilities (SIFs), their implementation to Philadelphia, and other related terms. Semi-structured discussion sessions were also conducted among members of the Institute of Clinical Bioethics at Saint Joseph’s University, resident physicians at Mercy Health System, and PCOM medical students. Topics of discussion included the risks, benefits, and ethics involved in initiating a CUES in Philadelphia, with research regarding past SIFs being uses as a comparative model.
RESULTS: The impact of a CUES in Philadelphia has been estimated to avert 3-48 cases of HIV infections annually, 15-213 cases of HCV infections annually, and between 24-76 deaths. In addition, the site is estimated to reduce costs due to skin infection by $1.5-1.9 Million annually, costs due to overdose deaths by upwards of $75 Million annually, as well as costs related to ambulance and hospital visits by $123,000 and $300,000 per averted case respectively. Ethical analysis revealed that safe injection is ethically permissible given the primary intent is to limit the user’s exposure to harm.
DISCUSSION: The implementation of a CUES in Philadelphia may be an effective tool to address opioid crisis. It would reduce healthcare costs through prevention of drug-related sequelae, offer treatment and resources for people seeking to overcome their opioid dependence, and act as an educational opportunity for future healthcare professionals by promoting student engagement with marginalized populations.