Supervised injection sites could open in U.S.

A Boston not-for-profit turned heads in April when it opened a safe room where drug users can ride out highs under medical supervision. The Supportive Place for Observation and Treatment, operated under the Boston Health Care for the Homeless program, specifically notes it is not a safe injection facility, therefore, drug-use activity is not permitted on the property.

Such facilities do exist, though, and they could make their way to the United States shortly. As their name implies, safe injection facilities (SIFs), also known as “drug consumption rooms,” provide a location in which users can legally prepare and consume drugs under observation.  

Ithaca, N.Y., Seattle and San Francisco are among the cities weighing the merits of opening the nation’s first SIF, with varying degrees of support.

A public health initiative

Proponents of SIFs argue that in addition to providing a safe environment for drug users, they also benefit their communities.

“From the public health perspective, it’s about reducing overdosing, HIV and hepatitis C,” says Daniel Raymond, policy director for the Harm Reduction Coalition. “A lot of communities are struggling with drug use in public spaces—in parking lots, behind buildings, restaurants, malls or fast food places. That results in a certain level of disorder and the potential for discarded syringes.”

While no SIFs exist in the United States, there are now about 100 operating in at least 66 cities in nine countries, according to the Drug Policy Alliance. The only SIF in North America so far, Insite in Vancouver, B.C., opened in 2003. According to an HRC report published in May, fatal overdoses in the area have dropped 35% compared to a 9% drop in the rest of Vancouver, and Insite reduced healthcare costs by $13 million ($14 million Canadian) over a 10-year period.

While specific policies vary by facility, drug users generally can continue to inject at SIFs indefinitely. They are not obligated to seek treatment, although SIF personnel can help make connections to treatment facilities for those who request assistance.

“If you’re concerned about an overdose, you don’t want to kick someone out because they are not pursuing a path to recovery on your timetable,” Raymond says. “That would really defeat the purpose. From my experience working in needle exchange programs, it’s almost like that old 12-Step saying, ‘This is about attraction, not promotion.’ You build a relationship with somebody, and they start to trust you and open up. The kinds of people who need service are people who already recognize they are struggling with an opioid use disorder.”

Legal concerns

In Ithaca, N.Y., the police chief has opposed the mayor’s recent SIF proposal. The sheriff of King County near Seattle says he is open to the possibility of a SIF, as proposed by Seattle’s mayor. Meanwhile in San Francisco, the mayor is opposed to the idea, but the sheriff is willing to consider it. Cooperation from law enforcement is a critical piece of successfully launching and operating a SIF, Raymond says.

“If people are afraid this is some kind of trap, that if they go in and identify themselves as somebody who is in possession of drugs and is there to inject and they’re at risk of arrest, then you could build the Taj Mahal of injection facilities and nobody will show up,” Raymond says. “Looking at the legal dimension to provide some assurances of protection is the first challenge. So far, no jurisdiction in the United States has taken that step.”

One piece of the puzzle

While the HRC supports SIFs as a tactic to combat the opioid crisis, Raymond cautions they must still be part of a more comprehensive plan, pointing to the progress made around Insite in Vancouver.

“It wasn’t as if the only thing we need is a supervised injection facility, and it’s going to solve all our problems,” he says of Vancouver. “It was part of a broader realignment around the role of law enforcement, drug treatment, prevention and harm reduction. It’s helpful as cities start to have these conversations to think about this as part of an integrated, comprehensive strategy, not just a standalone intervention.”

Tom Valentino is Senior Editor of Behavioral Healthcare.