The Estimated Costs and Benefits of a Hypothetical Supervised Consumption Site in Providence, Rhode Island

A study review

Read the paper here.

This project was led by Rhode Island Department of Health in collaboration with PPHC, the Institute for Clinical and Economic Review, and the University of Washington Comparative Health Outcomes, Policy, and Economics Institute.

Laura C. Chambers, Benjamin D. Hallowell, Xiao Zang, David M. Rind, Greg F. Guzauskas, Ryan N. Hansen, Nathaniel Fuchs, Rachel P. Scagos, Brandon D.L. Marshall. The estimated costs and benefits of a hypothetical supervised consumption site in Providence, Rhode Island. International Journal of Drug Policy, Volume 108, 2022.

Background: Overdose deaths have increased dramatically in the United States, including in Rhode Island. In July 2021, the Rhode Island government passed legislation supporting a two-year pilot program authorizing supervised consumption sites (SCSs) in response to this crisis. A SCS is a community-based facility where people may consume drugs with professional supervision to prevent fatal overdose and other drug-related harms. Facilities also provide resources and referrals to other health and social services, including addiction treatment. SCS are also known as harm reduction centers or overdose prevention sites.

Objective: To estimate the costs and health benefits of opening a hypothetical SCS in Providence, Rhode Island.

Method: We utilized a mathematical model to compare costs and overdose-related health outcomes for people who inject drugs under two scenarios: (1) Providence has a hypothetical SCS that includes syringe services provision, and (2) Providence has a syringe service program only (i.e., the status quo). We assumed that 0.95% of injections result in an overdose, the SCS would serve 400 clients monthly and have a net cost of $783,899 annually, 46% of overdoses occurring outside of the SCS result in an ambulance run and 43% result in an emergency department visit, 0.79% of overdoses occurring within the SCS would result in an ambulance run and an emergency department visit, and the SCS would lead to a 26% reduction in fatal overdoses within 0.25 miles of the facility.

Results: We found that, each year, a hypothetical SCS in Providence would prevent approximately 2 overdose deaths within 0.25 miles of the facility, as well as 261 ambulance runs, 244 emergency department visits, and 117 inpatient hospitalizations for emergency overdose care, compared to the scenario that includes a syringe service program only. Additionally, each year, the SCS would save $1,104,454 compared to the syringe service program only, accounting only for facility costs and short-term costs of emergency overdose care. Model parameters that had the greatest influence on our results included the percentage of injections resulting in overdose, the total number of injections occurring at the SCS each year, and the percentage of overdoses outside of the SCS that result in an emergency department visit.

Implications: Our results are generally consistent with prior studies of the costs and benefits of hypothetical SCSs in larger urban settings in the United States. We aimed to be conservative in our study and some potential health benefits and cost savings were not factored into our analysis (e.g., prevention of HIV, Hepatitis C, and other injection-related infections and the associated healthcare costs; increased initiation of addiction treatment). Therefore, we expect that the actual health benefits and cost savings of a SCS in Providence would be even greater those estimated in our study. Especially important factors that will influence the costs and benefits of potential SCS in Rhode Island include the service delivery model, location of the site, actual service utilization, and actual operational costs.

Takeaway: A SCS in Providence, Rhode Island, would save lives and result in substantial cost savings due to prevention of costly emergency overdose care. Collection of detailed operational, cost, and health outcome data at future SCSs in Rhode Island can inform quality improvement activities and enhance our understanding of the impacts of SCS.

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