Supervised injection sites Harm reduction

a clandestine kit containing materials inject illicit drugs (or legitimate ones illegitimately).



injection kit obtained needle-exchange programme.

supervised injection sites (sis), or drug consumption rooms (dcr), legally sanctioned, medically supervised facilities designed address public nuisance associated drug use , provide hygienic , stress-free environment drug consumers.

the facilities provide sterile injection equipment, information drugs , basic health care, treatment referrals, , access medical staff. offer counseling, hygienic , other services of use itinerant , impoverished individuals. programmes prohibit sale or purchase of illegal drugs. many require identification cards. restrict access local residents , apply other admission criteria, such have injection drug users, in europe don t exclude addicts consume other means.

the netherlands had first staffed injection room, although did not operate under explicit legal support until 1996. instead, first center legal inject drug in berne, switzerland, opened 1986. in 1994, germany opened first site. although, in netherlands operated in gray area , supported local authorities , consent police until bundestag provided legal exemption in 2000.

in europe, luxembourg, spain , norway have opened facilities after year 2000. did 2 existing facilities outside europe, sydney s medically supervised injecting center (msic) established in may 2001 trial , vancouver s insite, opened in september 2003. in 2010, after nine-year trial, sydney site confirmed permanent public health facility. of late 2009 there total of 92 professionally supervised injection facilities in 61 cities.

the european monitoring centre drugs , drug addiction s latest systematic review april 2010 did not find evidence support concerns dcr might encourage drug use, delay treatment entry or aggravate problems of local drug markets. jürgen rehm , benedikt fischer explained while evidence show dcr successful, interpretation limited weak designs applied in many evaluations, represented lack of adequate control groups. concluding leaves door open alternative interpretations of data produced , subsequent ideological debate.

the emcdda review noted research effects of facilities faces methodological challenges in taking account of effects of broader local policy or ecological changes , still concluded facilities reach target population , provide immediate improvements through better hygiene , safety conditions injectors. further facilitates not increase levels of drug use or risky patterns of consumption, nor result in higher rates of local drug acquisition crime. while usage associated self-reported reductions in injecting risk behaviour such syringe sharing, , in public drug use , increased uptake of detoxification , treatment services. however, lack of studies, methodological problems such isolating effect other interventions or low coverage of risk population, evidence regarding dcrs — while encouraging — insufficient drawing conclusions regard effectiveness in reducing hiv or hepatitis c virus (hcv) incidence. concluding there suggestive evidence modelling studies may contribute reducing drug-related deaths @ city level coverage adequate, review-level evidence of effect still insufficient.

critics of intervention, such drug prevention advocacy organisations, drug free australia , real women of canada point rigorous evaluations, of sydney , vancouver. 2 of centers, in sydney, australia , vancouver, british columbia, canada cost $2.7 million , $3 million per annum operate respectively, yet canadian mathematical modeling, there caution validity, indicated 1 life saved fatal overdose per annum vancouver, while drug free australia analysis demonstrates sydney facility statistically takes more year save 1 life. expert advisory committee of canadian government studied claims journal studies reduced hiv transmission insite not convinced these assumptions entirely valid. sydney facility showed no improvement in public injecting , discarded needles beyond improvements caused coinciding heroin drought, while vancouver facility had observable impact. drug dealing , loitering around facilities evident in sydney evaluation, not evident vancouver facility.

united states

in united states, efforts open supervised injection sites (sis, called safe injection sites) underway, although legality of sis still questionable , controversial. currently, federal law not explicitly define whether sis legal or not, leaves issue of legality open interpretation.  although still gray area, clauses of federal controlled substances act (csa) may threaten core of existence.  section 856 of csa states that:

“it shall unlawful to… manage or control place… , knowingly , intentionally… make available use… place purpose of unlawfully manufacturing, storing, distributing, or using controlled substance”.

currently, there no official, state-sanctioned supervised injection sites operating in united states, many cities working on gaining approval. in january 2017, bill introduced in favor of legalizing safe injection sites in california. in bill, assemblywoman susan eggman sought authorization of these facilities, otherwise known drug consumption programs , in various cities/ counties across california, including los angeles , san francisco. although bill passed through assembly , various committees, failed 2 votes on senate floor. in washington, similar efforts made open these facilities in seattle , king county, met strong opposition. in january 2017, senator mark miloscia proposed bill ban supervised injection sites in washington. despite political resistance through failed legislation, there still persists strong movement across major u.s. cities legalize these sites.

existing laws , vagueness hinder efforts toward legalizing sis in united states. instance, csa deems drug possession , management of areas utilized drug consumption illegal. legality of sis in question, facilities offering similar and/or underground services operate in united states. in boston, supportive place observation , treatment (spot) program not allow drug use on site, practices harm reduction strategies. spot provides space intoxicated individuals seek medical care, education, , support. in september 2014, social service agency developed underground sis evaluate impact , feasibility of implementing sis in united states. drug injection room , adjacent room post-injection monitoring, underground sis closely follows models of sis in european countries. though there no legally sanctioned sis in united states, underground sis , harm reduction programs provide services prevent health consequences associated injection drug use.

while legislative efforts have been made legalize , implement sis harm reduction, remains controversial issue , has been met protests , petitions opposition.  in washington, critics pushed passage of initiative-27 ban public funding of sis in king county, subsequently ruled in king county superior court infringement on authority of king county board of health. opponents of facilities argued implementation of sis contradict goal of preventing substance abuse. other opposition groups in california took issue liability involved if overdose occur, unsure if patient or healthcare staff responsible. in both san francisco , seattle, residents concerned location of sis, afraid facility increase crime rates in surrounding area. due these , other opposing viewpoints, legislative efforts implement sis in united states have been slow progression. 

in response movement in united states supporting opening of sis, states such new mexico , cities including seattle, san francisco, ithaca, new york city, , philadelphia have convened task forces study feasibility , impact of these sites , make recommendations. many of these efforts have been part of larger harm reduction programs focused on reducing prescription opiate , heroin abuse. part of evaluation, san francisco considered healthcare impact on citizens, such lives saved, hospital stays, , cases of hiv , hepatitis c. concluded sis potentially decrease these factors annually. city conducted surveys , focus groups gather opinion residents , business owners on these facilities. on half of survey respondents , focus group participants supported sis. benefits such reductions in drug usage, drug overdoses, , spread of disease identified, in addition concerns including non-usage of sis , increased crime in neighborhood. cost-benefit analysis of supervised injection site there has been completed , suggests 1 sis result in savings of $3.5 million u.s. dollars annually, due lower medical costs. elsewhere, harm reduction coalitions, academic public health researchers, nonprofit organizations, , professional medical societies have made contributions understanding roles of these facilities in harm reduction. in baltimore researchers @ johns hopkins university published report commissioned abell foundation recommendations opening 2 facilities in city. in boston massachusetts medical society adopted resolution supporting pilot program led state examine impact of these sites on lives saved.