Overdose prevention site closure: A reply to Day et al .

The report by Day et al.[1] has significant methodological limitations resulting in its misinterpreting that closing an overdose prevention site (OPS) does not cause harm and may increase opioid agonist therapy (OAT) utilization.The report [1] purports to compare similar services in two small cities before and after closure of a supervised consumption site (SCS), but this is not the case.When the full-service SCS closed in Lethbridge in 2020, it was relocated and replaced by a small OPS with limited resources [2].This replacement was criticized for its less central location, absence of inhalation rooms and lack of comprehensive services [3].The Red Deer SCS site was replaced by a 24/7 overdose prevention team, rapid access addiction medicine clinic and other resources on the day of closure to mitigate potential harms from closing [4].As such, the compared sites differed substantially and the report does not evaluate the simple closure of an SCS as enhanced services were put in place after.Differences in OAT prescribing and the stability of 'short-term effects on acute healthcare utilization and mortality' appear then to relate to differences in service availability.Even then, there was an increase in emergency room (ER) and inpatient services after the Red Deer site closure.