Essays on the Economics of Safe Consumption Sites

Berrigan, Patrick (2023) Essays on the Economics of Safe Consumption Sites. PhD thesis, Lancaster University.

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Abstract

In many countries, opioid overdoses are a substantial public health issue. Safe consumption sites are facilities where people who use drugs are provided with medical supervision while consuming drugs to reverse overdoses. Though safe consumption sites can reduce drug related adverse events, these facilities are not always welcomed in the communities where they are established. This public opposition can represent a barrier to the development and operation of sites. As a result, this thesis aimed to investigate current knowledge gaps that represent barriers to the establishment of safe consumption sites with respect to public opposition. Specifically, this thesis conducted a discrete choice experiment, described in Chapter 4, to determine the attributes of safe consumption sites that are correlated with public preferences for these facilitates. With respect to findings, the discrete choice experiment identified a set of attributes for safe consumption sites that influence public support for these facilities. Specifically, survey respondents disliked sites that increased cost to the healthcare system. Additionally, survey respondents preferred sites that were better able to reduce fatal overdoses, that could reduce improperly discarded needles, and that were accompanied by policies that provided compensation to individuals living near sites. This thesis also conducted a difference in differences analysis to assess the effectiveness of mobile versus brick & mortar safe consumption sites in preventing drug-related mortality, described in Chapter 5. It has been suggested that mobile sites are more acceptable to the public than brick & mortar facilities. If mobile sites are not less effective than brick & mortar facilities than mobile sites could represent a less controversial approach to safe consumption. The primary analysis of the difference in differences analysis did not find a significant association between drug related mortality and safe consumption site type, suggesting that mobile sites were not less effective than brick & mortar sites. However, several sensitivity analyses found results that conflicted with those of the primary analysis. When taken together, the findings of the primary and sensitivity analyses suggested that the optimal site type may be dependent on jurisdictional factors. As a result, policymakers who aim to develop sites should conduct jurisdictional specific research prior to implementation, to identify the optimal site type for the targeted community. To facilitate these two quantitative chapters literature reviews were conducted that are presented in Chapters 2 & 3.