As a response to the opiate epidemic, several U.S. cities have been considering establishing supervised injection facilities (SIFs), where people can consume pre-obtained drugs in safe settings. With public debate continuing on the merits and potential pitfalls of SIFs, a team of researchers has released the results of the first, formal study of an unsanctioned, “underground” facility which has been operating in the U.S. since 2014.
Their conclusion: unsanctioned supervised injection facilities can provide a rapid and user-driven response to urgent public health needs.
After more than two years of observation, researchers Alex Kral and Peter Davidson found that users of the facility were able to significantly reduce the personal and social risks of their drug use, and move toward recovery. Kral is an epidemiologist at RTI International, an independent, nonprofit research institute based in Research Triangle Park, N.C. Davidson is a medical sociologist and professor at the University of California-San Diego.
Along with a safe place to consume drugs, SIFs have trained staff who can provide emergency response in the event of an overdose or other medical emergency, and also provide counseling and referral to other social and health services.
There are more than 100 legally sanctioned facilities in 10 countries. The researchers note that “extensive research has shown they reduce overdose deaths, increase drug treatment uptake, and reduce social nuisance.”
The researchers conducted 23 interviews with people who used the unsanctioned, U.S. facility, staff, and volunteers, to assess its impact on peoples’ lives, including the influence of lack of formal legal sanction on its ability to function.
The study, published earlier this month in the International Journal of Drug Policy, said patients at the unsanctioned safe injection site reported multiple benefits from using the small facility.
The facility, which is mainly staffed by volunteers, has five stainless steel injection stations, a room for clients to rest and monitor the effects after drugs are administered, and a small area for staff to perform client outreach and unofficial referrals.
The researchers surveyed more than 100 users who gave themselves 2,574 injections at the SIF. Eighty percent are homeless, 91 percent are men and 80 percent are white. The vast majority injected heroin, but some used methamphetamine, cocaine or prescription opioids. On average, they injected drugs about 114 times per month. Four people have been revived at the site with the antidote naloxone after overdoses during the first three years of operation, Kral told the Washington Post.
Because they had a safe space to inject drugs, participants said they were less likely to inject in public spaces, were better able to practice hygienic injecting practices, and were better protected from fatal overdoses. The researchers found that the benefits of being “underground” included the ability to make rules and procedures based on user need rather than political concerns, and rapid response to need in the community.
The researchers concluded that the underground nature of the facility had the effect of limiting the size and diversity of the population served by the site, and also lessened the ability to closely link the service to drug treatment and other health and social services.
One thing that makes the program different from other safe injections sites (operating outside the U.S.) is that it is open by invitation only to drug users who are known to the staff members of the nonprofit organization, Kral told the Post. It is open four to six hours a day, five days a week and is staffed by people trained to respond to overdoses and to provide advice on safe and hygienic injection.
Research has shown that supervised injection sites reduce deaths from overdoses, cut the risk of HIV and hepatitis transmission by eliminating needle-sharing and provide users with access to health and social services, Kral and Davidson noted in their paper. For the surrounding community, they reduce public injections, improper disposal of syringes and drug-related crime, they said.
“The whole country knows this is a crisis. We need some new solutions,” Kral said “We need innovation at this point. This is not innovation out of thin air. This is an innovation that’s been proven.”