OPSPrep: Developing the service and evaluation model for overdose prevention services

Development work questions We will determine: For overdose prevention centres (OPCs), what works, for whom, in what circumstances? What are the core outcomes to evaluate OPCs?

How can we estimate the anticipated target groups, effects, costs and cost-effectiveness of OPCs in local areas of the UK?

How can we integrate OPCs into the existing UK health and social care environment to maximise utility and meet the needs of OPC service users? Background Reviews have shown OPCs improve health and meet social care needs of people who inject drugs [1-3].

At OPCs people use substances under trained supervision with sterile equipment, advice, and linked health/social care services to reduce drug use harms.

The UK Advisory Council for the Misuse of Drugs [4] and the Faculty of Public Health (FPH) in a publication [5] and an open letter signed by 70+ organisations [6] recommended opening OPCs to address the public health crisis in overdose deaths.

Although they have worked elsewhere including indicators of cost-effectiveness [1-3,7,8], we need to develop UK appropriate evaluation tools and service models which integrate with our health/social care system, meet the needs of potential UK service users, and reduce the cost of harm from drugs.

To facilitate a pilot evaluation in the subsequent Programme Grant for Applied Research, robust evaluation tools are urgently needed to understand effectiveness and cost-effectiveness.

Several settings (see Letters of Support) are working with us to prepare a facility for evaluation including one, sufficiently advanced to open in the next year.

To fulfil the ambitions of the NHS Long-term plan, we will support them to develop the right service model integrating with local health/social care partners.

Aims and objectives and Development work plan Aim of overall research programme: To deliver a rigorous evaluation of UK pilot OPCs.

The programme development grant will produce the research tools for the evaluation and develop the service model to facilitate the evaluation of at least one UK site in a programme grant for applied research (PGfAR).

The objectives align with workpackages (WP), informed by PPI (Lead: Mat Southwell expert-by-experience) To understand contexts, mechanisms, and outcomes of OPCs in a realist review (WP1: Lead Stevens). To create a core outcome set for UK evaluation (WP2: Lead Shorter).

To develop an epidemiological and cost-effectiveness model for the local estimation of effects, costs, and cost-effectiveness (WP3: Lead Vickerman).

To strengthen local partnerships in health/social care to enable the evaluation of at least one OPC in the proposed PGfAR and identify barriers and facilitators to service alignment to meet the needs of people who use drugs (WP4: Lead Shorter).

To bid for PGfAR funding with OPC site partners (WP4: Lead Stevens, with support from Khadjesari) Timelines: 12 months from 1/10/2022 Anticipated impact and dissemination: We will produce tools for a rigorous evaluation of OPCs to aid healthcare/public health decision making.

Results will be disseminated as research tools, peer-reviewed manuscripts, presentations to stakeholders/at conferences. The tools will be adopted in the evaluation of a pilot OPC in the full PGfAR.