Overdoses in the drug consumption room in Oslo: route of administration matters!

Background: Drug consumption rooms (DCR) are safe spaces where people can self-administer drugs hygienically, under supervision of healthcare personnel. DCRs have been found to mitigate overdose-related harms and improve uptake of addiction treatment and health services. However, overdoses continue to be frequently reported within DCRs. Further, most existing research on DCRs focuses on injecting drug use, with less known about non-injecting routes. In central Oslo, Norway, a fixed-site DCR opened in 2005, providing sterile equipment to people who use drugs. In 2019, legislative reforms allowed for the addition of inhalation within the facility. This study investigated overdoses that occurred at the DCR, with a focus on route of administration (injection, inhalation, nasal, rectal, and oral). 

Methods: Routinely collected administrative and clinical data was analyzed for people who attended the DCR from 2019-2022. Descriptive analyses were performed. 

Results: During the study period, there were over 104,926 visits to the DCR, with an average of 72 visits per day. The majority of clients were males (70 %).  Heroin was the main drug used when overdoses occurred, often in combination with alcohol and benzodiazepines. Injection was the most frequent mode of use during the study period, however a decrease was seen with 98.9% of the visits in 2019, to 75% in 2022. At the same time, inhalation increased each year. By 2022, 24% of the visits used inhalation. Oral, rectal, and nasal routes remained relatively similar during the study period. Annually, there was an average of 3 overdoses per week, all with injection as the mode of use. No overdoses occurred via inhalation. No fatal overdoses that occurred at the DCR. 

Conclusions: Our findings demonstrate that heroin overdoses remain a common event within DCRs, yet support that DCRs provide a safe space for drug use, as no fatalities occurred. No overdoses were from inhalation, highlighting a benefit of switching to this route of use.