Supervised Injection Facilities: A Controversial but Proven Solution to a Deadly Epidemic

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By Amanda Li and Michele Calvo

In 1995, at the peak of the United States’ HIV/AIDS epidemic, 43,115 people died from the disease within that one year alone. Now, in 2017, we are facing an even deadlier epidemic: the opioid crisis. Drug overdoses are currently taking more lives than the HIV/AIDS epidemic did at its peak; in 2015 alone, over 52,400 people died from a drug overdose in the U.S., with almost two-third of those deaths related to opioid use.

How do we confront this growing crisis that is now outpacing some of the current leading causes of death? Although controversial in the U.S., supervised injection facilities (SIFs) have existed in Europe and Canada for decades as a tool in combatting overdose death and drug-related harms. SIFs are hygienic locations where people who use drugs can legally consume pre-acquired drugs under the supervision of trained professionals. Not only do SIFs provide medical supervision and a safe, sterile environment for injection, but they also provide linkage to primary health care, information on how to reduce the harmful effects of drugs, and treatment referrals among other valuable services.  In order to make them more inclusive to other kinds of drug use and not just limited to injection-based drugs, SIFs have also been referred to as supervised/safer consumption spaces (SCS).

There are currently no SIFs/SCSs present in the United States as the idea of providing legal spaces for illicit drug use is highly controversial. However, there are over 100 SIFs located around the globe across 60+ cities and ten countries. The great news is that across these 100+ SIFs, some of which been around for more than 30 years, no known overdose-related deaths have occurred in these facilities. In fact, studies show that these SIFs effectively promote safer conditions for injecting, improve access to health care and drug treatment, reduce overdose deaths, and decrease the frequency of public injections without increasing the rate of drug trafficking, injecting, or crime.  Further, people who use drugs often face tremendous social isolation and stigma, and SIFs help provide a place where these people can feel respected, valued, and cared for.

Knowing the potential public health benefits that SIFs can bring to New York City (which had about a 60% increase in fatal opioid overdoses in 2016), the New York Academy of Medicine is a proud member of SIF NYC, collaborating with the other members of the coalition to advocate for the implementation of SIFs/SCSs in the city. The Academy is also partnering with the New York Community Trust and the NYC Department of Health and Mental Hygiene on a feasibility study around using SIFs to help address the city’s opioid epidemic. A report of the study’s findings will be available this summer 2017.

Fortunately, the push to bring SIFs into New York has been gaining momentum. On April 25, 2017, the Safe Consumption Spaces Campaign Launch began with the release of a letter signed by more than 100 healthcare professionals across NYC declaring their support for SIFs as an evidence-based public health intervention to reduce overdose and blood-borne infections. The campaign continues with a 10-day Safe Shape tour that showcases a SCS model and documentary about public injection in the state. This campaign will hopefully help create the public awareness and dialogue needed to finally bring a much-needed resource into New York.

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